L'ablation de la fibrillation auriculaire par radiofréquence unipolaire au cours de la chirurgie valvulaire mitrale

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Endovascular treatment of thoracoabdominal aortic aneurysms

BackgroundDevelopment in endograft design has extended endovascular treatment to include thoracoabdominal aortic aneurysms (TAAA). We report our experience using fenestrated and branched endografts in the management of TAAA.MethodsWe analyzed a cohort of consecutive patients treated electively for TAAA using endovascular techniques between 2006 and 2011. All data were collected prospectively. The relationships between preoperative risk factors and clinical outcome were examined using univariate and multivariate statistical techniques. We also compared the outcomes between 33 previously published early cases (EC) with the last 56 later cases (LC).ResultsEighty-nine patients (83 men) were treated. Median age was 69 years. All patients were deemed unfit for open surgery. The 30-day and in-hospital mortality rates were 8.9% and 10%, respectively. Multivariate analysis showed in-hospital mortality was associated with preoperative chronic renal failure and advanced age. Higher postoperative mean arterial blood pressure was a protective factor. Technical success rate was 96.6% (94% and 98% in the EC and LC groups, respectively; P = .14). The spinal cord ischemia (SCI) rate was 7.8% (15% and 3% in the EC and LC groups, respectively; P = .063) and was associated with chronic obstructive pulmonary disease and procedure duration. Six patients (6.7%) required temporary filtration, but none required permanent renal support (associated with left ventricular ejection fraction <40% and procedure duration). Median procedure duration decreased from 232 to 203 minutes (P = .01) in the EC and LC groups, respectively. Actuarial survival was 86.8% ± 3.7% at 1 year and 74.7% ± 6% at 2 years.ConclusionsAlthough we have treated a cohort at high operative risk, our midterm results compare favorably with the published series of conventional surgery. Accurate hemodynamic control represented by high-normal perioperative blood pressure seems to protect against severe postoperative complications

Results of F-EVAR in Octogenarians.

to evaluate the clinical outcomes after fenestrated endovascular aortic aneurysm repair (F-EVAR) in octogenarians

Total endovascular repair of an aortic arch aneurysm using an externalized transseptal guidewire technique

Total endovascular treatment of complex ascending and arch disease remains extremely challenging with difficulties provided by the curvature of the arch, the variable anatomy of the great vessels, the proximity of the coronary ostia, potential damage to the aortic valve, and ventricle and instability during deployment. Given this background, reports of the total endovascular treatment of aortic arch are sparse. We describe one challenging case using an arch branched endograft that was safely advanced and precisely positioned into the ascending aorta using an externalized transseptal guide wire technique. \uc2\ua9 2012 The Society of Thoracic Surgeons