Hybrid Approaches for Aortic Disease-Our Experience.

BACKGROUND: Despite significant technological advancements in endovascular aortic repair, the aortic arch remains a challenge due to anatomic complexity including arch angulation and morphology as well as the location of brachiocephalic vessels in relation to landing zones. Total endovascular solutions are in development and being studied, in the meantime, hybrid thoracic endovascular aortic repair (TEVAR) is a viable alternative to traditional open total arch replacement. METHODS: A retrospective case series was performed reviewing outcomes of 71 patients who underwent hybrid TEVAR in the aortic arch over the past 12 years at our facility. RESULTS: Major morbidity in the first 30 days post procedure was experienced by 3 patients (15.7%) and included one patient with stroke (n = 1), and another who experienced paraplegia and pulmonary complications (n = 1). There was one in-hospital death as a result of respiratory failure in a patient with multiple underlying comorbidities including chronic obstructive pulmonary disease on postoperative day 5 resulting in a 30-day mortality of 5.2%. After a mean follow-up of 30 months, the overall mortality remained 5.2%. Major morbidity occurred in one patient who developed retrograde type A dissection. There was no stenosis of bypass grafts identified on follow-up imaging. Endoleak was identified in 2 patients. One patient experienced persistent retrograde perfusion of the false lumen with interval aneurysmal degeneration which was managed with an Amplatz vascular plug at 120 months following the initial hybrid TEVAR (5.2%). CONCLUSIONS: Single-stage hybrid TEVAR in the aortic arch is technically feasible with a good mid-term survival and a long-term freedom from reintervention.

A narrative review of hybrid ablation for persistent and longstanding persistent atrial fibrillation.

Atrial fibrillation is the most common sustained arrhythmia and is characterized by rapid and irregular atrial activation with loss of atrial contraction. There has been a significant evolution of treatments over the past 30 years. Initially, cardiac surgeons developed approaches via sternotomy with superior efficacy, however early iterations of the procedure were associated with prolonged recovery time and frequent need for pacemaker placement. The current surgical approach to the maze procedure via sternotomy yields excellent efficacy and is a Class 1 recommendation for patients with atrial fibrillation undergoing a concomitant procedure. Several years following the initial development of the surgical maze procedure, cardiac electrophysiologists developed less invasive, however less efficacious catheter ablation options by percutaneous approach. Both the surgical and transcatheter approaches have their advantages and disadvantages with varying risks of complications and efficacy. Through the combination of expertise of cardiac surgeons paired with the electrophysiology team, a hybrid ablation procedure has been developed offering an increased efficacy with a less-invasive approach than the current gold standard treatment of Cox-maze IV procedure. This review will discuss the hybrid ablation procedure, review recent associated clinical trials, and discuss advantages and challenges associated with this multidisciplinary approach for management of patients with AF.

A Perspective from Los Angeles of COVID-19 effect and impact on cardiac surgery.

Coronavirus 2019 (COVID-19) captured worldwide attention as the virus spread from initial detection as a pneumonia of unknown cause in Wuhan, China in December 2019 to the declaration of a pandemic by the WHO only 3 months later. This paper describes the impact of COVID-19 on cardiac surgery services in the greater Los Angeles area. Discussion includes public health response to the pandemic, how local hospitals reacted to the expected surge in patients with COVID, the establishment of telemedicine services, and the projected future impact on California healthcare as a result of the COVID-19 pandemic.