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Current Practice and Future Perspectives in Aortic Surgery
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Current Practice and Future Perspectives in Aortic Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (20 November 2024) | Viewed by 6971

Special Issue Editors

Dr. Dimos E. Karangelis

E-Mail Website
Guest Editor
Department of Cardiothoracic Surgery, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100 Alexandroupolis, Greece
Interests: aortic surgery; aortic dissection; CABG; aortic valve; mitral surgery; mitral valve repair; minimally invasive cardiac surgery; coronary artery disease
Dr. Fotis A. Mitropoulos

E-Mail Website
Guest Editor
Department of Adult and Congenital Cardiac Surgery, Mitera Hospital, Athens, Greece
Interests: adult and congenital cardiac surgery; aortic dissection; aortic aneurysm; coronary artery disease; aortic valve; mitral surgery; mitral valve repair; minimally invasive cardiac surgery; tricuspid valve; pulmonary valve disease

Special Issue Information

Dear Colleagues,

The field of aortic surgery is an ever expanding and dynamic landscape, an exciting area of interest for clinicians, surgeons and specialists involved in diagnosis and treatment of aortic disease alike. Aortic surgery in particular, encompassing open surgical, and endovascular and hybrid treatments, has reached significant milestones over the last decade, especially since the scientific community has recently recognized the aorta as a separate organ with unique biology, functions and characteristics. This recognition was evidently depicted in the latest guidelines for diagnosing and treating acute and chronic syndromes of the aorta.

This Special Issue aims to provide a comprehensive overview of the latest advancements, challenges and future directions in the field of aortic surgery. More specifically, the goal for this Special Issue is to explore a wide range of topics, including established surgical techniques in aortic pathologies, i.e., aortic aneurysm and aortic dissection, perioperative management, emerging technologies and basic science considerations as well as advancements, to offer readers insights into the evolving landscape of aortic surgery. In addition to covering established practices, this Special Issue will also delve into cutting-edge research, highlighting innovative approaches, novel therapies and potential breakthroughs that hold promise for enhancing patient care and clinical outcomes.

The Special Issue will accept manuscripts in the form of original articles and reviews on the following topics:

  1. Open, endovascular and hybrid techniques for the treatment of aortic disease, including aortic valve disease;
  2. Basic science research and review articles with regard to the biology and pathophysiology of the aorta;
  3. Clinical research and translation research (stem cells, tissue engineering and regenerative medicine) in the field of aortic pathology and aortic surgery;
  4. Perioperative care and anesthetic management.

We look forward to collaborating with esteemed colleagues to deliver a high-quality and informative issue that will advance knowledge and foster dialogue in the field of aortic surgery.

Dr. Dimos E. Karangelis
Dr. Fotis A. Mitropoulos
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • aortic surgery
  • aortic aneurysm
  • aortic dissection
  • endovascular approach
  • aortic arch
  • TEVAR
  • ascending aorta
  • aortic valve replacement

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Published Papers (4 papers)

