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Article ; Online: Commentary: The severity of chronic obstructive pulmonary disease affects outcomes of thoracoabdominal aortic aneurysms repair-is GOLD the answer?

Lopez-Marco, Ana / Oo, Aung Y

The Journal of thoracic and cardiovascular surgery

2023

Language	English
Publishing date	2023-10-21
Publishing country	United States
Document type	Editorial
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2023.10.039
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Article ; Online: Patient-Specific Haemodynamic Analysis of Virtual Grafting Strategies in Type-B Aortic Dissection: Impact of Compliance Mismatch.

Girardin, Louis / Stokes, Catriona / Thet, Myat Soe / Oo, Aung Ye / Balabani, Stavroula / Díaz-Zuccarini, Vanessa

Cardiovascular engineering and technology

2024

Abstract: Introduction: Compliance mismatch between the aortic wall and Dacron Grafts is a clinical problem concerning aortic haemodynamics and morphological degeneration. The aortic stiffness introduced by grafts can lead to an increased left ventricular (LV) ... ...

Abstract	Introduction: Compliance mismatch between the aortic wall and Dacron Grafts is a clinical problem concerning aortic haemodynamics and morphological degeneration. The aortic stiffness introduced by grafts can lead to an increased left ventricular (LV) afterload. This study quantifies the impact of compliance mismatch by virtually testing different Type-B aortic dissection (TBAD) surgical grafting strategies in patient-specific, compliant computational fluid dynamics (CFD) simulations. Materials and methods: A post-operative case of TBAD was segmented from computed tomography angiography data. Three virtual surgeries were generated using different grafts; two additional cases with compliant grafts were assessed. Compliant CFD simulations were performed using a patient-specific inlet flow rate and three-element Windkessel outlet boundary conditions informed by 2D-Flow MRI data. The wall compliance was calibrated using Cine-MRI images. Pressure, wall shear stress (WSS) indices and energy loss (EL) were computed. Results: Increased aortic stiffness and longer grafts increased aortic pressure and EL. Implementing a compliant graft matching the aortic compliance of the patient reduced the pulse pressure by 11% and EL by 4%. The endothelial cell activation potential (ECAP) differed the most within the aneurysm, where the maximum percentage difference between the reference case and the mid (MDA) and complete (CDA) descending aorta replacements increased by 16% and 20%, respectively. Conclusion: This study suggests that by minimising graft length and matching its compliance to the native aorta whilst aligning with surgical requirements, the risk of LV hypertrophy may be reduced. This provides evidence that compliance-matching grafts may enhance patient outcomes.
Language	English
Publishing date	2024-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2543111-0
ISSN	1869-4098 ; 1869-408X
ISSN (online)	1869-4098
ISSN	1869-408X
DOI	10.1007/s13239-024-00713-6
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Article ; Online: Retrograde type A aortic dissection: a different evil.

Lopez-Marco, Ana / Adams, Benjamin / Oo, Aung Ye

Interactive cardiovascular and thoracic surgery

2022 Volume 35, Issue 6

Abstract: Retrograde type A aortic dissection (RTAAD) can be spontaneous or secondary to the instrumentation of the descending and thoraco-abdominal aorta. It has anatomical differences compared to antegrade type A aortic dissection that impact the management and ... ...

Abstract	Retrograde type A aortic dissection (RTAAD) can be spontaneous or secondary to the instrumentation of the descending and thoraco-abdominal aorta. It has anatomical differences compared to antegrade type A aortic dissection that impact the management and prognosis. Treatment is not standardized. We report our approach to spontaneous RTAAD in our institution between 2018 and 2022 (n = 15). The mean age was 60.1 years and 93% were male. Aortic valve, coronary arteries and supra-aortic trunks were spared by the dissection in 80% of the cases; distal extension to iliacs was common and lower limb malperfusion was present in 4 cases (27%). The ascending aorta was dilated at presentation in 60% of the cases. Emergency surgery with arch/FET replacement was offered to 11 patients (73%); 3 patients (20%) received a limited proximal aortic repair; 1 patient was treated conservatively. Overall mortality was 47% (100% for limited proximal repair and 22% for those who received arch/FET). We advocate for aggressive treatment of RTAAD excluding the primary entry tear to prevent immediate- and mid-term complications.
MeSH term(s)	Humans ; Male ; Middle Aged ; Female ; Blood Vessel Prosthesis Implantation/adverse effects ; Aorta, Thoracic/surgery ; Aneurysm, Dissecting/diagnostic imaging ; Aneurysm, Dissecting/surgery ; Aorta/surgery ; Prognosis ; Aortic Aneurysm, Thoracic/diagnostic imaging ; Aortic Aneurysm, Thoracic/surgery
Language	English
Publishing date	2022-10-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivac264
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Zs.A 5730: Show issues

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Article: Intercostal artery reattachment for prevention of spinal cord ischaemia.

