Complications of cerebrospinal fluid drainage after open descending thoracic and thoracoabdominal aortic aneurysm repair.

Objective: This study aimed to review a 10-year experience, identify cerebrospinal fluid drainage (CSFD)-related complications, and evaluate its usefulness in spinal cord protection.

Methods: This retrospective study reviewed all open descending thoracic aneurysm and thoracoabdominal aortic aneurysm (DTA/TAAA) repairs performed at our institution between January 2013 and September 2024. The analysis focused on patients who underwent CSFD for preoperative spinal cord protection.

Impact of new classification from the Society for Vascular Surgery and Society of Thoracic Surgeons on acute Stanford type A aortic dissection.

Objectives: The Stanford classification categorizes aortic dissection based on ascending aortic involvement, whereas the newer Society for Vascular Surgery/Society of Thoracic Surgeons (SVS/STS) classification emphasizes tear location. Thus, traditional Stanford type A dissection may be an SVS/STS type A dissection or SVS/STS type B0 dissection. We evaluated the impact of SVS/STS classification on perioperative characteristics and outcomes after acute Stanford type A dissection repair.

Aortic Root Reconstruction With Pledgeted Sutures in Patients With Acute Type A Aortic Dissection.

Background: The aortic root is invariably dissected in patients with acute type A aortic dissection (ATAD). We have used an aortic root reconstruction technique using pledgeted sutures to reattach the dissected wall without surgical glue. We reviewed our 2-decade experience to evaluate the results of aortic root reconstruction with pledgeted sutures in ATAD.

Outcomes of Redo Total Arch Replacement After Limited Arch Repair for Acute Type A Aortic Dissection.

Background: Despite the life-saving nature of emergency surgery for acute type A aortic dissection (ATAD), debate persists on whether limited or extended arch repair is preferable. This study evaluates outcomes of redo total arch replacement after initial, limited arch repair for ATAD.

Methods: We retrospectively reviewed all patients who underwent ascending and arch repair from September 1999 to December 2024.

Early Thoracic Endovascular Aortic Repair for Acute Type B Dissection Is Associated with Increased Complications: Results from the Gore Global Registry for Endovascular Aortic Treatment Registry.

Background: Several recent small trials have suggested that there is a potential benefit of early thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (TBAD), even for uncomplicated patients. We studied patients enrolled in the Gore Global Registry for Endovascular Aortic Treatment (GREAT) to compare outcomes of TEVAR in the early-acute phase with and without complicated presentation.

Methods: The GREAT registry was queried for patients treated with TEVAR for TBAD.

Outcomes after open repair of aortic aneurysms and dissections in cannabis consumers.

Objective: To investigate the influence of cannabis consumption on the mid- and long-term surgical outcomes of patients with aortic aneurysms or dissections.

Methods: All individuals aged 18 years and older with more than 6 months of cannabis use at the time of surgical repair for cardiovascular disease (aortic aneurysms or aortic dissection) between 2007 and 2023 were eligible. Patients were stratified into 2 groups based on their preoperative history of cannabis use: cannabis users and noncannabis users.

Routine intercostal artery reattachment strategy reduces delayed and permanent spinal cord injury after open descending thoracic and thoracoabdominal aortic aneurysm repair.

Objective: During open descending thoracic and thoracoabdominal aortic aneurysm (DTAA/TAAA) repair, we used a routine T8-T12 intercostal artery (ICA) reattachment strategy from July 2004 to June 2009 and after 2017, we used a selective ICA reattachment strategy (reattaching T8-T12 ICAs only when neuromonitor signals were lost) from July 2009 to 2016. This study reviewed our nearly 2-decade experience to assess the impact of 2 ICA reattachment strategies on spinal cord injury (SCI).

Methods: All open DTAA/TAAA repairs performed from July 2004 to June 2022 were included, except for cases without intraoperative cerebral spinal fluid drainage.

Morphology of true lumen and surgical outcomes of acute type A aortic dissection repair with superior mesenteric artery malperfusion.

Background: Acute type A aortic dissection (ATAD) can cause visceral malperfusion. Central aortic repair may resolve malperfusion, but some require further intervention. This study aimed to review outcomes after ATAD presenting with visceral malperfusion and to evaluate the predictive value of true lumen (TL) morphologies in preoperative computed tomography scan for persistent superior mesenteric artery (SMA) ischemia after central repair.

