Update in the management of aortic dissection.

Recent improvements in diagnosis, peri-operative management, surgical techniques and postoperative care have resulted in decreased mortality and morbidity in acute aortic dissections (AAD). The classic treatment algorithm indicates that type A patients require direct surgical intervention and type B patients should be treated medically, in absence of complications. Initial medical treatment is adopted in all AAD patients, as it reduces propagation of the dissection and aortic rupture.

Fontan conversion with concomitant arrhythmia surgery for the failing atriopulmonary connections: mid-term results from a single centre.

Objectives: Classical Atriopulmonary Fontan connections tend to fail in the long term due to progressive anastomotic site obstruction, right atrial enlargement, and refractory atrial arrhythmias. Conversion to total cavopulmonary connection with concomitant arrhythmia surgery is a promising treatment but optimal timing of the procedure remains controversial.

Methods: Between the years 2002 and 2009, 15 patients with a median age of 26.

Descending aortic diameter of 5.5 cm or greater is not an accurate predictor of acute type B aortic dissection.

Objective: The risk of acute type B aortic dissection is thought to increase with descending thoracic aortic diameter. Currently, elective repair of the descending thoracic aorta is indicated for an aortic diameter of 5.5 cm or greater.

In search of blood tests for thoracic aortic diseases.

A number of new diagnostic screening tools have been developed for the assessment of acute and chronic diseases of the thoracic aorta. Although standardized blood-based tests capable of detecting individuals at risk for aortic aneurysm and dissection disease are not yet available, our current knowledge is expanding at a rapid rate and the future is very promising. In this review, an update of the contemporary knowledge on blood tests for detecting thoracic aortic diseases in both preclinical and clinical settings is provided, offering the potential to predict adverse aortic events, such as enlargement, rupture, and dissection.

Retroperitoneal hematoma after percutaneous coronary intervention: prevalence, risk factors, management, outcomes, and predictors of mortality: a report from the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry.

Objectives: This study sought to evaluate the prevalence, risk factors, outcomes, and predictors of mortality of retroperitoneal hematoma (RPH) following percutaneous coronary intervention.

Background: Retroperitoneal hematoma is a serious complication of invasive cardiovascular procedures.

Methods: The study sample included 112,340 consecutive patients undergoing percutaneous coronary intervention in a large, multicenter registry between October 2002 and December 2007.

Descending thoracic and abdominal aortic coarctation in the young: Surgical treatment after percutaneous approaches failure.

Descending thoracic and abdominal aortic coarctations are characterized by a segmental narrowing that frequently involves the origin of the visceral and renal arteries. Optimal primary treatment is debated, being reported for both surgical and percutaneous complications. We describe our surgical experience with two youths presenting with failure of distal descending aortic stenting and with abdominal aortic coarctation post-balloon angioplasty, and associated thrombosis of a stented right renal artery and stenosis of the origin of the superior mesenteric artery (SMA).

Acute abdominal aortic dissection: insight from the International Registry of Acute Aortic Dissection (IRAD).

Background: Isolated acute dissection of the abdominal aorta is an unusual event that may present with several different clinical scenarios. Because its incidence is low, the natural history is unknown. We report data from the International Registry of Acute Aortic Dissection (IRAD), the largest group of patients treated for acute aortic dissections.

Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score.

Background: Surgical mortality for acute type A aortic dissection is frequently related to preoperative clinical conditions. We report a predictive score to identify risk of death that may be helpful to assist surgeons who are considering whether to proceed with surgical correction in the case of patients in extreme clinical risk.

Methods: Surgical outcome of 682 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2003 was analyzed.

Role and results of surgery in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD).

Background: The clinical profiles and outcomes of patients treated surgically for acute type B aortic dissection (ABAD) are often reported for those in small series or for those cared for at a single institution over a long time period, during which a continuous evolution in techniques has occurred. Accordingly, we sought to evaluate the clinical features and surgical results of patients enrolled in the International Registry of Acute Aortic Dissection by identifying primary factors that influenced surgical outcome and estimating average surgical mortality for ABAD in the current era.

