Objective: This study aimed to examine contemporary results of the frozen elephant trunk (FET) procedure in an all-comers patient cohort. Methods: Between January 2017 and May 2024, a total of 132 consecutive patients with either aortic aneurysm (n = 32), acute aortic dissection (n = 32), or chronic aortic dissection (n = 68) underwent total aortic arch replacement employing the FET technique. In-hospital data were collected prospectively and included preoperative characteristics, intraoperative data, and follow-up results. Results: The median cardiopulmonary bypass time, cardiac ischemia time, and selective antegrade cerebral perfusion time were 180 (161-205), 89 (70-113), and 45 (38-54) min, respectively. Total 30-day mortality rate was 7.6% (n = 10). The rate of major postoperative neurological complications was 6.8% (n = 9) for perioperative stroke and 2.3% (n = 3) for permanent spinal cord injury. Five patients (3.8%) required hemofiltration at the time of discharge due to postoperative kidney injury. Rates of subsequent endovascular and open aortic repair following primary FET were 40.9% (n = 54) and 3.8% (n = 5), respectively. The median time to reintervention was 86 (30-439) days. The median follow-up time was 25 (8-52) months, and overall survival rates at 1, 2, and 3 years were 89%, 89%, and 87%, respectively. Conclusions: Our data are consistent with current reports, indicating that the FET technique is a valuable adjunct in treating extensive aortic arch pathologies. The procedure provides an increasingly safe and effective option for complete aortic arch replacement, even in patients requiring a redo procedure.

Background: In critical LVOT obstruction, there are few prognostic scores for decision making between univentricular and biventricular repair: Rhodes-, Discriminant-, CHSS1- and CHSS2-Score. In the underlying studies the usual type of biventricular repair was either surgical or balloon valvuloplasty. The Ross–Konno operation changes the LVOT substantially and so some of the scores' parameters. The purpose of this study is to examine if these scores are still applicable if a Ross–Konno procedure is used.

Treatment of post-dissection arch and thoracoabdominal aortic aneurysms presents significant therapeutic challenges. True lumen collapse or take off of aortic branches from the false lumen makes endograft alignment difficult, if not impossible. We present herein the first successful case of an extensive thoracoabdominal electro aortic septotomy of the entire dissection membrane from the aortic arch down to the aortic bifurcation during an open redo aortic arch replacement employing the frozen elephant trunk technique. The procedure was performed on a 59 years old female patient presenting with a progressive post-dissection aortic aneurysm during follow-up with a maximum diameter of 6 cm 11 years after operating on an acute type A aortic dissection. Due to the extensive longitudinal aortic electric septotomy, we created a new “common lumen” for subsequent endovascular completion of the repair.

ObjectivesAlthough the Perceval sutureless aortic valve bioprosthesis presents a feasible alternative to conventional aortic valve prostheses, the extent of its applicability with respect to technical considerations for a real-world patient collective is still under debate.MethodsOne hundred patients received the Perceval prosthesis [males: 59; age: 72.5 (7.3–79) years] between December 2015 and February 2023 [EuroSCORE II: 2.8 (1.7–5.4)] for an aortic valve replacement (AVR), with additional concomitant procedures, for underlying severe aortic valve stenosis [n = 93 (93)], endocarditis [n = 5 (5)], and redo AVR [n = 7 (7)] including a prior surgical AVR [n = 4 (4)] and a failed transcatheter aortic valve implantation [n = 3 (3)]. Surgery was conducted primarily by median sternotomy [n = 71 (71)] and, alternatively, by the upper hemisternotomy approach [n = 29 (29)].ResultsOver a median follow-up time of 36.5 (16.5–53) months, eight patients (8%) underwent postoperative pacemaker implantation, with five (5%) due to high-grade atrioventricular block, while nine patients experienced a stroke (9%). The median values of maximum and mean gradients across all valve sizes were 22 (18–27.5) mmHg and 10 (13–18) mmHg, respectively. Two patients (2%) had moderate and one (1%) had severe paravalvular leakage, with the latter presenting the only case of underlying valve migration and induced redo AVR with valve explantation 2 days following initial surgery. Thirty-day mortality (and overall mortality) was 5% and 26%, respectively.ConclusionThe implantation of the Perceval bioprosthesis is feasible for a variety of indications, with excellent hemodynamic results and low complication rates in a real-world high-risk patient collective.

Pathogenic mechanisms in degenerative thoracic aortic aneurysms (TAA) are still unclear. There is an ongoing debate about whether TAAs are caused by uniform or distinct processes, which would obviously have a major impact on future treatment strategies. Clearly, the ultimate outcome of TAA subgroups associated with a tricuspid aortic valve (TAV) or a bicuspid aortic valve (BAV) is the same, namely a TAA. Based on results from our own and others' studies, we decided to compare the different TAAs (TAV and BAV) and controls using a broad array of analyses, i.e., metabolomic analyses, gene expression profiling, protein expression analyses, histological characterization, and matrix-assisted laser desorption ionization imaging. Central findings of the present study are the presence of noncanonical atherosclerosis, pathological accumulation of macrophages, and disturbances of lipid metabolism in the aortic media. Moreover, we have also found that lipid metabolism is impaired systemically. Importantly, all of the above-described phenotypes are characteristic for TAV-TAA only, and not for BAV-TAA. In summary, our results suggest different modes of pathogenesis in TAV- and BAV-associated aneurysms. Intimal atherosclerotic changes play a more central role in TAV-TAA formation than previously thought, particularly as the observed alterations do not follow classical patterns. Atherosclerotic alterations are not limited to the intima but also affect and alter the TAV-TAA media. Further studies are needed to i) clarify patho-relevant intima-media interconnections, ii) define the origin of the systemic alteration of lipid metabolism, and iii) to define valid biomarkers for early diagnosis, disease progression, and successful treatments in TAV-TAAs.

