Treating Aortic Disease
02. März 2017
02. März 2017
07. April 2017 (online)
Treatment of aortic disease is a progressively evolving field while the natural course of common pathologies (e.g., bicuspid valve associated proximal aneurysm formation and increased risk for acute type A dissection) is still poorly understood, constantly causing controversy amongst experts reflected by contemporary guidelines for proximal aortic pathologies. In the past two decades, surgical strategies have mainly focused on improving neurological outcome in the transverse arch and thoracoabdominal aortic surgery (e.g., favoring antegrade over retrograde selective cerebral perfusion (SCP) or staged cross-clamping to maintain blood flow to the spinal cord in thoracoabdominal aortic aneurysm [TAAA] repair). Endovascular technologies are rapidly evolving and progressively targeting more proximal segments of the aorta. Steadily higher life expectancy and refined imaging technologies led to an increasing awareness of the asymptomatic chronic aortic disease in elderly, often frail patients constituting a need for more conservative treatment strategies.
Aortic surgery always was one of Friedrich Mohr's favorite specialties, and he consequently developed the aortic program at the Leipzig Heart Centre, Germany into a world-renowned reference center for aortic disease, contributing and refining various surgical strategies (e.g., the elephant trunk or the “arch first” technique), creating new solutions (e.g., hybrid arch/descending repair). As a leader in the field, he excelled in strengthening his team with international experts, themed: “Team up experts to provide optimal patient care,” who brought new impulses and ideas contributing to a progressive growth of the program.
Moreover, under his leadership generations of young Leipzig cardiac surgeons have been trained to safely perform aortic operations even during their residency under the guidance of internationally renowned experts in the field.
Since 1994 over 5,500 aortic surgeries have been performed, constituting Leipzig's leading role as one of Germany's largest high-volume aortic centers ([Fig. 1]). Today more than 5% (and rising) of all open aortic repairs in Germany are performed at the Leipzig Heart Center.
- 1 Borst HG, Schaudig A, Rudolph W. Arteriovenous fistula of the aortic arch: repair during deep hypothermia and circulatory arrest. J Thorac Cardiovasc Surg 1964; 48: 443-447
- 2 Ergin MA, O'Connor J, Guinto R, Griepp RB. Experience with profound hypothermia and circulatory arrest in the treatment of aneurysms of the aortic arch. Aortic arch replacement for acute arch dissections. J Thorac Cardiovasc Surg 1982; 84 (5) 649-655
- 3 Misfeld M, Leontyev S, Borger MA , et al. What is the best strategy for brain protection in patients undergoing aortic arch surgery? A single center experience of 636 patients. Ann Thorac Surg 2012; 93 (5) 1502-1508
- 4 Leontyev S, Misfeld M, Daviewala P , et al. Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques-a single center study. Ann Cardiothorac Surg 2013; 2 (5) 606-611
- 5 Hiratzka LF, Bakris GL, Beckman JA , et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121 (13) e266-e369
- 6 Koeppel TA, Greiner A, Jacobs MJ. DGG-Leitline: Thorakale und thorakoabdominelle Aortenaneurysmen (2010). Available at: http://www.gefaesschirurgie.de/fileadmin/websites/dgg/download/LL_DTAA_und_TAAA_2011.pdf . Accessed March 9, 2017
- 7 Estrera AL, Miller III CC, Huynh TT, Porat E, Safi HJ. Neurologic outcome after thoracic and thoracoabdominal aortic aneurysm repair. Ann Thorac Surg 2001; 72 (4) 1225-1230 , discussion 1230–1231
- 8 Cheung AT, Weiss SJ, McGarvey ML , et al. Interventions for reversing delayed-onset postoperative paraplegia after thoracic aortic reconstruction. Ann Thorac Surg 2002; 74 (2) 413-419 , discussion 420–421
- 9 LeMaire SA, Price MD, Green SY, Zarda S, Coselli JS. Results of open thoracoabdominal aortic aneurysm repair. Ann Cardiothorac Surg 2012; 1 (3) 286-292
- 10 Greenberg RK, Lu Q, Roselli EE , et al. Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques. Circulation 2008; 118 (8) 808-817
- 11 Etz CD, Zoli S, Mueller CS , et al. Staged repair significantly reduces paraplegia rate after extensive thoracoabdominal aortic aneurysm repair. J Thorac Cardiovasc Surg 2010; 139 (6) 1464-1472
- 12 Etz CD, Debus ES, Mohr FW, Kölbel T. First-in-man endovascular preconditioning of the paraspinal collateral network by segmental artery coil embolization to prevent ischemic spinal cord injury. J Thorac Cardiovasc Surg 2015; 149 (4) 1074-1079