Reoperative aortic root and transverse arch procedures: a comparison with contemporaneous primary operations.

Objectives: Long-term survival and risk factors affecting outcome after reoperative root/ascending aorta and transverse arch procedures have not been clearly described.

Methods: Two hundred patients (138 male patients; age, 60 +/- 15 years) underwent reoperative root/ascending aorta (n = 100) or transverse arch (n = 100) procedures at our institution from January 1998 to December 2004 and were compared with 480 consecutive contemporaneous patients with primary procedures (323 male patients; age, 62 +/- 16 years; 335 proximal aorta and 145 transverse arch procedures).

Results: Reoperative proximal aorta procedures had a higher hospital mortality (7%) than primary root/ascending aorta procedures (3%), but there was a less dramatic difference in operative mortality after primary and reoperative arch procedures (9% vs 10%).

Spinal cord blood flow and ischemic injury after experimental sacrifice of thoracic and abdominal segmental arteries.

Objective: Spinal cord blood flow (SCBF) after sacrifice of thoracoabdominal aortic segmental arteries (TAASA) during thoracoabdominal aortic aneurysm (TAAA) repair remains poorly understood. This study explored SCBF for 72 h after sacrifice of all TAASA.

Methods: Fourteen juvenile Yorkshire pigs underwent complete serial TAASA sacrifice (T4-L5).

Long-term survival after the Bentall procedure in 206 patients with bicuspid aortic valve.

Background: The recognition that patients with a bicuspid aortic valve (BAV) are at risk for aorta-related death (rupture or dissection) has favored composite aortic root replacement in BAV patients who undergo aortic valve replacement for valve dysfunction as well as in asymptomatic BAV patients with significant aortic root dilatation. We report the results of Bentall operations in 206 BAV patients during an 18-year interval.

Methods: Two hundred six BAV patients (mean, 53 +/- 14 years, 84% male) underwent composite aortic root replacement between September 1987 and May 2005.

Aortic root reconstruction with a bioprosthetic valved conduit: a consecutive series of 275 procedures.

Objective: The study objective was to assess the results of aortic root reconstruction using composite conduits with stented bioprosthetic valves.

Methods: A review was conducted of 275 patients (202 were male, mean age 69 +/- 11 years, range 17-88 years) who underwent aortic root replacement using conduits constructed intraoperatively from pericardial valves and impregnated Dacron grafts between September 1993 and February 2005. There were 151 patients with degenerative aneurysms and 63 patients with atherosclerotic aneurysms; 43 patients had dissections (9 acute type A), 13 patients had endocarditis, and 5 patients had other pathologic conditions.

Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented?

Objective: Understanding the ability of the paraspinal anastomotic network to provide adequate spinal cord perfusion pressure (SCPP) critical for both surgical and endovascular repair of thoracoabdominal aortic aneurysms (TAAA).

Methods: To monitor pressure in the collateral circulation, a catheter was inserted into the distal end of the divided first lumbar segmental artery (SA) of 10 juvenile Yorkshire pigs (28.9+/-3.

Thoracic and thoracoabdominal aneurysm repair: is reimplantation of spinal cord arteries a waste of time?

Background: The impact of different strategies for management of intercostal and lumbar arteries during repair of thoracic and thoracoabdominal aortic aneurysms (TAA/A) on the prevention of paraplegia remains poorly understood.

Methods: One hundred consecutive patients with intraoperative monitoring of motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP) during TAA/A repair involving serial segmental artery sacrifice (October 2002 to December 2004) were reviewed.

Results: Operative mortality was 6%.