Enoch Akowuah

Open versus endovascular repair of traumatic aortic rupture: A systematic review

There have been several case reports, retrospective series, and registry data describing treatment of patients with traumatic aortic rupture (TAR) using endovascular stents (ES). Most are single-center studies with a limited number of patients. Few studies compare conventional surgical repair (SR) with ES. We performed a systematic review of these studies in an attempt to quantify the benefits of ES for TAR.

Patient preference for coronary artery bypass graft surgery performed on the arrested or beating heart: a questionnaire study

OBJECTIVEnPatient choice is now a major facet of health-care policy within the National Health Service. Our objective was to determine whether the patient would like to choose if the beating heart technique or the arrested heart technique is employed for their coronary artery bypass graft (CABG) surgery.nnnMETHODSnWe undertook a cross-sectional, self-reported questionnaire survey of patients referred to a regional cardiac surgical unit for elective coronary artery surgery between October 2008 and July 2009. The questionnaire was split into five sections as follows: (1) the patients awareness of beating heart and arrested heart techniques for CABG surgery, (2) an information sheet detailing both techniques, (3) patients preference of technique to be used for CABG surgery, (4) whether the patient would like to choose their surgeon according to the surgeons preferred technique and (5) demographics, including age, sex, and educational qualifications. Data are expressed as counts (percentages).nnnRESULTSnThe questionnaire was sent to 120 people; 88 returned a completed questionnaire, representing a response rate of 73%. Awareness of beating heart and arrested heart techniques for CABG surgery was reported by 35 respondents (40%). Of these, 74% respondents had no preference of technique used for CABG surgery. After reading the information sheet, 78 (89%) respondents reported no preference of technique used for CABG surgery. As many as 71 (81%) respondents reported that they did not want to be given an opportunity to choose the technique used for CABG surgery, and all respondents preferred to let the surgeon decide the appropriate technique. A binary logistic regression analysis showed that gender, age and level of education were not significant predictors of whether patients wanted to choose the technique to be used for their CABG surgery.nnnCONCLUSIONnCardiac surgical patients prefer to allow the surgeon to determine the technique to be used for their coronary artery operation and do not want to be offered the chance to choose their surgeon according to the surgeons preferred technique. Involvement of the patient in determining the operative technique is not always desired.

Aortic Coarctation Secondary to In-Stent Stenosis of a Covered Aortic Endoprosthesis

1 he use of covered endovascular stents to treat a variety of thoracic aortic pathology is well estabished. Although technical feasibility and medium effiacy have been demonstrated, there is little data regardng possible long-term complications. A 27-year-old man involved in a road traffic accident as diagnosed with traumatic aortic rupture at the aortic sthmus. Emergency endovascular repair was successully performed using a 26-mm Talent stent (Medtronic, inneapolis, MN). An excellent result was achieved Fig 1). Two years later he represented with upper body hyertension, symptoms of heart failure, and a clinical icture consistent with a coarctation of the aorta. An ortogram revealed narrowing at the distal end of the riginal stent and a filling defect (Fig 2). This was treated y the insertion of an uncovered stent within the original overed stent (Fig 3). The patient had a gradual resoluion of symptoms and has had no further complications o date. The stenosis within the original stent appeared to be aused by in-growth of material from within the stent tself. There was no evidence of structural disintegration f the stent. Recent long-term results of endovascular stenting of he abdominal aorta demonstrate a high rate of late