John Bozinovski

Outcomes and survival in surgical treatment of descending thoracic aorta with acute dissection.

BACKGROUND Thoracic aortic replacement for acute DeBakey type III aortic dissection is associated with significant morbidity and mortality. We report the outcomes of 76 consecutive patients who underwent surgical repair of the descending thoracic aorta or the thoracoabdominal aorta for acute dissection. METHODS During a 16-year period (1989 to 2004), we identified 76 patients who underwent surgery for acute type III aortic dissection. The average patient age was 64.1 +/- 12.3 years (range, 36 to 84), and 55 patients (72.4%) were male. Surgical adjuncts included hypothermic circulatory arrest (8 patients), left heart bypass (15 patients), and cerebrospinal fluid drainage (5 patients). The mean aortic clamp time was 38.4 +/- 17.3 minutes. Rupture was present in 17 patients (22.4%). RESULTS There was 1 intraoperative death. Operative mortality was 22.4% (17 patients), including 11 patients (14.5%) who died within 30 days of operation. Five patients (6.6%) had paraplegia, and 15 patients (19.7%) required hemodialysis, 7 temporarily. Cardiac complications occurred in 33 patients (43.4%), 2 patients (2.6%) were returned to the operating room for bleeding, and 10 patients (13.6%) required tracheostomy. The mean hospital stay was 26.0 +/- 29.7 days. Rupture was not associated with increased risk of postoperative complications or operative mortality. CONCLUSIONS In selected patients with emergent indications, operative intervention with open replacement of the descending thoracic aorta or thoracoabdominal aorta for acute dissection repair can be carried out with respectable mortality, morbidity, and survival rates.

Axillary Artery Cannulation in Surgery for Acute or Subacute Ascending Aortic Dissections

BACKGROUND Perfusion through the right axillary artery is an alternative to aortic or femoral artery cannulation during surgery for ascending aortic dissections. The results of this strategy, particularly beyond the immediate postoperative period, are not well described. METHODS Eighty-three patients (median age, 58 years) with acute or subacute ascending aortic dissection underwent surgical repair with right axillary artery perfusion through an interposition Dacron graft. Sixty-five patients (78%) had DeBakey type I dissections. Procedures performed concomitantly with ascending aortic replacement included root replacement (n = 16; 19%), aortic valve repair or replacement (n = 51; 61%), and coronary artery bypass grafting (n = 13; 16%). Hypothermic circulatory arrest with antegrade cerebral perfusion was used in the majority of patients (n = 60; 72%). We retrospectively studied short-term and midterm outcomes, including survival and complications relating to the axillary cannulation. RESULTS No patient incurred intraoperative axillary artery injuries or had arm ischemia. Fourteen patients (17%) died in the hospital or within 30 days of surgery, and 9 patients (11%) had strokes. Actuarial survival was 73% +/- 5% at 1 year and 64% +/- 6% at 3 years. Forty-six of the 57 surviving patients could be contacted by telephone; they reported few late complications related to the axillary artery cannulation site. These complications included 1 case each of right-arm weakness and right-arm numbness. CONCLUSIONS Surgical repair of acute aortic dissection with right axillary artery perfusion can be performed safely, with a relatively low risk of stroke and a high probability of midterm survival.

A Benign PFO in OPCAB Can Suddenly Take a Right Turn, but Maybe it Can’t Tolerate it

From the Division of Cardiac Surgery and the Department of Anesthesiology, University of British Columbia; and Royal Jubilee Hospital, Victoria, British Columbia, Canada. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication March 15, 2016; accepted for publication March 17, 2016. Address for reprints: John Bozinovski, MD,MSc, 106-2020 Richmond Road, Victoria, British Columbia, Canada, V8R 6R5 (E-mail: john.bozinovski@ubc.ca). J Thorac Cardiovasc Surg 2016;-:1-2 0022-5223/

Editorial commentaryA benign patent foramen ovale in off-pump coronary artery bypass can suddenly take a right turn, but can it be tolerated?

36.00 Copyright 2016 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2016.03.031 John Bozinovski, MD, MSc, and Brent W. Caton, MD

Open surgical repair of 2286 thoracoabdominal aortic aneurysms.

From the Division of Cardiac Surgery and the Department of Anesthesiology, University of British Columbia; and Royal Jubilee Hospital, Victoria, British Columbia, Canada. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication March 15, 2016; accepted for publication March 17, 2016. Address for reprints: John Bozinovski, MD,MSc, 106-2020 Richmond Road, Victoria, British Columbia, Canada, V8R 6R5 (E-mail: john.bozinovski@ubc.ca). J Thorac Cardiovasc Surg 2016;-:1-2 0022-5223/

Spectrum of Aortic Operations in 300 Patients With Confirmed or Suspected Marfan Syndrome

36.00 Copyright 2016 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2016.03.031 John Bozinovski, MD, MSc, and Brent W. Caton, MD