Multicentre analysis of current strategies and outcomes in open aortic arch surgery: heterogeneity is still an issue.

Objectives: The study was conducted to evaluate, on the basis of a multicentre analysis, current results of elective open aortic arch surgery performed during the last decade.

Methods: Data of 1232 consecutive patients who underwent aortic arch repair with reimplantation of at least one supra-aortic artery between 2004 and 2013 were collected from 11 European cardiovascular centres, and retrospective statistical examination was performed using uni- and multi-variable analyses to identify predictors for 30-day mortality. Acute aortic dissections and arch surgeries not involving the supra-aortic arteries were not included.

Short-term intravenous sodium nitrite infusion improves cardiac and pulmonary hemodynamics in heart failure patients.

Background: Nitrite exhibits hypoxia-dependent vasodilator properties, selectively dilating capacitance vessels in healthy subjects. Unlike organic nitrates, it seems not to be subject to the development of tolerance. Currently, therapeutic options for decompensated heart failure (HF) are limited.

Role of aldehyde dehydrogenase in hypoxic vasodilator effects of nitrite in rats and humans.

Background And Purpose: Hypoxic conditions favour the reduction of nitrite to nitric oxide (NO) to elicit vasodilatation, but the mechanism(s) responsible for bioconversion remains ill defined. In the present study, we assess the role of aldehyde dehydrogenase 2 (ALDH2) in nitrite bioactivation under normoxia and hypoxia in the rat and human vasculature.

Experimental Approach: The role of ALDH2 in vascular responses to nitrite was studied using rat thoracic aorta and gluteal subcutaneous fat resistance vessels from patients with heart failure (HF; 16 patients) in vitro and by measurement of changes in forearm blood flow (FBF) during intra-arterial nitrite infusion (21 patients) in vivo.

One-stage repair in complex multisegmental thoracic aneurysmal disease: results of a multicentre study.

Objectives: Patients with thoracic aneurysmal disease involving the arch and the descending or thoracoabdominal aorta may require more than one surgical intervention. The results of one-stage repair using a hybrid stent-graft in the frozen elephant trunk manner are presented.

Methods: Between January 2005 and March 2012, 113 (age 67 ± 10 years) of 358 registered patients in the International E-Vita Open Registry were operated on for combined arch and descending and thoracoabdominal aortic aneurysm.

Measurement of extravascular lung water following human brain death: implications for lung donor assessment and transplantation.

Objectives: The measurement of extravascular lung water could aid the assessment and guide the management of potential lung donors following brain death. We therefore sought to validate a single indicator thermodilution extravascular lung water index (EVLWI-T) measurement using gravimetry and to assess the impact and clinical correlates of elevated EVLWI-T in potential lung donors and transplant recipients.

Methods: In a prospective study, we measured serial EVLWI-T and haemodynamic and oxygenation data in 60 potential lung donors.

Spontaneous aortic rupture early postpartum without trauma or connective tissue disorder.

Rupture of the thoracic aorta is a rare but recognized complication following pregnancy. The common causes of thoracic aortic rupture in the peripartum period are trauma, dissecting aneurysms and saccular aneurysms secondary to systemic connective tissue disease. We report a case of non-traumatic spontaneous aortic rupture in a patient without trauma or systemic connective tissue disease 1 day postpartum, which was successfully managed by surgical repair of the thoracic aorta.

The future of aortic surgery in Europe.

At least every ten years, each specialty should reflect upon its past, its present and its future, in order to be able to reconfirm the direction in which it is headed, to adopt suggestions from inside and outside and, consequently, to improve. As such, the aim of this manuscript is to provide the interested reader with an overview of how aortic surgery and (perhaps more accurately) aortic medicine has evolved in Europe, and its present standing; also to provide a glimpse into the future, trying to disseminate the thoughts of a group of people actively involved in the development of aortic medicine in Europe, namely the Vascular Domain of the European Association of Cardio-Thoracic Surgery (EACTS).

A systematic review and meta-analysis of the cardioprotective effects of remote ischaemic preconditioning in open cardiac surgery.

Objective: To investigate the cardioprotective efficacy of remote ischaemic preconditioning (RIPC) in cardiac surgery.

Design: We have performed a systematic search of MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to identify randomized controlled trials involving RIPC.

Setting: Randomized controlled trials of RIPC in open cardiac surgery patients.

Remote ischaemic preconditioning in coronary artery bypass surgery: a meta-analysis.

Aim: Randomised trials exploring remote ischaemic preconditioning (RIPC) in patients undergoing coronary artery bypass graft (CABG) surgery have yielded conflicting data regarding potential cardiovascular and renal protection, and are individually flawed by small sample size.

