Donald M. Botta

Management of Type A Aortic Dissections: A Meta-Analysis of the Literature

The authors reviewed all published series of type A iatrogenic aortic dissections and performed meta-analyses to investigate the management and outcomes of this complication. The majority of type A iatrogenic aortic dissections occurred during cardiac surgery, but the incidence of iatrogenic aortic dissection was considerably higher during thoracic endovascular aortic repair. Intraoperative diagnosis of iatrogenic aortic dissection was made in 69% of patients, and surgical repair of the dissection was performed in 88%. The overall in-hospital mortality was 38%, and the intraoperative diagnoses (odds ratio 0.35; p = 0.01) and surgical repairs (odds ratio 0.09; p = 0.001) were associated with reduced in-hospital mortality in univariate regression analysis.

Indications for the Treatment of Thoracic Aortic Aneurysms

In an era of increasingly common and detailed imaging of the thorax, thoracic aortic aneurysms are being discovered in their precomplicated state with increasing frequency. At the same time, the list of potential treatments for thoracic aneurysms is beginning to expand. Deciding which treatment method to employ and which aneurysm to treat is often difficult. The risk of aneurysm complications must be balanced against the risks of the treatment. This work explores the behavior of thoracic aneurysms, the state-of-the-art in treatment, and a rational approach to the treatment decision is proposed.

Novel intracranial brain cooling catheter to mitigate brain injuries

Background The neuroprotective effects of cooling the spinal cord in a sheep model by a self-contained intrathecal catheter was reported recently by the authors. The present study was designed to determine if cooling catheters in the lateral ventricles of the brain can effectively cool the CSF and thereby reduce brain temperature while maintaining systemic normothermia. Methods The cooling catheter is a self-contained system that circulates a cold fluid and cools the CSF that circulates in the brain. The CSF in turn cools the surrounding brain by conduction. Burr holes were made in the skull and the catheter was placed into the lateral ventricles using the standard method for placement of ventriculostomy catheters. To monitor the cooling effect, four temperature probes were placed in the brain (left and right hemispheres of the brain in anterior and posterior locations to the ventricles). Results Five experiments were successfully completed. The mean brain temperature for all sheep decreased to 34.5°C (mean) during the 3 h cooling period (9.7% reduction from baseline brain temperature of 38.2°C). Cooling fluid was circulated through the catheter at a rate of 50 ml/min. The lowest achieved brain temperature during cooling was 26.7°C. When cooling was stopped, the brain temperature readings equilibrated with the core temperature promptly. Post mortem examination of the brains showed no morphologic changes under gross or histologic examinations. Conclusion Localized cooling of the brain to moderate hypothermic levels while maintaining relative systemic normothermia was demonstrated in an animal model with intraventricular cooling catheters.

Biomarkers for Diagnosis in Thoracic Aortic Disease: PRO

Identification of biomarkers for thoracic aortic aneurysm (TAA) disease is important because complications of TAAs are common. Preemptive operative repair of TAAs is effective in improving survival. However, elective surgical repair for asymptomatic aneurysms remains a clinical decision that must be based on the patients operative risk and the risk that a given TAA will rupture. Thus, it is vitally important to be able to identify which patients with TAAs are at the greatest risk for rupture or dissection. Markers in clinical use and potential markers at the cellular, protein, and molecular level are discussed.

Left Thoracotomy Approach for Implantation of the Abiomed Left Ventricular Assist Device

Abstract  We describe a left thoracotomy approach for implantation of the Abiomed AB5000 left ventricular assist device (LVAD). The technique is easily performed and spares the patient a sternotomy in anticipation of future transplantation or LVAD exchange. (J Card Surg 2012;27:395‐396)

Avoiding Technical Pitfalls in Left Ventricular Assist Device Placement

Left ventricular assist device (LVAD) placement is a serious surgical procedure. At our center, we accumulated a very large experience with the Novacor LVAD from the very first clinical trial, as well as from more recent experiences with the Jarvik 2000 and the HeartMate II. This article discusses technical issues that are common to all durable LVAD devices, with special emphasis on strategy and technical considerations aimed at avoiding surgical pitfalls.