Efficacy of unilateral cerebral perfusion for brain protection in aortic arch surgery.

Objectives: The aim of the study was to evaluate the surgical and neurological outcomes after aortic arch surgery using unilateral cerebral perfusion.

Methods: Between June 2004 and February 2017, a total of 1000 patients (mean age 63 ± 12; range, 14-88 years) with nonacutely dissected aortic pathology (aneurysm, porcelain aorta, chronic dissection, infection, and injury in 89.1%, 4.

Operative and Long-Term Outcomes After Curative Repair of Acute Dissection Involving the Proximal Aorta.

Background: The aim of the study was to evaluate operative and long-term results after acute type A aorta dissection (AAAD) operation, in which complete resection of all dissected aortic segments (curative repair) was achieved.

Methods: Among 205 consecutive patients operated on between 2002 and 2014 because of AAAD were 88 patients (42.9%), in whom the dissection did not extend into the downstream aorta.

Innominate artery pathology in the setting of aortic arch surgery: incidences, surgical considerations and operative outcomes.

Objectives: The aim of the study was to evaluate the incidences of innominate artery (IA) involvement in aortic arch pathology necessitating surgery, the surgical strategies and the operative results.

Methods: Among the 366 patients who underwent total/subtotal arch replacement because of non-acutely dissected aortic pathology between 2004 and June 2017, there were 46 (12.6%) patients (29 males; mean age 69 ± 10, range 35-84 years) with IA involvement.

Acute aortic dissection involving the root: operative and long-term outcome after curative proximal repair.

Objectives: The aim of the study was to evaluate operative and long-term results after surgery of acute aortic dissection involving the root, in which the proximal repair consisted of curative resection of all dissected aortic sinuses and was performed using either valve-sparing root repair or complete root replacement with a valve conduit.

Methods: Between August 2002 and March 2013, 162 consecutive patients (mean age 63 ± 14 years) underwent surgery for acute type A aortic dissection. Eighty-six patients with an involvement of the aortic root underwent curative surgery of the proximal aorta consisting of valve-sparing root repair (n = 54, 62.

Open aortic arch surgery in chronic dissection with visceral arteries originating from different lumens.

Objectives: Surgical management of chronic aortic dissection is controversial, especially when the dissection extends into the abdominal aorta in which the visceral arteries originate from different lumens and is combined with aortic arch pathology necessitating surgery. The aim of the study was to evaluate the results of open surgery in this complex aortic pathology.

Methods: Between June 2002 and 2015, a total of 17 patients (median age 57, range 32-76 years) necessitating complete arch replacement presented complex chronic dissection of the thoraco-abdominal aorta with the visceral arteries originating from different lumens.

Impact of surgical experience on outcome in surgery of acute type A aortic dissection.

Objectives: The study was conducted to evaluate our results of acute aortic dissection repair taking into account the impact of surgical experience in aortic surgery.

Methods: Between August 2002 and March 2013, 162 consecutive patients (mean age: 63 ± 14 years) underwent surgery for acute type A aortic dissection. All patients were operated on by one of the clinic's attending surgeons with wide experience in cardiac surgery (at least 2000 procedures performed personally), however about one-half of the patients (75 patients, 46%) were operated by the aortic team (AT) surgeons with profound experience in complex aortic pathologies.

Presentation of a quality management program in off-pump coronary bypass surgery.

Objective: To increase the number of off-pump coronary procedures at our institution, a new surgical team was formed. The first 3 years of "learning period" were accompanied by a quality management program aimed to control and adjust the surgical process and to ensure the safety and quality of the procedure.

Methods: All patients were operated on by the same surgeon between January 2004 and December 2006; all procedures were performed under the following quality management protocol.

Open aortic arch replacement in the era of endovascular techniques.

Objectives: Despite the progress in protection and surgical techniques, the proponents of endovascular techniques for aortic arch repair still consider conventional arch replacement to be high risk, mostly due to deep hypothermia, which in the past was generally used for cerebral and organ protection. The aim of the study was to evaluate the operative results of open aortic arch replacement using current perfusion and surgical techniques in which deep hypothermia is avoided.

Methods: Between October 2004 and February 2012, 131 consecutive patients with non-acute-dissected aortic arch pathology (mean age: 66 ± 11 years) were referred for surgery.

Near-infrared spectroscopy for neuromonitoring of unilateral cerebral perfusion.

Objectives: There is neither consensus regarding which methods of neuromonitoring are adequate and reliable for assessing cerebral cross-perfusion during unilateral cerebral perfusion (UCP) nor are any threshold values defined. The aim of the study was to evaluate the usefulness of near-infrared spectroscopy (NIRS) for the neuromonitoring of right-sided UCP, which is increasingly used for cerebral protection as a consequence of the recent rise in supra-aortic cannulation methods.

Methods: For the purpose of the study, 122 patients (mean age 67 ± 12 years) who underwent open aortic arch surgery between August 2007 and July 2011 using right-sided UCP with a duration time exceeding 20 min were evaluated.

Mild-to-moderate hypothermia in aortic arch surgery using circulatory arrest: a change of paradigm?

Objectives: Antegrade cerebral perfusion makes deep hypothermia non-essential for neuroprotection; therefore, there is a growing tendency to increase the body temperature during circulatory arrest with selective brain perfusion. However, very little is known about the clinical efficacy of mild-to-moderate hypothermia for ischemic organ protection during circulatory arrest. The aim of this study was to evaluate the safety and efficiency of mild-to-moderate hypothermia for lower-body protection during aortic arch surgery with circulatory arrest and antegrade cerebral perfusion.