Methods And Results: A comprehensive analysis of 290 clinical variables and their relation to surgical outcomes for 82 patients who required surgery for ABAD (from a population of 1256 patients; mean+/-SD age, 60.

Reduced systemic heparin dose with phosphorylcholine coated closed circuit in coronary operations.

In this prospective cohort study we addressed the clinical impact of a reduced anticoagulation protocol on the hospital outcome of patients undergoing coronary revascularization with cardiopulmonary bypass. 364 consecutive low to moderate risk patients scheduled for elective isolated coronary operations were admitted to the study. 184 patients (Control Group) received conventional open circuits and full systemic anticoagulation (target activated clotting time 480 seconds); 180 patients (Intraoperative ECMO group) received closed, phosphorylcholine coated circuits and a reduced systemic heparin dose (target activated clotting time 320 seconds).

The antithrombin III-saving effect of reduced systemic heparinization and heparin-coated circuits.

Objective: To investigate the perioperative changes of antithrombin III (AT-III) activity using reduced systemic heparinization and the possible role of AT-III in determining a better postoperative outcome.

Design: Prospective randomized study.

Setting: University hospital.

Risk factors for fatal myocardial infarction after coronary bypass graft surgery.

Background And Objective: The incidence and clinical impact of perioperative myocardial infarction during coronary artery bypass graft surgery vary greatly depending upon the diagnostic criteria applied. Fatal perioperative myocardial infarction has a less arguable diagnosis and clinical impact. The aim of this paper is to find out the risk factors for fatal myocardial infarction after coronary surgery.

Trillium biopassive surface: a new biocompatible treatment for extracorporeal circulation circuits.

139 patients undergoing cardiac surgery were included in a prospective, randomized trial. Patients were randomly allocated to receive cardiopulmonary bypass (CPB) with Trillium Biopassive Surface (TBS Group) coated oxygenators or conventional circuits (control group). 112 patients were studied with respect to postoperative biochemical profile; a subgroup of 27 patients was studied with respect to perioperative complement (C3a) activation.

Obesity and coronary artery surgery.

Objective: To assess whether obesity is a risk factor for morbidity and mortality in patients undergoing elective coronary artery revascularization.

Design: Prospective, clinical study.

Setting: University hospital.

Heparin-coated circuits for high-risk patients: a multicenter, prospective, randomized trial.

Background: Heparin-coated circuits (HCCs) in low-risk cardiac patients who have coronary revascularization have a limited impact on postoperative outcome. In this prospective, randomized investigation, we studied high-risk patients who had cardiac operations with or without HCCs.

Methods: A total of 886 patients who had cardiac operations with cardiopulmonary bypass and at least one patient-related or procedure-related risk factor were enrolled in a multicenter study.

Renal effects of low dose aprotinin in pediatric cardiac surgery.

Two groups of 15 children aged from 15 days to 6 years, undergoing surgery on cardiopulmonary by-pass for congenital heart disease have been retrospectively analyzed. Group A received a low-dose aprotinin treatment (30,000 KIU/kg in the priming solution); group C (control group) did not receive any aprotinin. Groups were homogeneous for pathology, cardiopulmonary by-pass time, aortic cross-clamping time, cyanotic/acyanotic patients ratio, temperature during cardiopulmonary bypass.

A guideline nomogram to control intraoperative haemodilution in cardiac surgery.

Intraoperative blood collection prior to cardiopulmonary bypass (CPB) is a common procedure in cardiac surgery. Its aims are to obtain fresh whole blood to be infused after CPB, to use autologous blood in the prime or to avoid too high levels of haematocrit (HCT) during CPB. Calculations to determine the amount of blood to be collected are generally based on theoretical assumptions.