Objectives: Treatment of aortic pathologies involving the distal ascending aorta, aortic arch, and descending aorta remains a complex and challenging procedure. Appropriate management is important to achieve satisfactory outcome. Surgical management aims to reduce the time of circulatory arrest. The optimal level of hypothermia is still a matter of debate. The present meta-analysis shows the influence of different temperature levels on mortality and morbidity following aortic arch surgery. Methods: We performed a meta-analysis of published data between January 2000 and March 2020 based on a literature research. 120 studies were included with a total of 32 323 patients divided into three different groups of systemic hypothermia (temperature group 1: ≥ 25 °C, temperature group 2: 25-20°C, temperature group 3: ≤ 20°C) were used for statistical analysis. Results: Early mortality was lowest in temperature group 1 compared to group 2 (OR = 1.42; 95% CI, 1.09-1.85; p=0.01) and group 3 (OR = 1.74; 95% CI, 1.20–2.52; p=0.003). Perioperative stroke appeared to be less frequently in temperature group 1 versus group 2 (OR = 1.48; 95% CI, 1.20-1.82; p=0.0002) and group 3 (OR = 1.61; 95% CI, 1.19 - 2.18; p=0.002). Similar results are obtained concerning new renal insufficiency (group 1 versus group 2: OR = 1.20; 95% CI, 0.91-1.57, p=0.19; group 1 versus 3: OR = 0.94; 95% CI, 0.67 - 1.32, p=0.73) and re-exploration for bleeding (group 1 versus group 2: OR = 1.10; 95% CI, 0.80-1.53, p=0.55; group 1 versus group 3: OR = 1.92; 95% CI, 1.26 - 2.94, p=0,0025). Conclusions: We observed that moderate level of hypothermia during circulatory arrest reduced the incidence of early mortality. Most dreaded neurologic complications occurred less frequently in TG 1. In contrast there was no difference with regards with new onset of renal failure which is commonly accepted as a reliable marker of the quality of visceral organ protection.

Objective: Aortic valve disease is the most prevalent valvular abnormality in the developed world and carries a high risk of morbidity and mortality.Transcatheter aortic valve replacement (TAVR) is favored over open-heart surgery in high-risk patients, and its use is steadily expanded towards lower-risk groups.Redo-TAVR requires meticulous planning.The Acurate Neo is a nitinol, self-expanding, supra-annular transcatheter heart valve (THV) and is a relatively recent addition to the market.We report, to the best of our knowledge, the first case of redo transapical (TA) TAVR with a Sapien 3 Ultra in an early degenerated Acurate Neo.Methods: An 83-year-old male patient was admitted with shortness of breath 4 years after TA-TAVR using an Acurate Neo, size L.Echocardiography revealed new severe valvular regurgitation.No paravalvular leakage was present.Cardiac catheterization confirmed the presence of coronary artery disease with a history of CABP and a patent LIMA graft.CT scan of the access route showed significant calcification and angulation of the iliac vessels, which made the TA approach necessary for initial TAVR.Trans-subclavian access was not an option because of the patent LIMA graft and a moderate kinking of the left subclavian artery.Therefore, we had to go for a true redo TA-TAVR.Results: After careful preoperative screening and planning, an Edwards 26mm S3 Ultra balloon-expandible valve (Edwards Lifesciences, Irvine, CA, USA) was selected and positioned relatively high to pin the first THV in a fully open position.Post-deployment, no mean invasive gradient across the aortic valve was present.Echocardiogram showed neither transvalvular nor paravalvular regurgitation.This excellent result could also be demonstrated by contrast aortography.This straightforward procedure lasted 54 minutes.Postoperative recovery was uneventful, with extubation in the operating room and transferred to the regular ward on the first postoperative day.He was discharged home after another 8 days with excellent pre-discharge transthoracic echocardiographic findings. Conclusion:This is the first reported case of a redo TA-TAVR procedure with an S3 Ultra balloon expandible valve due to a structurally destroyed Acurate Neo THV.Our successful case underlines the feasibility of redoing TA-TAVR even in an Accurate NEO despite its supraannular profile.

Objectives: The frozen elephant trunk technique has facilitated the treatment of various aortic arch pathologies. We describe herein our midterm results having a focus on aortic remodeling.

OBJECTIVES: To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute and elective thoracic and abdominal aortic procedures. METHODS: Forty departments shared their data on acute and elective thoracic and abdominal aortic procedures between January and May 2020 and January and May 2019 in Europe, Asia and the USA. Admission rates as well as delay from onset of symptoms to referral were compared. RESULTS: No differences in the number of acute thoracic and abdominal aortic procedures were observed between 2020 and the reference period in 2019 [incidence rates ratio (IRR): 0.96, confidence interval (CI) 0.89-1.04; P = 0.39]. Also, no difference in the time interval from acute onset of symptoms to referral was recorded (<12 h 32% vs > 12 h 68% in 2020, < 12 h 34% vs > 12 h 66% in 2019 P = 0.29). Conversely, a decline of 35% in elective procedures was seen (IRR: 0.81, CI 0.76-0.87; P < 0.001) with substantial differences between countries and the most pronounced decline in Italy (-40%, P < 0.001). Interestingly, in Switzerland, an increase in the number of elective cases was observed (+35%, P = 0.02). CONCLUSIONS: There was no change in the number of acute thoracic and abdominal aortic cases and procedures during the initial wave of the COVID-19 pandemic, whereas the case load of elective operations and procedures decreased significantly. Patients with acute aortic syndromes presented despite COVID-19 and were managed according to current guidelines. Further analysis is required to prove that deferral of elective cases had no impact on premature mortality.