Malperfusion in Patients with Acute Type A Aortic Dissection: A Nationwide Analysis.

Background: This study describes in detail the clinical burden of malperfusion associated with acute Type A aortic dissection (ATAAD) in a large, national cohort and the effect of treatment strategy on outcomes.

Methods: All patients undergoing repair of ATAAD between 2017 and 2020 in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were studied. Malperfusion was defined using STS definitions based on imaging or surgeon's evaluation.

Valve Sparing Aortic Root Replacement in the Resternotomy Setting.

Objectives: While valve-sparing aortic root replacement (VSRR) has demonstrated satisfactory outcomes, its utility in a reoperative sternotomy setting remains uncertain. This study evaluates the perioperative safety and long-term durability of reoperative sternotomy VSRR.

Methods: All consecutive VSRR at two centers from 2005-2020 were included.

Facilitating a More Diverse Workforce: The Value of Mentorship in Cardiothoracic Surgery.

Background: Cardiothoracic surgery (CTS) is one of the least diverse surgical specialties in both gender and race. Aside from the inherent benefits of a diverse working environment, mitigating this diversity gap improves patient care. Mentorship is important for creating a diverse, nurturing environment for trainees.

Comparison of Outcomes Between Low-Risk Aortic Valve Replacement Trials and a Surgical Registry.

Importance: It remains unknown whether outcomes of the Placement of Aortic Transcatheter Valves 3 (PARTNER 3) and Evolut Low Risk trials are comparable with surgical outcomes in nontrial settings, considering the added risk of concomitant cardiac operations.

Objective: To compare 30-day mortality and stroke incidences of patients in the surgical aortic valve replacement (SAVR) arm of low-risk trials with those of similar patients in the US Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD).

Design, Setting, And Participants: A cross-sectional sampling study was conducted of adults in the STS ACSD with severe aortic stenosis at low surgical risk for AVR who underwent SAVR during the years low-risk AVR trials (PARTNER 3 and Evolut Low Risk) were enrolling (calendar years 2016-2018).

Renal Failure in Type A-Aortic Dissection Repair: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis.

Background: We sought to identify predictors of acute renal failure (ARF) following acute type A aortic dissection (ATAAD) and its implications on postoperative outcomes.

Methods: ATAAD cases were identified from The Society of Thoracic Surgeons - Adult Cardiac Surgery Database (2017-2022). Cases with chronic dissection, prior aortic repair, primary endovascular repair, preoperative extracorporeal membrane oxygenation, preoperative renal failure, and operative room deaths were excluded.

Safety of prolonged bilateral antegrade cerebral perfusion in aortic arch surgery with moderate hypothermia.

Objectives: This study investigates the impact of bilateral antegrade cerebral perfusion (ACP) time on outcomes in aortic arch surgery.

Methods: In total, 961 patients underwent either hemiarch (n = 385) or total arch replacement (n = 576) with bilateral ACP and moderate hypothermia management between 2006 and 2020 across 2 aortic centres. ACP time was categorized into 4 groups (≤30 min: n = 169, 30-60 min: n = 298, 60-90 min: n = 261, >90 min: n = 233).

Importance of surgeon's experience in practicing valve-sparing aortic root replacement.

Background: Valve-sparing root replacement (VSRR) requires a unique skill set. This study aimed to examine the influence of surgeon's procedural volume on outcomes of VSRR.

Methods: This retrospective study included 1697 patients from 2 large, high-volume aortic centers who underwent aortic root replacement (ARR) between 2004 and 2021 and were potentially eligible for VSRR.

Reoperation after aortic root replacement and its impact on long-term survival.

Objective: Reoperation after aortic root replacement (ARR) is associated with increased operative risk and complexity. This study evaluated clinical outcomes and reoperation rates in patients undergoing ARR.

Methods: From 2004 to 2021, 2700 adult patients underwent an ARR in a 2-institution database.

Operative times and outcomes of complex endovascular repairs of thoracoabdominal aneurysms.

