Female sex is not a risk factor for post procedural mortality in coronary bypass surgery in the elderly: A secondary analysis of the GOPCABE trial.

Objective: Female sex is considered a significant risk in cardiac surgery and is included in the majority of scores for risk assessment. However, the evidence is controversial and older women undergoing cardiac surgery have not specifically been investigated. We assessed the influence of female sex on surgical risk (30-day mortality) in a secondary analysis of the GOPCABE trial (German Off-Pump Coronary Artery Bypass grafting in the Elderly (GOPCABE) trial, comparing on- to off-pump) and also evaluated its impact on risk prediction from commonly used risk scores.

Patient-tailored aortic root repair in adult marfanoid patients: Surgical considerations and outcomes.

Objective: The aim of the study was to evaluate the operative and functional results after individual, patient-tailored aortic root repair in marfanoid patients.

Methods: Among 518 patients who underwent operation between 2002 and January 2016, using patient-tailored aortic root repair with isolated sinus replacement, 42 patients fulfilled the original Ghent criteria. None/trivial, mild, moderate, and severe insufficiency grades were present in 5, 16, 10, and 11 patients, respectively.

Fifteen years of surgery for acute type A aortic dissection in moderate-to-mild systemic hypothermia†.

Objective: Surgery for acute type A aortic dissection remains a surgical challenge because of prolonged operative times, bleeding complications, and a considerable risk of neurological morbidity and mortality. The following study investigates the clinical results after surgical treatment for acute type A aortic dissection using selective antegrade cerebral perfusion and moderate-to-mild systemic hypothermia (≥28 °C).

Methods: Between January 2000 and January 2015, 453 consecutive patients underwent surgical treatment for acute type A aortic dissection at two aortic referral centres in Germany.

Use of the frozen elephant trunk technique in complicated chronic dissection with porcelain aorta and visceral arteries originating from different lumens.

A rare case of aortic arch aneurysm combined with chronic aortic dissection is reported. Because the visceral arteries originated from different, equivalently perfused lumens and the descending aorta was circumferentially calcified (porcelain aorta) limiting the possibilities of anastomosing, careful planning of the surgical strategy was of utmost importance. The complex surgery consisted of ascending and total arch replacement using the 'frozen elephant trunk' technique with Thoraflex™ Hybrid Prosthesis (Vascutek, Terumo, Inchinnan, Scotland); however, before insertion of the stent graft, an angioscopic resection of the dissection membrane in the proximal part of the descending aorta was carried out to ensure a complete expansion of the distal edge of the stent within the entire common lumen of the aorta and unimpaired distal flow in both lumens below the stent graft.

Multicentre analysis of current strategies and outcomes in open aortic arch surgery: heterogeneity is still an issue.

Objectives: The study was conducted to evaluate, on the basis of a multicentre analysis, current results of elective open aortic arch surgery performed during the last decade.

Methods: Data of 1232 consecutive patients who underwent aortic arch repair with reimplantation of at least one supra-aortic artery between 2004 and 2013 were collected from 11 European cardiovascular centres, and retrospective statistical examination was performed using uni- and multi-variable analyses to identify predictors for 30-day mortality. Acute aortic dissections and arch surgeries not involving the supra-aortic arteries were not included.

Aortic Valve Leaflet Perforation After Minimally Invasive Mitral Valve Repair.

We report on 3 consecutive patients who suffered significant aortic leaflet injury during minimally invasive mitral valve reconstruction procedures and who subsequently underwent reoperation in our institution. In all cases, aortic valves were preserved, and the perforated leaflets were repaired using autologous pericardial patches.

Acute aortic dissection involving the root: operative and long-term outcome after curative proximal repair.

Objectives: The aim of the study was to evaluate operative and long-term results after surgery of acute aortic dissection involving the root, in which the proximal repair consisted of curative resection of all dissected aortic sinuses and was performed using either valve-sparing root repair or complete root replacement with a valve conduit.

Methods: Between August 2002 and March 2013, 162 consecutive patients (mean age 63 ± 14 years) underwent surgery for acute type A aortic dissection. Eighty-six patients with an involvement of the aortic root underwent curative surgery of the proximal aorta consisting of valve-sparing root repair (n = 54, 62.

Open aortic arch surgery in chronic dissection with visceral arteries originating from different lumens.

Objectives: Surgical management of chronic aortic dissection is controversial, especially when the dissection extends into the abdominal aorta in which the visceral arteries originate from different lumens and is combined with aortic arch pathology necessitating surgery. The aim of the study was to evaluate the results of open surgery in this complex aortic pathology.

Methods: Between June 2002 and 2015, a total of 17 patients (median age 57, range 32-76 years) necessitating complete arch replacement presented complex chronic dissection of the thoraco-abdominal aorta with the visceral arteries originating from different lumens.

Cannulation and perfusion strategy in acute aortic dissection involving both common carotid arteries.

A rare case of acute aortic dissection with bilateral circumferential dissection of the common carotid artery (CCA), resulting in a severely narrowed true lumen and clinical signs of cerebral malperfusion is reported. After partial resection of the right CCA, a vascular prosthesis was interposed to restore the true lumen perfusion. To ensure sufficient cerebral and global perfusion, the interposition graft of the right CCA and a femoral artery were cannulated with a bifurcated arterial line.

Impact of surgical experience on outcome in surgery of acute type A aortic dissection.

Objectives: The study was conducted to evaluate our results of acute aortic dissection repair taking into account the impact of surgical experience in aortic surgery.

