Frozen elephant trunk in acute type A aortic dissection: surgical techniques and the extracorporeal circuit management.

Acute type A aortic dissection (ATAAD) is a challenging clinical condition with immediate and late complications. Frozen elephant trunk (FET) has been offered as a solution for it promises to address the late complications-false lumen thrombosis and aortic remodelling. Here, we describe the implantation of the FET in ATAAD with the surgical technique and extracorporeal circuit management. A 54-year-old male presented with retrograde type A aortic dissection with an entry point distal to the left subclavian artery. He underwent FET using Thoraflex™ hybrid vascular prosthesis (Vascutek, Inchinnan, Scotland). Three-month follow-up showed a complete obliteration of the false lumen in the descending thoracic aorta. FET in ATAAD is a valid option in the hands of experienced surgeons, while patient selection still remains the key in this surgery.

Narrowing of the dark valve: aortic stenosis in alkaptonuria.

The commonest cardiac pathology in patients with alkaptonuria is aortic stenosis. Patients with alkaptonuria and aortic stenosis may remain asymptomatic until the 6th decade. Surgeons may have to deal with per-operative difficulties as alkaptonuria is a systemic disease. Proper preoperative planning is important. The mechanical valve prosthesis is advisable in a patient with alkaptonuria and aortic stenosis considering disease pathophysiology. We report a 70-year-old male diagnosed with alkaptonuria and aortic stenosis, who underwent aortic valve (mechanical valve prosthesis) and ascending aorta replacement.

Prosthetic valve sparing aortic root replacement-A persuasive option in well-functioning aortic valve prosthesis.

OBJECTIVES: Only limited data is available on prosthetic valve sparing aortic root replacement after aortic valve replacement. The aim of the present study was to assess the short- and midterm outcomes of the patients who underwent such procedures. METHODS: From June 2004 to March 2018, 21 patients underwent this procedure. The mean age was 51.2 ± 10.2 years with a male predominance (85.7%). The mean time interval from aortic valve replacement to the present surgery was 10.62 years. RESULTS: One patient died in immediate postoperative period who was taken up for emergency surgery-acute type A aortic dissection. Kaplan-Meier estimates of 1, 3, and 5 year survival were 95.2% ± 0.04%, 85.7% ± 0.07% and 85.7% ± 0.07%, respectively. No cardiac or aortic reinterventions were performed during follow up with a 100% freedom from reoperation at 5 years. Fifteen patients (71.43%) had aortopathy and had borderline pathology at the time of first surgery, with all of them having a tear either in the aortic sinuses or pervious aortotomy site. CONCLUSION: The favorable short and midterm results suggests that prosthetic valve sparing aortic root replacement is a valid option when possible. Utmost care has to be taken at the primary surgery especially in patients with aortopathy, trying to avoid the need for a second surgery.

Hybrid aortic arch repair: 10-year experience from India.

PURPOSE: Hybrid aortic arch replacement (HAAR) is emerging as a safe treatment alternative for aortic arch pathologies. HAAR is divided into three groups. We have assessed our outcome for all three types of HAAR. METHOD: From January 2007 to December 2016, we have performed 119 endovascular aortic repair (EVAR) of the aorta of which 56 were hybrid aortic arch repair. The hybrid repair entailed aortic arch vessel debranching and concomitant/delayed antegrade ± retrograde EVAR stent grafting of the arch. For group I and II hybrid patients, we debranch the supra-aortic arch vessels without the aid of circulatory arrest. EVAR was performed on the following day. In group III, hybrid antegrade EVAR of the thoracic aorta and arch reconstruction was performed in single stage. RESULTS: Of the 56 patients, 16 were in group I, 32 in group II, and 8 in group III. Mean age was 59.9 ± 9.4 years with 78.57% (n = 44) being males. Aortic dissection was the primary pathology in 31 (55.36%) patients followed by aneurysm in 24 (42.86%) patients. Marfans syndrome was present in 28.57% (n = 16) patients. Redosternotomy was performed in 10.71% patients (n = 6). Incidence of stroke was 5.38% (n = 3) and there was no patients with renal dysfunction requiring hemodialysis. There were two retrograde aortic dissections and two endoleaks, both in group I patients. Thirty days in-hospital mortality was 5.38% (2 in group I and 1 in group II). CONCLUSION: Hybrid aortic arch replacement can be performed with good postoperative outcome. Type II hybrid is better than type I hybrid in our experience. As experience increases, the outcome continues to improve.

An aorto--oesophageal fistula following endograft: sealing of fistulae with omentum and replacement of the aorta.

Aorto-oesophageal fistulae represent <10% of all aortoenteric fistulae and occur in 1.9% of patients who undergo thoracic endovascular aortic repair for treatment of thoracic aortic aneurysms. Untreated patients have a mortality close to 100%. A 74-year-old man had aorto-oesophageal fistulae secondary to thoracic endovascular aortic repair. He had a functioning left internal thoracic artery graft to the left anterior descending artery and a calcific distal aortic arch. He underwent replacement of the thoracic aorta and sealing of the fistulous tract with omentum, and the latter was used to wrap the neoaorta.

Repair of left subclavian artery and aberrant right subclavian artery aneurysms.

Left subclavian artery aneurysm with an aneurysm of the aberrant right subclavian artery is a rare condition with a reported incidence of 0.13% to 1%. We report the successful surgical correction of both conditions in a 34-year-old man.

Aortic root replacement in a patient with previous multiple surgeries for coarctation of aorta.

Coarctation of the aorta is commonly associated with congenital and acquired cardiac pathology that may require surgical intervention. Adult patients with recurrent coarctation of the aorta, with or without associated intracardiac disease pose a surgical challenge. We report a 32-year-old man who presented with ascending aortic aneurysm with severe aortic regurgitation who underwent three previous surgeries for recurrent coarctation.