Lopez-Marco, Ana / Thet, Myat Soe / Sajiram, Sarvananthan / Adams, Benjamin / Oo, Aung Y

Annals of cardiothoracic surgery

2023 Volume 12, Issue 5, Page(s) 511–513

Language	English
Publishing date	2023-09-20
Publishing country	China
Document type	Editorial
ZDB-ID	2713627-9
ISSN	2304-1021 ; 2225-319X
ISSN (online)	2304-1021
ISSN	2225-319X
DOI	10.21037/acs-2023-scp-09
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Article ; Online: Preoperative B-Type Natriuretic Peptides to Predict Postoperative Atrial Fibrillation in Cardiac Surgery: A Systematic Review and Meta-Analysis.

Thet, Myat Soe / Hlwar, Khun Eaint / Thet, Khaing Soe / Han, Khin Phue Phue / Oo, Aung Ye

Heart, lung & circulation

2023 Volume 33, Issue 1, Page(s) 23–32

Abstract: Background: Post-operative atrial fibrillation (AF) is the most common complication following cardiac surgery. There has been extensive exploration of clinical variables, imaging, and biomarkers to predict its occurrence after cardiac surgery. In this ... ...

Abstract	Background: Post-operative atrial fibrillation (AF) is the most common complication following cardiac surgery. There has been extensive exploration of clinical variables, imaging, and biomarkers to predict its occurrence after cardiac surgery. In this study, we examine the emerging biomarkers B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) to assess their pre-operative values and correlations with the occurrence of post-operative AF in patients undergoing cardiac surgery. Methods: A comprehensive literature search was conducted using PubMed, EMBASE, MEDLINE via Ovid, ClinicalTrials.Gov, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify studies published until March 2023. The studies were included if they reported pre-operative BNP or NT-proBNP values and the development of post-operative AF in cardiac surgery patients. Subsequently, data were extracted, and a meta-analysis was performed using Review Manager 5.4 4 (The Cochrane Collaboration, 2020) and SPSS version 28 (IBM Corp, Armonk, NY, USA) to assess the difference between pre-operative BNP and NT-proBNP levels between patients with post-operative AF (AF group) and those without (No-AF group) using a random-effect model. Further analysis was performed in three subgroups: isolated coronary artery bypass grafting, isolated valve, and combined/mixed surgery group. Result: A total of 20 studies, including 9,079 participants were identified and included in the systematic review and meta-analysis. Pre-operative BNP levels were reported in 11 studies, and NT-proBNP levels were reported in 10 studies, of which one study reported both BNP and NT-proBNP levels. There is an overall significant difference between pre-operative levels of BNP (p=0.03, I Conclusions: Elevated levels of both BNP and NT-proBNP were observed in patients who developed post-operative AF after undergoing cardiac surgery. In particular, pre-operative NT-proBNP levels were elevated in all patients irrespective of the type of surgical procedure, but elevated pre-operative BNP was only seen in valve surgery patients. These findings suggest the potential usefulness of NT-proBNP as a promising biomarker for predicting the occurrence of post-operative AF following cardiac surgery.
MeSH term(s)	Humans ; Atrial Fibrillation/etiology ; Atrial Fibrillation/complications ; Biomarkers ; Cardiac Surgical Procedures/adverse effects ; Natriuretic Peptide, Brain ; Natriuretic Peptides ; Peptide Fragments ; Vasodilator Agents
Chemical Substances	Biomarkers ; Natriuretic Peptide, Brain (114471-18-0) ; Natriuretic Peptides ; Peptide Fragments ; Vasodilator Agents
Language	English
Publishing date	2023-12-23
Publishing country	Australia
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2020980-0
ISSN	1444-2892 ; 1443-9506
ISSN (online)	1444-2892
ISSN	1443-9506
DOI	10.1016/j.hlc.2023.10.015
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Zs.A 4988: Show issues

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Article ; Online: Thoracoabdominal aneurysmectomy: Operative steps for Crawford extent II repair.

Lopez-Marco, Ana / Adams, Benjamin / Oo, Aung Ye

JTCVS techniques

2020 Volume 3, Page(s) 25–36

Abstract: Background: Open surgical repair remains the gold standard for treatment of thoracoabdominal aortic aneurysm (TAAA). Surgery aims to replace the whole length of the diseased distal aorta while protecting the spinal cord and the visceral organs to limit ... ...

