Alexander the Great's life-threatening thoracic trauma

Alexander the Great was a world-class leader with tremendous courage. He paid no heed to the dangers of the battlefield, so he was always in the front lines. However, his excessive courage put his life in danger. Herein, we present an analysis of the information contained in the chronicles about a very severe, life-threatening thoracic trauma that nearly killed the great stratelates. The detailed descriptions made by Arrianus allow us to conclude that Alexander the Great experienced a nearly fatal case of tension pneumothorax. Information on how he was managed is also presented. © The Korean Society for Thoracic and Cardiovascular Surgery. 2018

Endovascular stent grafting for ascending aorta diseases

Objective Conventional open surgery encompassing cardiopulmonary bypass has been traditionally used for the treatment of ascending aorta diseases. However, more than one in five of these patients will be finally considered unfit for open repair. We conducted a systematic review and meta-analysis to investigate the role of thoracic endovascular aortic repair (TEVAR) for aortic diseases limited to the ascending aorta. Methods The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We investigated patients' baseline characteristics along with early (30 days/in-hospital stay) and late (beyond 30 days/in-hospital stay) outcomes after TEVAR limited to the ascending aorta and not involving the arch vessels. Separate analyses for case reports and case series were conducted, and pooled proportions with 95% confidence intervals (CIs) of outcome rates were calculated. Results Approximately 67% of the patients had a prior cardiac operation. TEVAR was performed mainly for acute or chronic Stanford type A dissection (49%) or pseudoaneurysm (28%). The device was usually delivered through the femoral artery (67%), and rapid ventricular pacing was used in nearly half of the patients. Technical success of the method was 95.5% (95% CI, 87.8-99.8). Among the early outcomes, conversion to open repair was 0.7% (95% CI, 0.1-4.8), whereas mortality was 2.9% (95% CI, 0.02-8.6). We estimated a pooled rate of 1.8% (95% CI, 0.1-7.0) for neurologic events (stroke or transient ischemic attack) and 0.8% (95% CI, 0.1-5.6) for myocardial infarction. Late endoleak was recorded in 16.4% (95% CI, 8.2-26.0), and 4.4% (95% CI, 0.1-12.4) of the population died in the postoperative period. Finally, reoperation was recorded in 8.9% (95% CI, 3.1-16.4) of the study sample. Conclusions TEVAR in the ascending aorta seems to be safe and feasible for selected patients with various aortic diseases, although larger studies are required. © 2017 Society for Vascular Surger

Aortic Arch Reconstruction: Are Hybrid Debranching Procedures a Good Choice?

Introduction: Conventional open total arch replacement is the treatment of choice for surgical aortic arch pathologies. However, it is an invasive procedure, requiring cardiopulmonary bypass and deep hypothermic circulatory arrest leading to significant morbidity and mortality rates. Hybrid aortic arch debranching procedures without (type I) or with (type II) ascending aorta replacement seek to limit operative, bypass, and circulatory arrest times by making the arch repair procedure simpler and shorter. Material and Methods: A meta-analysis and detailed review of the literature published from January 2013 until December 2016, concerning hybrid aortic arch debranching procedures was conducted and data for morbidity and mortality rates were extracted. Results: As far as type I hybrid aortic arch reconstruction is concerned, among the 122 patients included, the pooled endoleak rate was 10.78% (95%CI = 1.94–23.40), 30-day or in-hospital mortality was 3.89% (95%CI = 0.324–9.78), stroke rate was 3.79% (95%CI = 0.25–9.77) and weighted permanent paraplegia rate was 2.4%. In terms of type II hybrid approach, among 40 patients, endoleak rate was 12.5%, 30-day or in-hospital mortality rate was 5.3%, stroke rate was 2.5%, no permanent paraplegia was noticed and late mortality rate was 12.5%. Conclusions: Hybrid aortic arch debranching procedures are a safe alternative to open repair with acceptable short- and mid-term results. They extend the envelope of intervention in aortic arch pathologies, particularly in high-risk patients who are suboptimal candidates for open surgery. © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ

Frozen Elephant Trunk: An Alternative Surgical Weapon Against Extensive Thoracic Aorta Disease. A Three-Year Meta-Analysis

Background: Conventional open total arch replacement is the treatment of choice for surgical aortic arch pathologies. However, it is a two-stage procedure related to high cumulative and interval mortality rates. Hybrid type III aortic arch reconstruction, the so-called “frozen elephant trunk” is a one-stage alternative approach. Methods: A meta-analysis and detailed review of the literature published from January 2013 until December 2016, concerning frozen elephant trunk hybrid approach was conducted and data for morbidity and mortality rates were extracted. Results: Among 989 patients included, the pooled 30-day or in-hospital mortality rate was 5.04% (95%CI = 1.13–10.74), stroke rate was 2.38% (95%CI = 0.13–6.30), and the irreversible paraplegia due to spinal cord injury rate was 0.63% (95%CI = 0.00–2.73). Finally, the pooled cumulative survival at 1 year was remarkably high (86.7%, 95%CI = 81.08–92.90). Conclusions: Frozen elephant trunk is a safe alternative to conventional elephant trunk repair for extensive aortic arch pathologies with acceptable short- and mid-term results, avoiding the interval mortality hazard. © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ

Treatment of aortic arch rupture grade III with hybrid arch replacement: the key role of perfusion preservation

Hybrid arch replacement is a well-accepted method for the treatment of lesions involving the aortic arch, though its benefits compared to classic surgical techniques remain controversial. Multiple surgical approaches have been analyzed in the literature for the treatment of such a challenging pathology. In this case report, we describe the surgical management of a 72-year-old man presenting with a complicated aortic arch rupture. The patient was treated urgently with a type I hybrid arch replacement in two stages, with total preservation of cerebral and systemic perfusion. Our case shows that hybrid arch methods are applicable even in emergency cases. © 2021, Indian Association of Cardiovascular-Thoracic Surgeons