Methods: Three investigators independently searched the MEDLINE, EMBASE and Cochrane databases to identify randomised trials testing RIPC in patients undergoing CABG.

Results: Nine studies with 704 patients were included.

Subtle changes in renal function are associated with differences in late survival following adult cardiac surgery.

Objectives: To determine the predictors of post-operative renal function following adult cardiac surgery, and to assess the influence of this on late survival.

Methods: Prospectively collected data were analysed on 8032 patients who underwent coronary artery bypass grafting, valve surgery or combined procedures from 1 January 1998 until 31 December 2008, who did not require preoperative renal replacement therapy. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease formula accounting for ethnicity pre-operatively, post-operatively on the fourth post-operative day, and the post-operative nadir based upon the peak post-operative creatinine within 30 days of surgery.

Chronic kidney disease after nonrenal solid organ transplantation: a histological assessment and utility of chronic allograft damage index scoring.

Background: It is proposed that chronic calcineurin inhibitor (CNI) nephrotoxicity has a central role in chronic kidney disease after nonrenal solid organ transplantation (NRSOT), although there are little data on renal histology in this setting. The aim of this study was to assess the histological features and renal outcomes of a cohort of patients with chronic kidney disease after NRSOT.

Methods: Renal biopsies of 62 NRSOT recipients were evaluated for histological diagnoses.

Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection.

Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary.

The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta: a multicenter experience.

Background: Because of the extensive involvement of the aorta, surgical treatment of its chronic dissection continues to represent a surgical challenge. We conducted a study of a multicenter experience to describe a multicenter experience in the treatment of this complex pathology, using the frozen elephant trunk (FET) technique.

Methods: Between January 2005 and May 2010, 240 patients underwent treatment with the FET technique and had their clinical data collected in the International E-vita Open Registry.

Endocrine changes in brain death and transplantation.

Following brain death (BD) many hormonal changes occur. These include an increase and then a fall in the levels of circulating catecholamines, reduced levels of anti-diuretic hormone and cortisol as well as alterations in the hypothalamic-pituitary thyroid axis consistent with the non-thyroidal illness syndrome. In an era when the numbers of potential recipients listed for transplantation are greater than the number of donors, with an increasing donor age, a detailed knowledge of the endocrine changes and pathophysiological consequences of these is essential to optimise the management of the brain-stem dead organ donor.

UK guidelines for referral and assessment of adults for heart transplantation.

Patients with advanced heart failure have a dismal prognosis and poor quality of life. Heart transplantation provides an effective treatment for a subset of these patients. This article provides cardiologists with up-to-date information about referral for transplantation, the role of left ventricular assist devices prior to transplant, patient selection, waiting-list management and donor heart availability.

Recommendations for haemodynamic and neurological monitoring in repair of acute type a aortic dissection.

During treatment of acute type A aortic dissection there is potential for both pre- and intra-operative malperfusion. There are a number of monitoring strategies that may allow for earlier detection of potentially catastrophic malperfusion (particularly cerebral malperfusion) phenomena available for the anaesthetist and surgeon. This review article sets out to discuss the benefits of the current standard monitoring techniques available as well as desirable/experimental techniques which may serve as adjuncts in the monitoring of these complex patients.

Which troponometric best predicts midterm outcome after coronary artery bypass graft surgery?

Background: Various troponin I measurements (troponometrics) have been used as surrogate markers of patient outcome after coronary artery bypass grafting (CABG). Our aim was to define the postoperative troponometric best able to predict in-hospital and late mortality.

Methods: In 440 patients (seen from January 2000 to September 2004) undergoing isolated on-pump CABG with standardized anesthesia, perfusion, cardioplegia, and postoperative care, we followed all-cause mortality (census June 2009, 100% complete).

Incidence and outcome of Levitronix CentriMag support as rescue therapy for early cardiac allograft failure: a United Kingdom national study.

Objective: Primary graft failure is the most common cause of mortality early after heart transplantation. The availability of relatively low-cost short-term mechanical support devices has altered the management of primary graft failure but there are few data on clinical outcome. Here, we describe the UK experience with Levitronix CentriMag support following heart transplantation across multiple centres.

Antithymocyte globulin induction therapy for adult heart transplantation: a UK national study.

Background: Induction therapy with antithymocyte globulin (ATG) after heart transplantation (HTx) has never been assessed in a placebo-controlled randomized trial. We investigated trends in use of ATG and its relationship to outcome after HTx in a national cohort.

Methods: Between July 1995 and March 2008, 2,151 adult HTxs were performed.