Abstract	Background: Open surgical repair remains the gold standard for treatment of thoracoabdominal aortic aneurysm (TAAA). Surgery aims to replace the whole length of the diseased distal aorta while protecting the spinal cord and the visceral organs to limit ischemia-related complications. The substantial associated surgical risks, including death, paraplegia, renal failure requiring permanent dialysis, and respiratory complications leading to prolonged intensive care unit stay, still outweigh the natural history of TAAA with conservative treatment. Methods: We describe in detail our current approach to open extent II TAAA repair with a step-by-step illustration of the technique and the surgical adjuncts. Results: We routinely perform left heart bypass with mild passive hypothermia (34°C), cerebrospinal fluid drainage, sequential aortic cross-clamping, monitoring of motor evoked potentials (MEPs) and cerebral, paraspinal, and lower limb oxygen saturation by near-infrared spectrometry, as well as selective visceral perfusion via the celiac and superior mesenteric arteries and renal protection with intermittent administration of Custodiol HTK (histidine-tryptophan-ketoglutarate) solution via the renal arteries. We advocate for individual branch reimplantation using a branched thoracoabdominal graft when possible, and we selectively reattach 1 or more pairs of the lower thoracic intercostal arteries and/or high lumbar arteries, even in the absence of a significant reduction in the MEPs signal. The distal anastomosis is usually constructed above the aortic bifurcation and occasionally to each iliac separately using a bifurcated graft. Conclusions: Favorable early outcomes and a durable TAAA repair can be achieved at experienced high-volume centers with standardized preoperative selection and multidisciplinary team-based intraoperative and postoperative management of these patients.
Language	English
Publishing date	2020-06-25
Publishing country	United States
Document type	Journal Article
ISSN	2666-2507
ISSN (online)	2666-2507
DOI	10.1016/j.xjtc.2020.06.028
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Article ; Online: Ministernotomy repair of inadvertent proximal right subclavian artery injury following right internal jugular central venous catheter insertion.

Thet, Myat Soe / Kyaw Tun, Jimmy / Oo, Aung Ye / Lopez-Marco, Ana

BMJ case reports

2022 Volume 15, Issue 4

Abstract: A man in his 60s was referred for urgent coronary artery bypass grafting (CABG) procedure following acute coronary syndrome. After induction of general anaesthesia, right jugular venous catheterisation under two-dimensional ultrasound guidance was ... ...

Abstract	A man in his 60s was referred for urgent coronary artery bypass grafting (CABG) procedure following acute coronary syndrome. After induction of general anaesthesia, right jugular venous catheterisation under two-dimensional ultrasound guidance was planned as part of perioperative management. While obtaining vascular access, the pulsatile flow was noted once the dilator was inserted, having to abandon the procedure and immediately apply manual pressure. CT angiogram showed proximal right subclavian artery injury with active contrast extravasation and resultant large haematoma in the neck. The patient underwent urgent exploration of the injured vessel through a J-shaped ministernotomy, and primary repair of the artery was performed. The patient recovered from the procedure without any complications. He continued to stay in the hospital for a few days, afterwards, he underwent the initially planned CABG surgery. He was discharged home on day 5 after surgery without further concerns.
MeSH term(s)	Catheterization, Central Venous/adverse effects ; Catheterization, Central Venous/methods ; Central Venous Catheters/adverse effects ; Humans ; Jugular Veins/diagnostic imaging ; Jugular Veins/surgery ; Male ; Subclavian Artery/diagnostic imaging ; Subclavian Artery/injuries ; Subclavian Artery/surgery ; Thoracic Injuries/complications ; Vascular System Injuries/etiology ; Vascular System Injuries/surgery
Language	English
Publishing date	2022-04-22
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-247809
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Article ; Online: Efficacy of chest X-rays after drain removal in adult and pediatric patients undergoing cardiac and thoracic surgery: A systematic review.

Thet, Myat S / Han, Khin P P / Hlwar, Khun E / Thet, Khaing S / Oo, Aung Y

Journal of cardiac surgery

2022 Volume 37, Issue 12, Page(s) 5320–5325

Abstract: Background: Chest X-rays are routinely obtained after the removal of chest drains in patients undergoing cardiac and thoracic surgical procedures. However, a lack of guidelines and evidence could question the practice. Routine chest X-rays increase ... ...

