Related Experiment Videos
Complete thromboendarterectomy of the calcified ascending aorta and aortic arch
P R Vogt1, M Hauser, U Schwarz
1Clinic for Cardiovascular Surgery, Institute for Diagnostic Radiology, Department of Neurology, University Hospital, Zurich, Switzerland.
Insights
Thromboendarterectomy effectively removes severe atherosclerotic plaques from the aorta, reducing surgical risks and cerebrovascular events. Follow-up showed no aortic dilation, indicating a safe and effective procedure for high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Neurosurgery
Background:
- Ascending aorta and transverse arch atherosclerotic plaques elevate surgical risks and predict cerebrovascular events.
- Severe plaques (grade IV+V) pose significant challenges in cardiac operations.
- Identifying effective interventions for these high-risk patients is crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of thromboendarterectomy for severe aortic arch plaques.
- To assess the impact of this procedure on operative risk and cerebrovascular events.
- To determine the long-term patency and structural integrity of the endarterectomized aorta.
Main Methods:
- Twenty-two patients (mean age 68) with severe aortic arch plaques underwent coronary artery bypass grafting and/or aortic valve replacement.
- Complete thromboendarterectomy of the ascending aorta and transverse arch was performed during hypothermic circulatory arrest.
- Postoperative follow-up included magnetic resonance imaging and transthoracic echocardiography at 21 months.
Main Results:
- One perioperative death (4.5%) and one early/late adverse neurologic event (4.5%/4.7%) occurred.
- Follow-up examinations showed normal diameters of the endarterectomized aorta.
- No dilatation of the treated aortic segments was observed.
Conclusions:
- Thromboendarterectomy is a viable option for patients with severe ascending aorta and transverse arch plaques.
- The procedure offers acceptable surgical risk and a low recurrence rate of cerebrovascular events.
- Endarterectomy does not lead to aortic dilatation, ensuring structural integrity post-surgery.
Background:
Arteriosclerotic plaques of the ascending aorta and transverse arch increase the operative risk of cardiac operations and are strong predictors for late cerebrovascular events.
Methods:
Twenty-two patients, mean age 68 +/- 6 years (range, 55 to 77 years), with grade IV + V plaques of the ascending aorta and transverse arch underwent coronary artery bypass grafting (n = 21) and aortic valve replacement (n = 8). Cerebrovascular emboli from unknown sources were found preoperatively in 8 patients (36%). All were in sinus rhythm. Complete thromboendarterectomy of the ascending aorta and transverse arch was performed during hypothermic circulatory arrest. After 21 +/- 12 months (range, 4 to 44 months), magnetic resonance imaging and transthoracic echocardiography of endarterectomized vessels was performed.
Results:
There was one perioperative death (4.5%), one early (4.5%), and one late (4.7%) adverse neurologic event. Follow-up examinations revealed normal diameters of the endarterectomized aorta.
Conclusions:
For patients with grade IV + V plaques, thromboendarterectomy of the ascending aorta and transverse arch can be performed with an acceptable surgical risk and a low recurrence rate for cerebrovascular events. Dilatation of the endarterectomized aorta was not observed.