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Research

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15 pages, 1546 KiB  
Article
Long-Term Outcomes in Patients Managed with the EndurantTM Endograft under Elective Setting
by Konstantinos Spanos, Petroula Nana, George Volakakis, George Kouvelos, Konstantinos Dakis, Christos Karathanos, Eleni Arnaoutoglou, Miltiadis Matsagkas and Athanasios Giannoukas
J. Clin. Med. 2024, 13(18), 5601; https://doi.org/10.3390/jcm13185601 - 21 Sep 2024
Viewed by 1126
Abstract
Background/Objectives: Device selection during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) remains an important issue for ensuring endograft durability. This study evaluated the early and follow-up outcomes of elective EVAR with the Endurant platform. Methods: A single-center retrospective analysis [...] Read more.
Background/Objectives: Device selection during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) remains an important issue for ensuring endograft durability. This study evaluated the early and follow-up outcomes of elective EVAR with the Endurant platform. Methods: A single-center retrospective analysis was conducted including consecutive elective EVAR procedures with the Endurant II/IIs (2008 to 2024) device. Primary outcomes were technical success, mortality and major complications at 30 days. Survival, endoleak I/III and freedom from reintervention were secondary outcomes. Cox proportional hazards models were employed for risk-adjusted follow-up outcomes. Results: In total, 361 patients were included (72.7 ± 7 years; 96% males; mean AAA diameter 62 ± 14 mm); 92% received a bifurcated device, and 89% conformed to the instructions for use. Technical success was 99.7%. Intra-operative adjunctive procedures included 4.4% proximal cuffs and 1.7% endoanchors. The thirty-day mortality rate was 0.6%, and the major complication rate was 4.1%. Survival was 81% (SE 4.8%), 72% (SE 6.4%) and 52% (SE 9.2%) at 4, 6 and 8 years, with aneurysm-related mortality at 1.7%. Freedom from endoleak Ia was 76% (SE 7.3%) at 6 years, freedom from endoleak Ib was 79% (SE 7.4%) at 7 years and freedom from endoleak III was 94% (SE 3.7%) at 5 years. Freedom from reintervention was 71% (SE 6.1%) and 55% (SE 7.9%) at 5 and 7 years, respectively. No device-related co-factor affected long-term outcomes. Conclusions: Endurant II/IIs endograft is a safe and effective EVAR solution with excellent early outcomes and low long-term aneurysm-related mortality. The need for reintervention in the long term affected less than 50% of cases. Full article
(This article belongs to the Special Issue Current Practice and Future Perspectives in Aortic Surgery)
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11 pages, 428 KiB  
Article
The Role of Downsizing of Large-Bore Percutaneous Femoral Access for Pelvic and Lower Limb Perfusion in Transfemoral Branched Endovascular Aortic Repair
by Daour Yousef Al Sarhan, Tilo Kölbel, Alessandro Grandi, Petroula Nana, José I. Torrealba, Christian-Alexander Behrendt and Giuseppe Panuccio
J. Clin. Med. 2024, 13(18), 5375; https://doi.org/10.3390/jcm13185375 - 11 Sep 2024
Cited by 1 | Viewed by 1190
Abstract
Background: Transfemoral access (TFA) is a valuable alternative to upper extremity access (UEA) for branched endovascular aortic repair (bEVAR). However, TFA requires large introducer sheaths, which can reduce blood flow to lower limbs and the pelvis. This study aimed to evaluate the [...] Read more.
Background: Transfemoral access (TFA) is a valuable alternative to upper extremity access (UEA) for branched endovascular aortic repair (bEVAR). However, TFA requires large introducer sheaths, which can reduce blood flow to lower limbs and the pelvis. This study aimed to evaluate the efficacy of sheath downsizing to maintain lower limb perfusion during TFA–bEVAR. Methods: A single-center retrospective review was conducted including patients managed with TFA-performed bEVAR between December 2020 and May 2021. Intra-operative lower limb perfusion was assessed using non-invasive ankle blood pressure measurements and great toe pulse oximetry, with measurements being taken prior to puncture (baseline), one minute after 10F-sheath insertion, three minutes after the main body delivery system insertion, and three minutes after downsizing to a 14F sheath. Outcomes included the incidence of limb perfusion reduction (LPR), defined as a drop in the ankle–brachial index (ABI) < 0.5 or peripheral oxygen saturation (SpO2) < 90%. Results: Out of 47 patients, 24 met the inclusion criteria. LPR occurred in 4.2% of cases after 10F-sheath placement, and 87.5% after main body delivery system placement, and decreased to 12.6% after downsizing to a 14F sheath. No periprocedural major bleeding occurred. Two patients required revision for inadequate hemostasis post-operatively. SCI occurred in 16% of patients, all recovered by discharge. Pre-operative hypogastric artery occlusion was related to persistent LPR after downsizing (100% vs. 16%, p = 0.009). Conclusions: Downsizing the introducer sheath during bEVAR is feasible and safe to restore lower limb and pelvic perfusion. Further research is needed to clarify the access downsizing value during bEVAR. Full article
(This article belongs to the Special Issue Current Practice and Future Perspectives in Aortic Surgery)
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13 pages, 3432 KiB  
Article
Sex-Related Differences in Life Expectancy Compared to General Population after Surgery for Ascending Aortic Aneurysm
by Marcel Almendárez, Francesco Formica, Jorge Gutierrez Sáenz de Santamaría, Pablo Avanzas, Alain Escalera, Rut Alvarez-Velasco, Isaac Pascual, Jacobo Silva, Rocío Díaz, Alberto Alperi and Daniel Hernández-Vaquero
J. Clin. Med. 2024, 13(15), 4554; https://doi.org/10.3390/jcm13154554 - 4 Aug 2024
Cited by 1 | Viewed by 1218
Abstract
Background/Objectives: Understanding sex-based differences in cardiovascular outcomes is paramount to improving clinical outcomes. Surgery is an aggressive but effective therapy for ascending aortic aneurysm. We sought to determine if being a woman is a risk factor for long-term mortality after this surgery. [...] Read more.
Background/Objectives: Understanding sex-based differences in cardiovascular outcomes is paramount to improving clinical outcomes. Surgery is an aggressive but effective therapy for ascending aortic aneurysm. We sought to determine if being a woman is a risk factor for long-term mortality after this surgery. We compared their life expectancy with a general population of the same age, sex, year, and region. Methods: We compared men and women undergoing AAA surgery at our institution from 2000 to 2019. After balancing the population with propensity score (PS) matching, we compared long-term mortality control with a Cox regression. We determined the RS using the Ederer II method and compared it to a healthy reference population of the same age, sex, and region. Results: From 2000 to 2019, 232 women and 506 men underwent ascending aortic aneurysm surgery. After a mean follow-up of 51.5 ± 34.5 months, sex was not an independent risk factor for long-term mortality in the multivariable analysis [HR: 0.68 (95% CI 0.43–1.07, p = 0.23)]. Matching by baseline characteristics, 196 pairs were analyzed with no differences regarding mortality in the Cox regression [HR: 1.11 (95% CI 0.65–1.9, p = 0.23)]. Men and women who survived the postoperative period presented a relative survival of 100.3% (95% CI 97.4–101%) and 100.3% (95% CI 98.9–101.1%), respectively, similar to the reference population without the disease. Conclusions: For patients undergoing AAA surgery, sex was not an independent predictor of mortality. Men and women who survived the postoperative period presented a similar life expectancy to that of the reference population (people free from the disease of the same age, sex, year, and region). Full article
(This article belongs to the Special Issue Current Practice and Future Perspectives in Aortic Surgery)
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Review