Using machine learning to predict outcomes of patients with blunt traumatic aortic injuries.

Background: The optimal management of blunt thoracic aortic injury (BTAI) remains controversial, with experienced centers offering therapy ranging from medical management to TEVAR. We investigated the utility of a machine learning (ML) algorithm to develop a prognostic model of risk factors on mortality in patients with BTAI.

Methods: The Aortic Trauma Foundation registry was utilized to examine demographics, injury characteristics, management and outcomes of patients with BTAI.

Simultaneous submission of seven CTSA proposals: UM1, K12, R25, T32-predoctoral, T32-postdoctoral, and RC2: strategies, evaluation, and lessons learned.

Translation is the process of turning observations in the research laboratory, clinic, and community into interventions that improve people's health. The Clinical and Translational Science Awards (CTSA) program is a National Center for Advancing Translational Sciences (NCATS) initiative to advance translational science and research. Currently, 64 "CTSA hubs" exist across the nation.

Insights From the Histopathologic Analysis of Acquired and Genetic Thoracic Aortic Aneurysms and Dissections.

Objective: The purpose of this study was to apply contemporary consensus criteria developed by the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology to the evaluation of aortic pathology, with the expectation that the additional pathologic information may enhance the understanding and management of aortic diseases.

Methods: A scoring system was applied to ascending aortic specimens from 42 patients with heritable thoracic aortic disease and known genetic variations and from 86 patients from a single year, including patients with known genetic variations (n = 12) and patients with sporadic disease (n = 74).

Results: The various types of lesions of medial degeneration and the overall severity of medial degeneration overlapped considerably between those patients with heritable disease and those with sporadic disease; however, patients with heritable thoracic aortic disease had significantly more overall medial degeneration (P = .

Addition of aspirin to venous thromboembolism chemoprophylaxis safely decreases venous thromboembolism rates in trauma patients.

Background: Trauma patients exhibit a multifactorial hypercoagulable state and have increased risk of venous thromboembolism (VTE). Despite early and aggressive chemoprophylaxis (CP) with various heparin compounds ("standard" CP; sCP), VTE rates remain high. In high-quality studies, aspirin has been shown to decrease VTE in postoperative elective surgical and orthopedic trauma patients.

Development and Validation of a Risk Prediction Tool for In-hospital Mortality After Thoracic Endovascular Repair in Patients with Blunt Thoracic Aortic Injury Using the Aortic Trauma Foundation Registry.

Background: The objective of our present effort was to use an international blunt thoracic aortic injury (BTAI) registry to create a prediction model identifying important preoperative and intraoperative factors associated with postoperative mortality, and to develop and validate a simple risk prediction tool that could assist with patient selection and risk stratification in this patient population.

Methods: For the purpose of the present study, all patients undergoing thoracic endovascular aortic repair (TEVAR) for BTAI and registered in the Aortic Trauma Foundation (ATF) database from January 2016 as of June 2022 were identified. Patients undergoing medical management or open repair were excluded.

Emergency vascular repairs in trauma: Predictors of poor prognosis and a novel scoring system.

Background: Vascular injuries comprise 1% to 4% of all trauma patients, and there are no widely used risk-stratification tools. We sought to establish predictors of revascularization failures and compare outcomes of trauma and vascular surgeons.

Methods: We performed a single-institution, case-control study of consecutive patients with traumatic arterial injuries who underwent open repair between 2016 and 2021.

Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repair.

Objective: To evaluate our institutional experience with rapid cooling for hypothermic circulatory arrest in proximal aortic repair.

Methods: We retrospectively reviewed data from 2171 patients who underwent proximal aortic surgery requiring hypothermic circulatory arrest between 1991 and 2020. Cooling times were divided into quartiles and clinical outcome event rates were compared across quartiles using contingency table methods.

In vivo evaluation of a new hybrid graft using retrograde visceral perfusion for thoracoabdominal aortic repair in an animal model.

Objectives: The SPIDER technique for hybrid thoracoabdominal aortic aneurysm repair can avoid thoracotomy and extracorporeal circulation. To improve technical feasibility and safety, the new Thoracoflo graft, consisting of a proximal stent graft connected to a 7-branched abdominal prosthesis, was evaluated in a pig model for technical feasibility testing, before implantation in humans.

