Early and late results of descending thoracic and thoracoabdominal aortic aneurysm open repair with deep hypothermia and circulatory arrest.

Objective: Open repair of descending thoracic aortic and thoracoabdominal aortic aneurysms may carry low morbidity and mortality, depending on experience of the surgeon and operative technique used. Although thoracic endovascular aortic repair is less invasive, its limitations include anatomy and pathology of the aorta, proximity of major branches, and significant complication and reintervention rates. We retrospectively reviewed a 2-surgeon experience (J.

Preservation of renal function utilizing hypothermic circulatory arrest in the treatment of distal thoracoabdominal aneurysms (types III and IV).

Although left heart bypass and hypothermia are often used in the performance of type I and type II thoracoabdominal aneurysms (TAAs), most of these more distal aneurysms are done utilizing the clamp and sew technique. Renal failure occurs between 8.6% to 39% in recent series of patients following surgery for type III and IV TAAs.

Optimal end-organ protection for thoracic and thoracoabdominal aortic aneurysm repair using deep hypothermic circulatory arrest.

Background: Despite the advent of numerous protective strategies, thoracic and thoracoabdominal aortic replacement remains a high risk. While mortality rates have improved over the last 15 years, the incidence of adverse outcomes (including stroke, renal failure, and paraplegia, as well as death) remains at 13% to 30% in all published series. The use of deep hypothermic cardiopulmonary bypass with circulatory arrest has been associated with high morbidity in the past; however, we report a single surgeon's experience of improved end-organ protection with low morbidity and mortality utilizing this technique.

Use of BioGlue in aortic surgery: proper application techniques and results in 92 patients.

Background: Surgery for pathology of the proximal aorta requires aortic wall reconstruction, re-approximation of the graft to native vessels, and potentially root replacement and valve resuspension or replacement. The purpose of this study is to describe proper application techniques and the results obtained with the adjunctive use of BioGlue Surgical Adhesive in this challenging patient population.

Methods: Between August 1998 and June 2002, 92 consecutive patients underwent ascending/arch repairs, ascending/root repairs, Ross procedures, or ascending/arch repairs with a concomitant Ross procedure using BioGlue as an adjunct for anastomotic hemostasis.

Improved results with resection of extensive thoracoabdominal aneurysms.

Thoracoabdominal aneurysms are the most extensive of aortic aneurysms, and their correction is associated with the greatest number of complications. The introduction of new techniques has reduced the morbidity and mortality of surgery for these formidable lesions. A description of some of these techniques, as applied to 33 patients, is summarized, and the results presented.

One-stage segmental resection of extensive thoracoabdominal aneurysms with left-sided heart bypass.

Purpose: The purpose of this study is to describe a technique for resection of extensive thoracoabdominal aneurysms, which the authors believe will lower morbidity and mortality rates.

Methods: In an effort to minimize the risk of spinal cord ischemia, we have used a combination of sided heart bypass (left atrium to left femoral artery) with local cooling of the intercostal and visceral arteries and segmental resection of the aneurysm. Segmental resection of the aneurysm allows perfusion of the spinal cord and abdominal viscera as the proximal anastomosis is completed and as each pair of intercostal arteries is reimplanted.

Ruptured abdominal aortic aneurysms in a private hospital: a decade's experience (1980-1989).

Despite refinements in elective resection of abdominal aortic aneurysms, morbidity and mortality rates for ruptured abdominal aortic aneurysms (RAAAs) remain high. Between January 1, 1980 and December 31, 1989, we treated 208 patients with RAAAs whose mean age was 70 years. The overall mortality rate was 49.

Severe hypoxia related to uncomplicated atrial septal defect.

A 73-year-old man was admitted to our institution with severe hypoxia. Cardiac catheterization and transesophageal echocardiography revealed an atrial septal defect with an interatrial right-to-left shunt but with no pulmonary hypertension. Direct examination at surgery revealed an elongated thoracic aorta that caused the aortic annulus to reside at the level of the diaphragm and the heart to be positioned transversely in the mediastinum.

Delayed postoperative bleeding from polytetrafluoroethylene carotid artery patches.

Patch angioplasty of the internal carotid artery after endarterectomy has been advocated as a means of decreasing early postoperative carotid artery thrombosis, as well as reducing the incidence of recurrent carotid artery stenosis. Noninfectious rupture of saphenous vein patches in the early postoperative period has been reported by several authors, leading others to advocate the use of prosthetic patches. This report describes three patients in whom delayed bleeding through needle holes along the suture lines in polytetrafluoroethylene cardiovascular patches occurred between 1.

Septic complications after cardiac catheterization and percutaneous transluminal coronary angioplasty.

Septic complications after cardiac catheterization and percutaneous transluminal coronary artery angioplasty are distinctly uncommon. However, we have recently treated nine patients with sepsis and life-threatening complications after cardiac catheterization alone or after catheterization and subsequent percutaneous transluminal coronary angioplasty. The common denominator in all patients was either repeat puncturing of the ipsilateral femoral artery or leaving the femoral artery sheath in for 1 to 5 days after the procedure.

Combined coronary artery bypass grafting and bilateral renal revascularization for unstable angina and impeding renal failure.

The purpose of our article is to describe a patient with severe hypertension and moderate renal insufficiency, unstable angina, and a 6 cm abdominal aortic aneurysm. A previous aortogram had demonstrated severe bilateral renal artery stenoses. Cardiac catheterization demonstrated severe coronary disease.

Rupture of the distal thoracic esophagus following blunt trauma: case report.

Rupture of the distal thoracic esophagus is an unusual injury following blunt abdominal trauma. We recently encountered this injury in a patient following a relatively minor motor vehicle accident. An improperly positioned seatbelt was presumed contributory in this case.

Post inferior myocardial infarction ventricular septal rupture.

Mortality from ventricular septal rupture after myocardial infarction (MI) is high. Ventricular septal rupture after inferior MI is particularly associated with a high risk because of difficulty in diagnosis and surgical approach. These three case reports show how diagnosis and correction can be expedited by emergency transportation and color-flow echo-Doppler cardiography.

Transesophageal echocardiography. A technique for intraoperative monitoring.

Cardiac ischemia and myocardial infarction continue to be major causes of perioperative morbidity and mortality, despite aggressive intraoperative monitoring. Intraoperative TEE is evolving as a helpful noninvasive monitor in patients with coronary artery disease and valvular heart disease. Early detection of ischemia and evaluation of valve function with continuous imaging has allowed the use of TEE as a dynamic tool to optimize therapeutic management of cardiac dysfunction that was not always readily available by conventional invasive techniques.

Intraoperative pulmonary angioscopy using the flexible fiberoptic choledochoscope.

The use of fiberoptic angioscopy can be an important adjunct to the performance of pulmonary embolectomy. This technique can be performed rapidly and allows direct visualization of the pulmonary arteries.