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16 pages, 3899 KiB  
Review
Hybrid Aortic Arch Replacement with Frozen Elephant Trunk (FET) Technique: Surgical Considerations, Pearls, and Pitfalls
by Dimos Karangelis, Theodora M. Stougiannou, Konstantinos C. Christodoulou, Henri Bartolozzi, Maria Eleni Malafi, Fotios Mitropoulos, Dimitrios Mikroulis and Martin Bena
J. Clin. Med. 2024, 13(23), 7075; https://doi.org/10.3390/jcm13237075 - 22 Nov 2024
Viewed by 1432
Abstract
The involvement of the aortic arch in thoracic aortic aneurysms (TAA), or acute aortic dissections (AAD), represents a challenging clinical entity, mandating a meticulous surgical plan, tailored to each individual case. The advent of endovascular techniques and the introduction of modern arch protheses [...] Read more.
The involvement of the aortic arch in thoracic aortic aneurysms (TAA), or acute aortic dissections (AAD), represents a challenging clinical entity, mandating a meticulous surgical plan, tailored to each individual case. The advent of endovascular techniques and the introduction of modern arch protheses have led to the implementation of the frozen elephant trunk (FET) technique. This one-step hybrid operation consists of a total aortic arch replacement combined with an antegrade delivery of a stent–graft for the descending aorta, which acts as a proximal landing zone facilitating a potential distal endovascular reintervention. In this manner, this technique addresses acute and chronic arch disease with an acceptable morbidity and mortality. Several FET prosthetic devices are available on the global market and have exhibited favourable outcomes, although with some disadvantages in complex cases; similarly, the hybrid procedure described in this review has also been associated with complications, such as coagulopathy and neurological and graft-related events. The purpose of this review is to thus provide key insights into successful hybrid aortic arch replacements and to discuss useful tips and relevant considerations regarding its use. Full article
(This article belongs to the Special Issue Current Practice and Future Perspectives in Aortic Surgery)
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