Methods: Retroperitoneal exposure of the infradiaphragmatic aorta, including visceral and renal arteries, was performed in 7 pigs (75-85 kg).

Deep Hypothermic Circulatory Arrest With Retrograde Cerebral Perfusion: How Long Is Safe?

Background: Cerebral protection strategies during proximal aortic repair remains controversial due to lack of evidence and large patient cohort studies. We herein evaluated our 3-decade experience using hypothermic circulatory arrest with retrograde cerebral perfusion (DHCA/RCP) to evaluate for its safety and safe duration during proximal aortic repair.

Methods: All proximal aortic repairs using DHCA/RCP from January 1991 to December 2020 performed at our institution were included in the analyses.

Informed Consent for Placebo-Controlled Trials: Do Ethics and Science Conflict?

The use of a placebo has been considered the best method for controlling bias in a prospective randomized clinical trial and provides the most rigorous test of treatment efficacy for evaluating a medical therapy. Placebos commonly produce clinically important effects particularly in studies where the primary outcomes are subjective. Yet the potential beneficial or harmful effects of placebos are often not addressed in designing a clinical trial, calculating the sample size, seeking consent, or interpreting clinical trial results.

Differences in Mid-Term Outcomes Between Patients Undergoing Thoracic Endovascular Aortic Repair for Aneurysm or Acute Aortic Syndromes: Report From the Global Registry for Endovascular Aortic Treatment.

Purpose: To analyze differences in baseline characteristics, overall mortality, device-related mortality, and re-intervention rates in patients who underwent thoracic endovascular aortic repair (TEVAR) for descending thoracic aortic aneurysm (DTAA) with atherosclerotic/degenerative cause or acute aortic syndrome (AAS), using the Global Registry For Endovascular Aortic Treatment (GREAT).

Materials And Methods: Patients submitted to TEVAR for AAS or DTAA, included in GREAT, were eligible for this analysis. Primary outcome was 30-day all-cause mortality rate.

Reappraisal of the role of motor and somatosensory evoked potentials during open distal aortic repair.

Objective: Intraoperative motor and somatosensory evoked potentials have been applied to monitor spinal cord ischemia during repair. However, their predictive values remain controversial. The purpose of this study was to evaluate the impact of motor evoked potentials and somatosensory evoked potentials on spinal cord ischemia during open distal aortic repair.

Mortality in Congenital Diaphragmatic Hernia: A Multicenter Registry Study of Over 5000 Patients Over 25 Years.

Objective: To determine if risk-adjusted survival of patients with CDH has improved over the last 25 years within centers that are long-term, consistent participants in the CDH Study Group (CDHSG).

Summary Background Data: The CDHSG is a multicenter collaboration focused on evaluation of infants with CDH. Despite advances in pediatric surgical and intensive care, CDH mortality has appeared to plateau.

In-hospital outcomes and long-term survival of women of childbearing age with aortic dissection.

Objective: In the present study, we defined the outcomes and effects of pregnancy in a cohort of women of childbearing age with acute aortic dissection (AAD).

Methods: We reviewed our database of AAD to identify all eligible female patients. Women aged <45 years were included.

Effectiveness of Standard Local Anesthetic Bupivacaine and Liposomal Bupivacaine for Postoperative Pain Control in Patients Undergoing Truncal Incisions: A Randomized Clinical Trial.

Importance: Liposomal bupivacaine for pain relief is purported to last 3 days compared with 8 hours with standard bupivacaine. However, its effectiveness is unknown in truncal incisions for cardiothoracic or vascular operations.

Objective: To compare the effectiveness of single-administration standard bupivacaine vs liposomal bupivacaine in patients undergoing truncal incisions.

Endovascular treatment of complicated versus uncomplicated acute type B aortic dissection.

Objective: The study objective was to analyze the outcomes of thoracic endovascular aortic repair performed for complicated and uncomplicated acute type B aortic dissections.

Methods: Patients from WL Gore's Global Registry for Endovascular Aortic Treatment who underwent thoracic endovascular aortic repair for acute type B aortic dissections were included, and data were retrospectively analyzed.

Results: Of 5014 patients enrolled in the Global Registry for Endovascular Aortic Treatment, 172 underwent thoracic endovascular aortic repair for acute type B aortic dissections.