Publications by authors named "S Iesu"
Background: Deep hypothermic circulatory arrest (DHCA) at ≤20°C for aortic arch surgery has been widely used for decades, with or without cerebral perfusion (CP), antegrade (antegrade cerebral perfusion [ACP]), or retrograde. In recent years nadir temperature progressively increased to 26°C-28°C (moderately hypothermic circulatory arrest [MHCA]), adding ACP. Aim of this multicentric study is to evaluate early results of aortic arch surgery and if DHCA with 10 min of cold reperfusion at the same nadir temperature of the CA before rewarming (delayed rewarming [DR]) can provide a neuroprotection and a lower body protection similar to that provided by MHCA + ACP.
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- The study focuses on a new aggressive treatment method for acute type A aortic dissection using the frozen elephant trunk (FET) technique, which extends repair to the aortic arch and proximal descending thoracic aorta.
- A total of 66 patients (average age ~63 years, mostly men) underwent emergency surgery between December 2017 and January 2022, with researchers assessing 30-day mortality, in-hospital mortality, and postoperative complications.
- Results showed a 30-day mortality rate of 10.6% and in-hospital mortality of 13.6%, with key predictors for long-term survival identified, including left ventricular ejection fraction and presence of peripheral vascular disease
The frozen elephant trunk (FET) technique is an increasingly common procedure to treat complex extensive aortic disease both in elective and emergency setting. In a contemporary era, several prostheses are available to be used by surgeons performing such procedures, merging the advantages of endovascular and conventional surgery and preparing a more useful landing zone for second-stage downstream endovascular or open repair. Thoraflex hybrid (Terumo Aortic, Scotland) is a largely used hybrid vascular device merging a conventional surgical vascular graft made of gelatin-sealed woven polyester graft with a nitinol self-expanding stent graft.
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- The study evaluates early clinical outcomes of the frozen elephant trunk (FET) technique for treating complex aortic diseases, transitioning from traditional methods.
- A total of 70 patients were treated, with a 100% technical success rate; however, in-hospital mortality was 14.2% with some occurrences of major strokes and spinal cord injury.
- The FET technique showed promising results in a real-world context, suggesting good feasibility and outcomes, particularly in neurological complications, but further refinement and protocols for safety are needed.
Acute type A aortic dissection (ATAAD) is an indisputable emergency with very poor outcomes without surgical treatment. Although the aortic arch is often involved in the aortic dissection, its optimal management during surgical therapy remains uncertain. A conservative tear-oriented approach has traditionally been adopted, limiting the procedure to the ascending aorta (or hemiarch) replacement.
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