Diminished spinal cord perfusion despite distal aortic perfusion: an acute translational large animal experiment with occluded segmental arteries.

Objectives: Neuroprotective measures have been established in open thoraco-abdominal aortic aneurysm repair to reduce the incidence of postoperative paraplegia. Distal aortic perfusion (DaP) is meant to increase blood flow to the abdominal organs and the spinal cord. Cerebrospinal fluid (CSF) drainage is part of peri- and postoperative clinical routine.

Near-Infrared Spectroscopy for Spinal Cord Monitoring-A Roadmap to Translational Research in Aortic Medicine.

Extensive aortic aneurysms represent a unique challenge necessitating interdisciplinary efforts for safe and effective treatment. Despite various adjunctive neuroprotective strategies, ischemic spinal cord injury remains a devastating complication. This article describes the implementation of collateral network near-infrared spectroscopy as the first noninvasive spinal cord monitoring modality in the setting of extensive open and endovascular aortic repair, from early conceptualization to clinical utilization.

Is perioperative fast-track management the future of proximal aortic repair?

Objectives: The Bentall procedure is the gold standard for patients with combined aortic root dilation and valve dysfunction. Over the past decade, fast-track (FT) perioperative anaesthetic management protocols have progressively evolved. We reviewed our results for selected patients undergoing Bentall surgery under an FT protocol.

Iatrogenic Type A Aortic Dissection: Challenges and Frontiers-Contemporary Single Center Data and Clinical Perspective.

Iatrogenic aortic dissection (IAD) is a rare but devastating complication in cardiac surgery and related procedures. Due to its rarity, published data on emergency surgery following IAD are limited. Herein, we discuss IAD occurring intra- and postoperatively, including those occurring during transcatheter aortic valve replacement and cardiac catheterization, and present benchmark data from our consecutive, single-center experience.

Sex-Related Differences After Proximal Aortic Surgery: Outcome Analysis of 1773 Consecutive Patients.

Background: Guidelines on the management of aortic aneurysm disease do not account for sex differences regarding surgical procedures on the proximal aorta, although faster aneurysm growth, increased rupture risk, and higher postoperative mortality have been found in women. We therefore analyzed outcome differences between men and women receiving operations on the proximal aorta.

Methods: A total of 1773 patients underwent nonemergency surgical procedures on the aortic valve (AV) and proximal aorta at our institution between 2000 and 2018.

Impact of distal aortic perfusion on 'segmental steal' depleting spinal cord blood flow-a quantitative experimental approach.

Objectives: Aortic steal is an underestimated risk factor for intraoperative spinal cord ischaemia. A negative effect on spinal cord perfusion in thoraco-abdominal aneurysm repair has been suspected if blood drains away from the cord initiated by a reversal of the arterial pressure gradient. The amount of blood and pressure loss via back-bleeding of segmental arteries and the impact of distal aortic perfusion (DaP) have not been analysed yet.

Is implantable cardioverter defibrillator surgery in patients with an implanted left ventricular assist device safe under uninterrupted oral anticoagulation?

Background: Implantable cardioverter-defibrillator (ICD) surgery in patients with implanted left ventricular assist devices (LVAD) is associated with an increased risk of bleeding complications because of the need to ensure that these patients are adequately anticoagulated. Our study aimed to evaluate the safety of our new strategy of uninterrupted oral anticoagulation compared to heparin-bridging during the surgical interval.

Methods: Between January 2009 and January 2020, 116 patients with LVAD underwent ICD surgery.

Interventions Triggered During Routine Use of NIRS Cerebral Oxygenation Monitoring in Cardiac Surgical Patients.

Objective: The purpose of this study was to determine the incidence and types of interventions triggered during a drop of baseline near-infraredspectroscopy (NIRS) values in consecutive cardiac surgical patients.

Design: A single-center, retrospective observational study.

Setting: A university-affiliated tertiary care center.

Supracommissural replacement of the ascending aorta and the aortic valve via partial versus full sternotomy-a propensity-matched comparison in a high-volume centre.

Objectives: Full sternotomy (FS) is the common surgical access for patients undergoing open aortic valve replacement (AVR) with concomitant supracommissural replacement of the tubular ascending aorta. Since minimally invasive approaches are being used with increasing frequency in cardiac surgery, the aim of this study was to compare outcomes of patients undergoing AVR with supracommissural replacement of the tubular ascending aorta via FS versus partial upper sternotomy (PS).

Methods: We included all patients who underwent elective AVR with concomitant supracommissural replacement of the tubular ascending aorta at our institution between 2000 and 2015.

Spinal cord monitoring using collateral network near-infrared spectroscopy during extended aortic arch surgery with a frozen elephant trunk.

The true incidence of spinal cord injury associated with modern hybrid extended arch/descending aortic procedures utilizing a frozen elephant trunk (fET) remains unclear, and it is estimated with ~5-8%. Prolonged distal arrest without sufficient hypothermic protection as well as extended coverage of segmental arteries have been suggested to cause this complication, previously uncommon in open arch surgery. Recently, extensive clinical and experimental research led to the implementation of a new method of collateral network near-infrared spectroscopy (cnNIRS) to non-invasively monitor spinal cord oxygenation in the setting of extensive thoracoabdominal aortic repair.