Abstract	Background: Chest X-rays are routinely obtained after the removal of chest drains in patients undergoing cardiac and thoracic surgical procedures. However, a lack of guidelines and evidence could question the practice. Routine chest X-rays increase exposure to ionizing radiation, increase health-care costs, and lead to overutilisation of available resources. This review aims to explore the evidence in the literature regarding the routine use of chest X-rays following the removal of chest drains. Materials & method: A systematic literature search was conducted in PubMed, Medline via Ovid, Cochrane central register of control trials (CENTRAL), and ClinicalTrials. gov without any limit on the publication year. The references of the included studies are manually screened to identify potentially eligible studies. Results: A total of 375 studies were retrieved through the search and 18 studies were included in the review. Incidence of pneumothorax remains less than 10% across adult cardiac, and pediatric cardiac and thoracic surgical populations. The incidence may be as high as 50% in adult thoracic surgical patients. However, the reintervention rate remains less than 2% across the populations. Development of respiratory and cardiovascular symptoms can adequately guide for a chest X-ray following the drain removal. As an alternative, bedside ultrasound can be used to detect pneumothorax in the thorax after the removal of a chest drain without the need for ionizing radiation. Conclusion: A routine chest X-ray following chest drain removal in adult and pediatric patients undergoing cardiac and thoracic surgery is not necessary. It can be omitted without compromising patient safety. Obtaining a chest X-ray should be clinically guided. Alternatively, bedside ultrasound can be used for the same purpose without the need for radiation exposure.
MeSH term(s)	Humans ; Adult ; Child ; X-Rays ; Pneumothorax ; Thoracic Surgery ; Thoracic Surgical Procedures/methods ; Heart ; Radiography, Thoracic
Language	English
Publishing date	2022-11-06
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/jocs.17114
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Zs.A 2221: Show issues

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Article: Fulminant Herpes Pneumonia Postaortic Surgery with Known Ankylosing Spondylitis

Asemota, Nicole / Ike, Ikenna David / Oo, Aung Ye / Lopez-Marco, Ana

AORTA

2022 Volume 10, Issue 05, Page(s) 256–258

Abstract: Herpes simplex virus (HSV) pneumonitis is rare after cardiac surgery. A 36-year-old gentleman with ankylosing spondylitis underwent emergency surgery for a complex aortic aneurysmal disease. Preoperative treatment of aortitis with antitumor necrosis ... ...

Abstract	Herpes simplex virus (HSV) pneumonitis is rare after cardiac surgery. A 36-year-old gentleman with ankylosing spondylitis underwent emergency surgery for a complex aortic aneurysmal disease. Preoperative treatment of aortitis with antitumor necrosis factor and steroid medication and surgical stress including cardiopulmonary bypass potentially created an immunosuppressive state and reactivation of undiagnosed HSV. Rapid HSV pneumonia ensued, culminating in fulminant organ failure and mortality. HSV pneumonia should be considered postoperatively in patients with severe respiratory distress, especially if immunocompromised.
Keywords	pneumonia ; herpes simplex ; postoperative ; immunosuppression
Language	English
Publishing date	2022-10-01
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	2325-4637
ISSN (online)	2325-4637
DOI	10.1055/s-0042-1757791
Database	Thieme publisher's database

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Article ; Online: On-X aortic valve replacement patients treated with low dose warfarin and low dose aspirin.

Oo, Aung Y / Loubani, Mahmoud / Gerdisch, Marc W / Zacharias, Joseph / Tsang, Geoffrey M / Perchinsky, Michael J / Hagberg, Robert Carl / Joseph, Mark / Sathyamoorthy, Mohanakrishnan

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2024

Abstract: Objectives: To assess if warfarin targeted to INR 1.8 (range 1.5-2.0) is safe for all patients with an On-X aortic mechanical valve.: Methods: This prospective, observational registry follows patients receiving warfarin targeted at an INR of 1.8 ( ... ...

Abstract	Objectives: To assess if warfarin targeted to INR 1.8 (range 1.5-2.0) is safe for all patients with an On-X aortic mechanical valve. Methods: This prospective, observational registry follows patients receiving warfarin targeted at an INR of 1.8 (range 1.5-2.0) plus daily aspirin (75-100 mg) after On-X aortic valve replacement. The primary end-point is a composite of thromboembolism, valve thrombosis, and major bleeding. Secondary end-points include the individual rates of thromboembolism, valve thrombosis, and major bleeding, as well as the composite in subgroups of home or clinic-monitored INR and risk categorization for thromboembolism. The control was the patient group randomized to standard-dose warfarin (INR 2.0-3.0) plus daily aspirin 81 mg from the PROACT trial. Results: A total of 510 patients were enrolled at 23 centers in the UK, United States, and Canada. Currently, the median follow-up duration is 3.4 years, and median achieved INR is 1.9. The primary composite end-point rate in the low INR patients is 2.31% vs 5.39% (95% confidence interval 4.12%-6.93%) per patient-year in the PROACT control group, constituting a 57% reduction. Results are consistent in subgroups of home or clinic-monitored, and high-risk patients, with reductions of 56%, 57%, and 57%, respectively. Major and total bleeding are decreased by 85% and 73%, respectively, with similar rates of thromboembolic events. No valve thrombosis occurred. Conclusions: Interim results suggest that warfarin targeted at an INR of 1.8 (range 1.5-2.0) plus aspirin is safe and effective in patients with an On-X aortic mechanical valve with or without home INR monitoring.
Language	English
Publishing date	2024-04-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezae117
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