Vadim Kotowicz

Old Solutions for New Troubles in Complications after Thoracic Endovascular Aortic Repair

Background  The authors present two cases with type B aortic dissection initially treated by endovascular stent graft who developed aortic complications posttreatment and required surgical treatment. Case Description  A 50-year-old woman and a 65-year-old man underwent endovascular treatment for thoracic aortic aneurysm associated with type B dissection and —both of them evolved with endoleak type 1. The first case was related to aortobronchial fistula, and the second one was associated with ascending aortic aneurysm. An extra-anatomical ascending aorta-supraceliac aorta bypass grafting was decided due to the persistent leak. Conclusion  Surgery is an excellent choice for complex complications after thoracic endovascular aortic repair with previous failed attempts of endovascular resolution.

Aortic Annulus Enlargement vs. Conventional Surgery in Patients with Small Aortic Annulus Undergoing Aortic Valve Replacement

Background: The goal of aortic valve replacement for severe stenosis is to relieve symptoms and prevent the mortality associated with the disease. Appropriate prosthetic valve size must be selected for each patient according to body surface area to avoid patientprosthesis mismatch. Objective: The aim of this study was to evaluate transvalvular gradient reduction at one-year follow-up in patients with small aortic annulus undergoing valve replacement with annular enlargement vs. conventional replacement surgery. Methods: A retrospective cohort study was performed including patients with small aortic annulus undergoing valve replacement from January 2011 to December 2015. Two groups were selected: Group AAE consisting of patients in whom aortic annular enlargement was necessary and Group RVA19 involving patients in whom a #19 mm prosthetic valve was conventionally implanted. Results: Postoperative gradients (within the first 3 months and at one year) were significantly lower in the group with aortic annular enlargement. Median cardiopulmonary bypass time increased 14 minutes in Group AAE. Bioprostheses were used in most cases. There was no statistically significant difference in mortality between the groups. Conclusions: Aortic annular enlargement improves postoperative, short-term and at one year follow-up transvalvular gradients.

Midterm Outcomes after Endovascular Therapy in Claudicant Patients

INTRODUCCION : El objetivo de este trabajo es analizar nuestros resultados en el tratamiento endovascular de los pacientes con sintomas de claudicacion intermitente. MATERIAL Y METODOS : Entre octubre de 2010 y enero de 2015 se trataron 115 extremidades en 90 pacientes. El objetivo primario fue evaluar el exito tecnico, complicaciones y seguimiento clinico. RESULTADOS: Se consiguio el exito tecnico en 99.1% de las extremidades. La media de seguimiento fue de 18 meses (entre 1-36 meses). Se realizo el seguimiento en el 96.5% de las extremidades, 93.7% se encontraban asintomaticas; 3.6% sintomaticas con mejoria y 2.7% sin cambios clinicos. CONCLUSION : El tratamiento endovascular para el paciente claudicantes es seguro, eficaz y presenta baja morbimortalidad asociada en grupos experimentados. En aquellos pacientes que deseen incrementar de forma significativa el perimetro de marcha el tratamiento endovascular deberia considerarse como el tratamiento de eleccion.

Complex Reoperation for Late Complications After Acute Type A Aortic Dissection Surgery

The correct management of acute Type A dissection continues to be a challenge. The primary goal is to save the patient´s life. However, the decision regarding the surgical approach determines possible later complications. We present the case of a 59-year-old female patient with a past history of emergent surgery for acute Type A dissection treated by supracoronary ascending and aortic valve replacement 19 years previously. Later, in a second endovascular approach, the descending aorta was treated by a thoracic endoprosthesis. During follow-up a dilated aortic root and a Type I endoleak were observed, and complex reoperation was required. We performed a total aortic arch replacement with a 4-branched graft and a complete aortic root replacement using the Cabrol technique for the reinsertion of the coronary arteries. The mechanical aortic normally functioning valve was preserved. The patient was discharged 30 days postoperatively.