ABSTRACT
BACKGROUND: Traditionally, a venous diameter of less than 3 mm was not considered for creation of AVF. Some studies have reported smaller venous size could be used for operation. AVF created with a smaller vein may have a lower maturation rate. Currently, percutaneous angioplasty is also used to enhance the maturation of AVF. This study aimed to establish whether the BAM procedure could offer comparable results for AVF created with a smaller vein. METHODS: From January 2016 to July 2021, 290 patients who received native AVF operation were enrolled in this study. All of the preoperative venous sizes were measured by Duplex ultrasonography under tourniquet enhancement. The study cohort was categorized into two groups based on the pre-operative venous diameter: smaller vein group (SVG, 2.5 < size < 3 mm, 53.1%) and normal vein group (NVG, size ⩾ 3 mm, 46.9%). RESULTS: The mean age was 64 ± 12.9 years, and 58.6% of patients were male. Hypertension and DM were the most common comorbidities. Most patients underwent operation of radio-cephalic fistula (71.4%). The overall primary maturation rate was 79%. The primary maturation rate was significantly higher in the NVG (86% vs 72.7%, p = 0.009). However, after the BAM procedure, the secondary maturation rate was similar in both groups (94.1% vs 90.3%, p = 0.319). CONCLUSIONS: According to our study, the BAM procedure can significantly increase the maturation rate, and the secondary maturation rate was similar in both groups. Thus, more patients can be given the opportunity to undergo creation of an AVF for long-term hemodialysis.
ABSTRACT
BACKGROUND: Neurological complications are an important concern in the repair of type A aortic dissection. Supra-aortic involvement is considered to be an important risk factor for neurological injuries. However, the optimal brain protection strategy still remains controversial. The aim of the present study was to assess the efficacy and short-term results of retrograde cerebral protection techniques in the treatment of acute type A aortic dissection. METHODS: Between 2005 and 2013, 185 patients who underwent repair of acute type A aortic dissection were enrolled in this study, all of whom received retrograde cerebral perfusion. The patients were divided into two group: 102 patients who had at least one carotid artery involved as the carotid dissection group, and 83 patients who had no carotid artery involvement as the non-carotid dissection group. RESULTS: The mean age of the patients was 57.8 years and 69% were male. The 30-day mortality rate was 10.3%, and the overall in-hospital mortality rate was 11.9%. Eight patients (4.3%) developed new permanent neurological deficits (PNDs) including two in the non-carotid dissection group and six in the carotid dissection group. Although new PND was milder in the carotid dissection group, there was no significant difference (p = 0.248). The proportion of patients who received a coronary artery bypass graft was significantly higher in the carotid dissection group (1 vs. 8, p = 0.037). CONCLUSIONS: According to our study, the retrograde cerebral perfusion technique is an easy and safe procedure, especially for patients with concomitant carotid dissection.
ABSTRACT
A 73-year-old man with a history of severe aortic regurgitation underwent aortic valve replacement with a bioprosthesis. Nine years later, he presented with heart failure and was diagnosed with chronic type A dissection and severe aortic stenosis. During surgery, a fistula from the ascending aortic aneurysm to the right atrium was found incidentally. Replacement of the aortic valve and ascending aorta were performed successfully. The fistula was closed with sutures. The patient was discharged uneventfully on postoperative day 16.
Subject(s)
Aortic Aneurysm/etiology , Aortic Dissection/etiology , Aortic Valve Insufficiency/surgery , Aortic Valve/surgery , Heart Diseases/etiology , Heart Valve Prosthesis Implantation/adverse effects , Vascular Fistula/etiology , Aged , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/surgery , Aortic Valve Insufficiency/diagnosis , Aortic Valve Stenosis/etiology , Aortography/methods , Blood Vessel Prosthesis Implantation , Computed Tomography Angiography , Heart Atria/diagnostic imaging , Heart Diseases/diagnostic imaging , Heart Diseases/surgery , Heart Failure/etiology , Humans , Male , Multidetector Computed Tomography , Reoperation , Severity of Illness Index , Time Factors , Treatment Outcome , Vascular Fistula/diagnostic imaging , Vascular Fistula/surgeryABSTRACT
UNLABELLED: A 10-year-old boy with polysplenia syndrome was diagnosed with complex congenital heart disease, including common atrium, bilateral superior vena cava, complete atrioventricular canal defect, severe pulmonary stenosis, interrupted inferior vena cava, and patent ductus arteriosus. Previously, he underwent a bilateral bidirectional Glenn shunt operation with ligation of the patent ductus arteriosus in April, 2009, when he was six years old. During the operation, his left anterior descending coronary artery (LAD) was injured accidently due to abnormally high coronary artery takeoff. Consequently, a coronary artery bypass graft [right internal mammary artery (RIMA) to LAD proximal, end-to-end] was performed. On July 24, 2013, he received the last stage of a total cavopulmonary connection with an extracardiac conduit (22 mm PTFE graft) at ten years of age. The RIMA was not injured during redo-sternotomy and he was discharged uneventfully 11 days after the operation. KEY WORDS: Congenital heart disease; Coronary artery bypass surgery; Coronary injury.
