OBJECTIVES: To assess the clinical features, pathologic findings, postoperative results and the effects of immunosuppressive therapy in patients with Beh et's disease (BD). METHODS: We reviewed the postoperative course of the 9 BD patients who underwent a total of 17 aortic valve replacement procedures with prosthetic valves. RESULTS: Histological examination of the aortic valve commonly revealed diffuse myxoid degeneration (75 percent). Of 17 valve replacement surgeries, 13 surgeries resulted in complications, such as detachment of the prosthetic valve with perivalvular leakage and dehiscence of the sternotomy wound, within an average of 5 months (range from 1 month to 14 months). The rate of prosthetic valve detachment was 76 percent (13 of 17 surgeries). Four of the 9 patients (44 percent) who underwent aortic valve replacement procedures died of heart failure or infection associated with the detachment of the prosthetic valve, and perivalvular leakage within an average of 9 months. Aortic insufficiency associated with dehiscence of the prosthetic valve developed in 11 of 12 surgical cases (92 percent) with a mechanical valve and 2 of 5 surgical cases (40 percent) with tissue valves. Thirteen of 15 surgeries (87 percent) which were not given postoperative immunosuppressive therapy developed complications, while none of 2 surgeries that used postoperative immunosuppressive therapy with prednisolone (1 mg/kg/day) and azathioprine (100 mg/day) had these complications. CONCLUSION: The rates of prosthetic valve detachment in BD involving aortic valve were higher than those of other diseases. Aortic valve involvement was also one of the poor prognostic factors in BD. Intensive postoperative immunosuppressive therapy and surgical methods may be important factors for postoperative results.
Adult ; Aortic Valve/pathology ; Aortic Valve Insufficiency/*etiology/pathology ; Behcet Syndrome/*complications/drug therapy/pathology ; Female ; Heart Valve Diseases/*complications/pathology/surgery ; Heart Valve Prosthesis Implantation/*mortality ; Human ; Immunosuppression ; Male ; Postoperative Complications ; Prosthesis Failure ; Survival Analysis

Although unilateral antegrade selective cerebral perfusion (UASCP) is considered a safe cerebral protection strategy during aortic surgery, an optimum temperature remains to be defined. This study compared outcomes in patients undergoing UASCP at either <24degrees C or > or =24degrees C. Between 2000 and 2007, 104 consecutive patients underwent aortic surgery using UASCP. Patients were divided into two groups according to systemic temperature: group A comprised 64 patients undergoing deep hypothermia (<24degrees C); and group B comprised 40 patients undergoing moderate hypothermia (> or =24degrees C). Both groups were similar in terms of the extent of aortic replacement and mean UASCP time. The total cardiopulmonary bypass time and aortic cross clamp time were longer in group A. Both groups were similar in terms of 30-day mortality rate (9.4% group A, 10.0% group B), and in terms of temporary (6.7% group A, 7.7% group B) and permanent (11.3% group A, 2.6% group B) neurological deficits. Multivariate analysis showed preoperative shock status was a risk factor for in-hospital mortality, and a preoperative history of a cerebral incident was a risk factor for permanent neurological deficit. UASCP under moderate hypothermia is a relatively safe and effective cerebral protective strategy during aortic surgery.
Aged ; Aorta, Thoracic/surgery ; Aortic Diseases/mortality/pathology/*surgery ; Body Temperature ; Cardiopulmonary Bypass/methods ; *Cerebrovascular Circulation ; Female ; Hospital Mortality ; Humans ; *Hypothermia, Induced ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Reperfusion/methods ; Risk Factors ; Shock/complications ; Stroke/complications ; Treatment Outcome

OBJECTIVETo summarize the experience of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures.

METHODSIt was a retrospective study. From January 2002 to December 2014, 42 high risk patients with aortic arch disease were treated by supra-arch debranching hybrid with subsequent endovascular repair in the First Affiliated Hospital of Sun Yat-sen University. There were 39 male and 3 female patients with a mean age of (53±13) years (ranging from 34 to 80 years). Of the 42 patients, 7 were thoracic aortic aneurysm, 20 were Stanford type B aortic dissection and 15 were Stanford type A aortic dissection. After the supra-aortic debranching technique, simultaneous (n=16) or staged (n=26, mean interval (7±3) days) endovascular repair were performed. Fisher exact test was used to compare the in-hospital mortality of ascending aorta based debranching and non-ascending aorta based debranching.

RESULTSTechnical success rate was 81.0% (34/42). The overall 30-day complication rate was 31.0% (13/42), including 3 cerebral stroke (7.1%), 8 endoleak (19.0%, including 6 type I endoleak and 2 type II endoleak), 1 circulatory failure, 1 aorto-tracheal fistula. The 30-day mortality was 9.5% (4/42), 2 died of cerebral stroke, 1 died of circulatory failure, 1 died of aorto-tracheal fistula. The in-hospital mortality of ascending aorta based debranching group was obviously higher than that of the non-ascending aorta based debranching group (4/16 vs. 0, P=0.02). The median time of follow-up was 64.8 (2 to 156.9) months. CT scanning was performed at 1, 3 months after surgery and annually thereafter. The overall survival rate was 76.6%. During the follow-up period, there was 4 deaths, and 2 of them were aortic artery related (5.3%). There were 4 de novo complications during the follow-up period, 1 stroke attributed to bypass occlusion was cured by medical treatment, 2 pseudoaneurysm was successfully treated with open surgery, 1 stent-graft induced new distal entry tear was successfully treated with a tapered stent-graft, there was no new endoleak during follow up period, 3 type I endoleak disappeared spontaneously, and 1 type II endoleak disappeared after secondary intervention.

CONCLUSIONSEndovascular repair of aortic arch disease hybrid with supra-arch debranching procedure is low invasive with favorable long-term outcomes. It is suitable for high risk patients of poor general condition with little tolerance to aortic arch replacement. The in-hospital mortality is higher in the ascending aorta based debranching group than in the non-ascending aorta based debranching group. Stroke is a critical fatal complication and should be attached attention.

Adult ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting ; surgery ; Aorta ; pathology ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Aortic Diseases ; surgery ; Blood Vessel Prosthesis Implantation ; Endoleak ; complications ; Endovascular Procedures ; Female ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Stroke ; complications ; Survival Rate ; Tomography, X-Ray Computed