Background: Owing to the significant morbidity and mortality of open thoracoabdominal aortic aneurysm surgery, complex endovascular repairs have become increasingly common, but still carry substantial risk. These repairs require large-bore access, with resultant pelvic and lower extremity ischemia. We, therefore, hypothesized that operative timing would be associated with outcomes, because efficient surgery would limit the ischemic time as well as anesthesia time.

Development of a Novel Society of Thoracic Surgeons Aortic Surgery Mortality and Morbidity Risk Model.

Background: The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD) was expanded in 2017 to include more granular detail on thoracic aortic surgeries. We describe the first validated risk model in thoracic aortic surgery from the STS ACSD.

Methods: The study population consisted of patients undergoing nonemergent isolated ascending aortic aneurysm repair by open or clamped distal anastomoses, including those requiring aortic root or valve replacement.

A novel hybrid prosthesis for open repair of acute DeBakey type I dissection with malperfusion: Early results from the PERSEVERE trial.

Background: Outcomes after hemiarch repair for acute DeBakey type I aortic dissection (ADTI) remain unfavorable, with high rates of major adverse events and negative aortic remodeling. The PERSEVERE study evaluates the safety and effectiveness of the AMDS Hybrid prosthesis, a novel bare metal stent, in patients presenting with preoperative malperfusion.

Methods: PERSEVERE is a prospective single-arm investigational study conducted at 26 sites in the United States.

Relationship between indexed surgery and postcardiotomy extracorporeal life support outcomes.

Objectives: Veno-arterial extracorporeal life support (V-A ECLS) is increasingly being utilized for postcardiotomy shock (PCS), though data describing the relationship between type of indexed operation and outcomes are limited. This study compared V-A ECLS outcomes across four major cardiovascular surgical procedures.

Methods: This was a single-center retrospective study of patients who required V-A ECLS for PCS between 2015 and 2022.

Left ventricular reverse remodeling after aortic valve replacement or repair in bicuspid aortic valve with moderate or greater aortic regurgitation.

Objective: Bicuspid aortic valve (AV) patients with aortic regurgitation (AR) differ from tricuspid AV patients given younger age, greater left ventricle (LV) compliance, and more prevalent aortic stenosis (AS). Bicuspid AV-specific data to guide timing of AV replacement or repair are lacking.

Methods: Adults with bicuspid AV and moderate or greater AR who underwent aortic valve replacement or repair at our center were studied.

Adverse Technical Events During Aortic Root Replacement.

Background: Although adverse technical events during aortic root replacement (ARR) are not uncommon and are extremely challenging, there is scant literature to help surgeons prepare for such situations. We describe our experience of outstanding technical events during ARR.

Methods: This is a retrospective study of 830 consecutive ARRs at a single center from 2012 to 2022.

Blood flow assessment technology in aortic surgery: a narrative review.

Background And Objective: Blood flow assessment is an emerging technique that allows for assessment of hemodynamics in the heart and blood vessels. Recent advances in cardiovascular imaging technologies have made it possible for this technique to be more accessible to clinicians and researchers. Blood flow assessment typically refers to two techniques: measurement-based flow visualization using echocardiography or four-dimensional flow magnetic resonance imaging (4D flow MRI), and computer-based flow simulation based on computational fluid dynamics modeling.

Open, endovascular or hybrid repair of aortic arch disease: narrative review of diverse strategies with diverse options.

Objectives: The management of aortic arch disease is complex. Open surgical management continues to evolve, and the introduction of endovascular repair is revolutionizing aortic arch surgery. Although these innovative techniques have generated the opportunity for better outcomes in select patients, they have also introduced confusion and uncertainty regarding best practices.

Long-term outcomes after aortic root replacement for bicuspid aortic valve-associated aneurysm.

Objective: Patients with congenital bicuspid aortic valve often require root replacement. This study aims to describe their long-term rates of mortality and reoperation.

Methods: This is a multicenter retrospective study of 747 patients with bicuspid aortic valve who underwent aortic root replacement for aortic aneurysm between 2004 and 2020.

Treatment options for isolated aortic valve insufficiency: a review.

Aortic insufficiency (AI) is a valvular disease with increasing prevalence in older patients. The modern era provides numerous options for the management of AI which is explored here. Traditional interventions included aortic valve replacement with either mechanical or bioprosthetic aortic valves.