The effect of proximal anastomosis on the expansion rate of a dilated ascending aorta in coronary artery bypass surgery: a prospective study

Background: This study was designed to determine the short- and long-term effects of proximal aortic anastomosis, performed during isolated coronary artery bypass grafting (CABG) in patients with dilatation of the ascending aorta who did not require surgical intervention.Methods: The study was performed on 192 (38 female and 160 male patients; mean age, 62.1 ± 9.2 years; range, 42­80 years) patients with dilatation of the ascending aorta who underwent CABG surgery between 1 June 2006 and 31 May 2014. In group 1 (n = 114), the saphenous vein and left internal mammarian artery grafts were used, and proximal anastomosis was performed on the ascending aorta. In group 2 (n = 78), left and right internal mammarian artery grafts were used, and proximal aortic anastomosis was not performed. Pre-operatively and in the first and third years postoperatively, the ascending aortic diameter was measured and recorded using transthoracic echocardiography at four different regions (annulus, sinus of Valsalva, sinotubular junction and tubular aorta).Results: A statistically significant difference was found between the groups for the number of grafts used and the duration of aortic cross-clamping and cardiopulmonary bypass. No significant intergroup difference was seen for the mean diameter of the ascending aorta (p > 0.05). Annual changes in the aortic diameter were found to be extremely significantly different in both groups (p = 0.0001). Mean values of the aortic diameter at the level of the sinotubular junction and tubular ascending aorta, mean aortic diameters (p = 0.002 and p = 0.0001, respectively), annual increase in diameter (p = 0.0001 and p = 0.0001, respectively), and mean annual difference in diameter (p = 0.0001 and p = 0.0001, respectively) at one and three years postoperatively were statistically significantly different between the groups.Conclusion: In patients with ascending aortic dilatation who did not require surgical intervention and who had proximal anastomosis of the ascending aorta and underwent only CABG, we detected statistically significant increases in the diameter of the sinotubular junction and tubular aorta up to three years postoperatively

The effects of treatment in patients with childhood asthma on the elastic properties of the aorta

Introduction: The study aimed to investigate the effects of treatment in patients with childhood asthma on the elastic properties of the aorta and cardiovascular risk.Methods: The study was performed in 66 paediatric patients diagnosed with bronchial asthma (BA). All patients were administered the ß2 agonist, salbutamol, for seven days, followed by one month of montelukast and six months of inhaled steroid treatment. All patients underwent conventional transthoracic echocardiographic imaging before and after treatment. Aortic elasticity parameters were considered to be the markers of aortic function.Results: Aortic elasticity parameters, including aortic strain (15.2 ± 4.8 and 18.8 ± 9.5%, p = 0.043), aortic distensibility (7.26 ± 4.71 and 9.53±3.50 cm2/dyn, p = 0.010) and aortic stiffness index (3.2 ± 0.6 and 2.8 ± 0.5, p = 0.045 showed significant post-treatment improvement when compared to pre-treatment values. Tricuspid annular plane systolic excursion (TAPSE) was also observed to improve after treatment (1.81 ± 0.38 and 1.98 ± 0.43, p = 0.049). Conclusion: The study demonstrated that when provided at appropriate doses, medications used in BA may result in an improvement in aortic stiffness

Minimally Invasive Surgery to the Aortic Arch - Endovascular Repair combined with Ebranching: 4 Case Reports

Traditional repair of aortic arch aneurysms requires cardiopulmonary bypass and a period of profound hypothermia and circulatory arrest - allowing detachment of the head vessels off the aneurysm; and their anastomosis onto the graft. The procedure is safe and reproducible; however morbidity is significant and includes air embolism; stroke; excessive bleeding and acidosis. In addition the procedures are time-consuming; and cardioplegic arrest is also necessary; resulting in the potential for low cardiac output. Aortic arch aneurysms are not typically suitable for With improving techniques of descending aortic repair with stent grafts; hybrid techniques; which involve aortic arch debranching - thereby creating a proximal landing zone of adequate length; followed by stenting over the aortic arch are becoming popular. Methods: Four cases are presented. The technique involves initial sternotomy or upper sternal split; detachment of the innominate and left common carotid arteries; and their reattachment to the ascending aorta by separate grafts (debranching procedure). During this time a side clamp is placed on the ascending aorta. The left subclavian is usually left intact for technical reasons; unless there is a dominant left vertebral artery. This is safe as the shoulder has adequate collateral circulation; and stenting over this vessel is therefore well tolerated. The aortic arch is then completely covered with a stent graft which is inserted via the femoral artery. Arteriography was performed at the end of the procedure to confirm stent graft position and exclusion of the lesion. Results: All surgical transpositions were successful; and the patients recovered without neurologic; bleeding or cardiac complications. Surgical conversion for aortic graft was never required. There were no endoleaks. Mean duration of follow up was 53.5 months (range 21-77). Conclusions: Endovascular repair of the descending thoracic aorta; initially reserved for inoperable patients; is now becoming the accepted initial management. With improved technology and endografts it is now the safest option; especially for traumatic dissection. These techniques have now extended to the aortic arch. Debranching of the aortic avoiding cardiopulmonary bypass and circulatory arrest. Good pre-operative planning is necessary to make the procedure feasible

Immediate endovascular stent-graft repair of an acute traumatic rupture of the thoracic aorta : case report

We describe a case of emergency endovascular stentgraft placement for acute traumatic rupture of the thoracic aorta in a patient with an associated unstable type II odontoid fracture. The stent-graft placement procedure was performed within 4 hours of admission under sedation and local anaesthesia while the neck remained externally splinted. After exclusion of the rupture the patient could then undergo treatment of the associated cervical fracture and other injuries