Effect of cerebrospinal fluid pressure elevation on spinal cord perfusion during aortic cross-clamping with distal aortic perfusion.

Objectives: Distal aortic perfusion (DaP) is a widely accepted protective adjunct facilitating early reinstitution of visceral perfusion during extended thoracic and thoraco-abdominal aortic repair. DaP has also been suggested to secure distal inflow to the paraspinal collateral network via the hypogastric arteries and thereby reduce the risk of spinal cord ischaemia. However, an increase in cerebrospinal fluid (CSF) pressure is frequently observed during thoracoabdominal aortic aneurysm repair.

Twenty-year outcomes of minimally invasive direct coronary artery bypass surgery: The Leipzig experience.

Objective: Minimally invasive direct coronary artery bypass (MIDCAB) surgery involving left anterior descending coronary artery grafting with the left internal thoracic artery through a left anterior small thoracotomy is being routinely performed in some specified centers for patients with isolated complex left anterior descending coronary artery disease, but very few reports regarding long-term outcomes exist in literature. Our study was aimed at assessing and analyzing the early and long-term outcomes of a large cohort of patients who underwent MIDCAB procedures and identifying the effects of changing trends in patient characteristics on early mortality.

Methods: A total of 2667 patients, who underwent MIDCAB procedures between 1996 and 2018, were divided into 3 groups on the basis of the year of surgery: group A, 1996-2003 (n = 1333); group B, 2004-2010 (n = 627) and group C, 2011-2018 (n = 707).

Impact of a surgical approach for implantation of durable left ventricular assist devices in patients on extracorporeal life support.

Background: The aim of this study was to evaluate the impact of the surgical approach on the postoperative outcome in patients who underwent left ventricular assist device (LVAD) implantation after having received veno-arterial extracorporeal life support (va-ECLS) using data from a European registry (ECLS-VAD). Five hundred and thirty-one patients were included.

Methods: A propensity score-adjusted outcome analysis was performed, resulting in 324 patients in the full sternotomy (FS) group and 39 in the less invasive surgery (LIS) group.

Experimental near-infrared spectroscopy-guided minimally invasive segmental artery occlusion.

Objectives: Minimally invasive staged segmental artery (SA) coil- and plug embolization is a new method for paraplegia prevention associated with extensive aortic procedures. Near-infrared spectroscopy of the paraspinal collateral network (cnNIRS) has emerged as a non-invasive method for spinal cord monitoring. The aim of this study was to evaluate cnNIRS to guide minimally invasive SA occlusion.

Spinal cord protection in thoracoabdominal aortic aneurysm surgery: a multimodal approach.

Spinal cord injury (SCI) is one major complication of open and endovascular thoracic and thoracoabdominal aortic aneurysm repair. Despite numerous neuroprotective adjuncts, the incidence of SCI remains high. This review article discusses established and novel adjuncts for spinal cord protection, including priming and preconditioning of the paraspinal collateral network, intraoperative systemic hypothermia, distal aortic perfusion, motor- and somatosensory evoked potentials and noninvasive cnNIRS monitoring as well as peri- and postoperative drainage of cerebrospinal fluid.

Ischemic Spinal Cord Injury-Experimental Evidence and Evolution of Protective Measures.

Background: Paraplegia remains one of the most devastating complications of descending and thoracoabdominal aortic repair. The aim of this review is to outline the current state of art in the rapidly developing field of spinal cord injury research.

Methods: A review of PubMed and Web of Science databases was performed using the following terms and their combinations: spinal cord, injury, ischemia, ischemia-reperfusion, ischemic spinal cord injury, paraplegia, paraparesis.

David aortic valve-sparing reimplantation versus biological aortic root replacement: a retrospective analysis of 411 patients.

Objectives: This study aimed to compare short- and long-term results for patients undergoing either aortic valve-sparing reimplantation (David) procedure (AVr-D) or biological aortic root replacement (Bentall) procedure (ARr-B-bio) for aortic root pathology.

Methods: We compared outcomes for patients who underwent AVr-D ( = 261) or ARr-B-bio ( = 150) between 2000 and 2015 at our institution. The mean age of patients was 55 ± 13 years and 21.

Mapping the collateral network: Optimal near-infrared spectroscopy optode placement.

Background: Paraplegia after extensive aortic procedures is a disastrous complication, and maintenance of adequate spinal cord perfusion/oxygenation is pivotal to its prevention. Collateral network (CN) near-infrared spectroscopy (cnNIRS) has been introduced as a noninvasive method for indirect spinal cord oxygenation monitoring. However, the CN has not been investigated in its entirety using this monitoring modality.

Propensity score matched comparison of isolated, elective aortic valve replacement with and without concomitant septal myectomy: is it worth it?

Background: Septal myectomy during open aortic valve replacement (AVR) is an effective surgical treatment for asymmetric secondary basal septal hypertrophy. Concerns regarding higher rates of complications associated with this procedure have been raised - such as permanent pacemaker implantation. The aim of this study was to compare outcomes and complications of patients with and without concomitant septal myectomy using propensity score matching applied to a large, consecutive single center cohort.