Methods: Between August 2002 and March 2013, 162 consecutive patients (mean age: 63 ± 14 years) underwent surgery for acute type A aortic dissection. All patients were operated on by one of the clinic's attending surgeons with wide experience in cardiac surgery (at least 2000 procedures performed personally), however about one-half of the patients (75 patients, 46%) were operated by the aortic team (AT) surgeons with profound experience in complex aortic pathologies.

Bio-Bentall procedure versus isolated biological aortic valve replacement: a case-match study.

Objectives: The aim of the study was to evaluate whether a complete aortic root replacement using a composite graft with biological valve prosthesis carries a higher early or late postoperative risk than isolated valve replacement.

Methods: Between 1998 and 2008, 182 consecutive patients underwent complete aortic root and ascending aorta replacement using a self-assembled composite graft with a biological valve prosthesis located within the vascular tube (modified Bentall procedure). In the same period, 1959 patients received an isolated aortic valve replacement using a biological valve prosthesis.

Acute kidney injury after on-pump or off-pump coronary artery bypass grafting in elderly patients.

Background: An exploratory analysis of the German Off Pump Coronary Artery Bypass Grafting in Elderly Patients (GOPCABE) trial was performed to investigate the effect of off-pump coronary artery bypass grafting (CABG) on kidney function after the operation.

Methods: Data on kidney function were available from 1,612 patients, representing 67% of the study population. Preoperative kidney function was graded according to the glomerular filtration rate.

Rationale and design of the Left Atrial Appendage Occlusion Study (LAAOS) III.

Background: Occlusion of the left atrial appendage (LAA) is a promising approach to stroke prevention in atrial fibrillation (AF). However, evidence of its efficacy and safety to date is lacking. We herein describe the rationale and design of a definitive LAA occlusion trial in cardiac surgical patients with AF.

The impact of unilateral versus bilateral antegrade cerebral perfusion on surgical outcomes after aortic arch replacement: a propensity-matched analysis.

Objectives: Antegrade cerebral perfusion during mild systemic hypothermia has been successfully used in aortic arch surgery. Whether bilateral antegrade cerebral perfusion is more neuroprotective then unilateral antegrade cerebral perfusion has been the subject of much debate.

Methods: Between 2000 and 2012, 1097 patients underwent aortic arch replacement using 28°C to 30°C antegrade cerebral perfusion perfusate during mild systemic hypothermia in a pressure-controlled manner (≥70 mm Hg).

Long-term results after aortic root replacement using self-assembled valve composite grafts in patients with small aortic annulus.

Objectives: The study was aimed to evaluate operative and long-term results after complete root replacement using self-assembled valve composite grafts in patients with a small aortic annulus.

Methods: Among 547 consecutive patients who received the Bentall procedure between 2000 and 2012, a total of 29 patients (61 ± 10; range 42-79 years) had an annulus of ≤20 mm (mean 19.0 ± 0.

Valve-sparing aortic root repair in acute type A dissection: how many sinuses have to be repaired for curative surgery?

Objectives: The aim of the study was to evaluate operative and long-term results of valve-sparing aortic root surgery in acute type A dissection. The repair consisted of selective replacement of all dissected and pathological sinuses.

Methods: Forty-six patients (mean age 62 ± 14; range 29-88 years, 3 with Marfan syndrome), operated on between August 2001 and July 2011 due to acute type A aortic dissection, underwent valve-sparing root repair, resulting in a valve preservation rate of 56% in acute aortic dissection surgery involving the aortic root.

Open aortic arch replacement in the era of endovascular techniques.

Objectives: Despite the progress in protection and surgical techniques, the proponents of endovascular techniques for aortic arch repair still consider conventional arch replacement to be high risk, mostly due to deep hypothermia, which in the past was generally used for cerebral and organ protection. The aim of the study was to evaluate the operative results of open aortic arch replacement using current perfusion and surgical techniques in which deep hypothermia is avoided.

Methods: Between October 2004 and February 2012, 131 consecutive patients with non-acute-dissected aortic arch pathology (mean age: 66 ± 11 years) were referred for surgery.

Cardiac surgery in patients with a porcelain aorta in the era of transcatheter valve implantation.

Objectives: New surgical and perfusion techniques allow the avoidance of deep hypothermia during open aortic arch surgery, which is generally necessary in patients with an unclampable porcelain aorta. The aim of the study was to evaluate operative and long-term results in patients with a porcelain aorta who underwent conventional cardiac surgery using current surgical and perfusion techniques.

Methods: Between November 2003 and February 2012, 30 consecutive patients (mean age 68 ± 11 years, 10 patients had previous cardiac surgery with use of glue in 5 of them) with porcelain aorta diagnosed by computed tomography and defined as a severe circular calcification of the proximal thoracic aorta were referred for cardiac surgery.

Near-infrared spectroscopy for neuromonitoring of unilateral cerebral perfusion.

Objectives: There is neither consensus regarding which methods of neuromonitoring are adequate and reliable for assessing cerebral cross-perfusion during unilateral cerebral perfusion (UCP) nor are any threshold values defined. The aim of the study was to evaluate the usefulness of near-infrared spectroscopy (NIRS) for the neuromonitoring of right-sided UCP, which is increasingly used for cerebral protection as a consequence of the recent rise in supra-aortic cannulation methods.

Methods: For the purpose of the study, 122 patients (mean age 67 ± 12 years) who underwent open aortic arch surgery between August 2007 and July 2011 using right-sided UCP with a duration time exceeding 20 min were evaluated.