Application of the hybrid algorithm for the treatment of coronary chronic total occlusions requires the operator to readily deploy complex techniques and advanced technologies to achieve successful revascularization. Patient-specific factors and limitations in torquability and material strength of low-profile equipment such as microcatheters can result in procedural complications due to device fracture. Using a mini-series of 2 cases to demonstrate the successful application of antegrade dissection re-entry techniques to overcome such challenges, we highlight procedural complexities and risk, and review prior approaches and literature.
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http://dx.doi.org/10.25270/jic/22.00211 | DOI Listing |
J Clin Med
December 2024
Department of Cardiovascular Surgery, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Karabaglar, Izmir 35360, Türkiye.
Acute type A aortic dissection is among the many types of catastrophic cardiovascular emergencies. The development of serious morbidity, especially neurological complications after the operation, remains a huge threat. We aimed to present comparatively the results of using unilateral or bilateral antegrade cerebral perfusion to minimize these threats and to demonstrate the postoperative effects of antegrade cerebral perfusion choices.
View Article and Find Full Text PDFJ Clin Med
November 2024
Department of Cardiac Surgery, CINRE Hospital, 84103 Bratislava, Slovakia.
The involvement of the aortic arch in thoracic aortic aneurysms (TAA), or acute aortic dissections (AAD), represents a challenging clinical entity, mandating a meticulous surgical plan, tailored to each individual case. The advent of endovascular techniques and the introduction of modern arch protheses have led to the implementation of the frozen elephant trunk (FET) technique. This one-step hybrid operation consists of a total aortic arch replacement combined with an antegrade delivery of a stent-graft for the descending aorta, which acts as a proximal landing zone facilitating a potential distal endovascular reintervention.
View Article and Find Full Text PDFInterdiscip Cardiovasc Thorac Surg
December 2024
Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Objectives: To assess the effects of unilateral versus bilateral antegrade cerebral perfusion (u-ACP vs b-ACP) on postoperative complications and mid-term follow-up results in Asian patients with acute type A aortic dissection (ATAAD) undergoing total arch replacement (TAR) + the frozen elephant trunk (FET).
Methods: Clinical baseline data and postoperative complications of 702 ATAAD patients undergoing TAR+ FET at China Cardiovascular Centre Fuwai Hospital between January 2019 and December 2022 were collected. Patients were categorized into two groups based on antegrade cerebral perfusion: unilateral (n = 402) and bilateral (n = 300).
Catheter Cardiovasc Interv
December 2024
Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan.
The complexity of chronic total occlusion percutaneous coronary intervention (CTO PCI) involving calcification is high, and completing the procedure with an antegrade approach is often challenging. However, calcification is also a significant obstacle in the retrograde approach, where it has been reported as a predictor of CTO PCI failure even after successful channel crossing. Overcoming calcification in the retrograde approach is, therefore, crucial.
View Article and Find Full Text PDFJ Coll Physicians Surg Pak
December 2024
Department of Thoracic and Cardiovascular Surgery, Changsha Hospital of Traditional Chinese Medicine (Changsha Eighth Hospital), Changsha, Hunan, China.
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