The Experts below are selected from a list of 291 Experts worldwide ranked by ideXlab platform
Fred A. Weaver - One of the best experts on this subject based on the ideXlab platform.
-
Ex vivo renal Artery Reconstruction for complex renal Artery disease.
Journal of Vascular Surgery, 2014Co-Authors: Sung W. Ham, Fred A. WeaverAbstract:Objective The objective of this study was to evaluate long-term outcome of renal revascularization by ex vivo renal Artery Reconstruction for complex renal Artery disease. Methods From 1987 to 2012, 23 patients (17 women; mean age, 45 years) with complex renal Artery lesions underwent open renal revascularization by ex vivo technique. Underlying disease included fibromuscular dysplasia with aneurysm (11), atherosclerotic aneurysm (6), Takayasu arteritis (3), and other (3). Outcomes analyzed included primary, primary assisted, and secondary patency rates; antihypertensive medication requirements; renal function and preservation; and mortality. Late graft patency, renal size, and cortical thickness were analyzed by serial renal duplex ultrasound examinations. Results Twenty-four kidneys in 23 patients were revascularized by ex vivo renal Artery reconstructive techniques. Perioperative complications were limited to two patients requiring reoperation for bleeding. Renal function did not change, and there were no in-hospital deaths. During a mean follow-up of 44 months, a single bypass graft occluded, requiring repeated bypass, which was performed with renal preservation. Primary, primary assisted, and secondary patency rates were 94% at 5 and 10 years. Compared with preoperative values, systolic and diastolic blood pressure and the number of antihypertensive medications were reduced ( P P = .25 and P = .35, respectively). In addition, there was no difference in treated kidney size or renal cortical thickness on follow-up compared with preoperative measurements ( P = .15 and P = .62, respectively). No patient required dialysis. There were three late deaths, none related to the renal procedure, providing 5- and 10-year survival of 85% and 68%, respectively. Conclusions Ex vivo renal Artery Reconstruction for complex renal Artery disease confers a benefit in blood pressure while preserving renal mass and function. This technique should be considered a competitive alternative to other open surgical techniques for the management of complex renal Artery disease.
-
Preliminary retrograde visceral Artery Reconstruction for thoracoabdominal aortic aneurysms.
Annals of vascular surgery, 2007Co-Authors: Alexander B. Chao, Kevin Major, Douglas B. Hood, Kaushal R. Patel, Vincent L. Rowe, Fred A. WeaverAbstract:The recent availability of thoracic endografts has expanded the options for treatment of thoracoabdominal aortic pathology. However, disease that involves the visceral aortic segment presents a special challenge due to the need to preserve mesenteric perfusion. We present three patients in whom preliminary retrograde visceral Artery Reconstruction was used as an adjunct prior to endovascular repair.
-
Orthotopic ex vivo renal Artery Reconstruction.
The American surgeon, 1994Co-Authors: Douglas B. Hood, Fred A. WeaverAbstract:Ex vivo renal Artery Reconstruction is a technique used to repair renal vascular lesions not amenable to conventional in situ methods of revascularization, either because of anatomical considerations or the inability of the kidney to tolerate the extended period of warm ischemia necessary to complete the procedure. In general, this refers to lesions at or beyond the division of the main renal Artery into the segmental branches. The kidney is mobilized to the level of the abdominal wall after dividing the origins of the renal Artery and vein from the aorta and inferior vena cava, respectively. The ureter is left intact. The kidney is cooled by placing it in an external slush bath and by perfusion through the renal vessels of a cold electrolyte solution. A suitable conduit (usually saphenous vein or hypogastric Artery) is then prepared for grafting. After completion of the distal anastomosis(es), the kidney is returned to the renal fossa, and the proximal anastomosis to the aorta is completed. The renal vein is then reattached, thus completing revascularization of the kidney. We report our experience with five orthotopic ex vivo renal Artery Reconstructions. Indications for the procedure, details of the technique, and expected results are discussed.
John F Ladisa - One of the best experts on this subject based on the ideXlab platform.
-
optical coherence tomography for patient specific 3d Artery Reconstruction and evaluation of wall shear stress in a left circumflex coronary Artery
Cardiovascular Engineering and Technology, 2011Co-Authors: Laura M Ellwein, Hiromasa Otake, Timothy J Gundert, Bonkwon Koo, Toshiro Shinke, Yasuhiro Honda, Junya Shite, John F LadisaAbstract:Image-based computational models for quantifying hemodynamic indices in stented coronary arteries often employ biplane angiography and intravascular ultrasound for 3D Reconstruction. Recent advances in guidewire simulation algorithms and the rise of optical coherence tomography (OCT) suggest more precise coronary Artery Reconstruction may be possible. We developed a patient-specific method that combines the superior resolution of OCT with techniques for imaging wire pathway Reconstruction adopted from graph theory. The wire pathway with minimum bending energy was determined by applying a shortest path algorithm to a graph representation of the Artery based on prior studies indicating a wire adopts the straightest configuration within a tortuous vessel. Segments from OCT images are then registered orthogonal to the wire pathway using rotational orientation consistent with geometry delineated by computed tomography (CT). To demonstrate applicability, OCT segments within the stented region were combined with proximal and distal CT segments and imported into computational fluid dynamics software to quantify indices of wall shear stress (WSS). The method was applied to imaging data of a left circumflex Artery with thrombus acquired immediately post-stenting and after a 6-month follow-up period. Areas of stent-induced low WSS returned to physiological levels at follow-up, but correlated with measurable neointimal thickness in OCT images. Neointimal thickness was negligible in areas of elevated WSS due to thrombus. This novel methodology capable of reconstructing a stented coronary Artery may ultimately enhance our knowledge of deleterious hemodynamic indices induced by stenting after further investigation in a larger patient population.
Shigeo Tanaka - One of the best experts on this subject based on the ideXlab platform.
-
Simultaneous subclavian Artery Reconstruction in coronary Artery bypass grafting
The Annals of thoracic surgery, 1997Co-Authors: Masami Ochi, Shigeo Yamauchi, Toshimi Yajima, Ryuzo Bessho, Shigeo TanakaAbstract:Subclavian Artery occlusive lesion, although rare, is sufficiently important to consider before coronary Artery bypass grafting because it can cause not only symptoms of the lesion per se, but also the postoperative coronary-subclavian steal phenomenon. Four patients undergoing coronary Artery bypass grafting received simultaneous Reconstruction of the subclavian Artery. During aortic cross-clamping, an 8-mm ring-reinforced polytetrafluoroethylene graft was attached to the aorta perpendicularly. The prosthetic graft was led to the proximal segment of the axillary Artery through the second intercostal space and anastomosed to the inferior surface of the Artery. Three patients received unilateral Reconstruction of the subclavian Artery, whereas another received bilateral Reconstruction. There were no complications related to the subclavian Reconstruction procedure. Post-operative angiograms revealed excellent patency of the prosthetic grafts. All of the patients have been asymptomatic with follow-up periods ranging from 9 to 50 months. To perform simultaneous subclavian Artery Reconstruction along with coronary Artery bypass grafting, the aortoaxillary bypass procedure using an 8-mm polytetrafluoroethylene graft may be the method of choice because it has lower potential for complications and is less technically demanding.
Eric Bezon - One of the best experts on this subject based on the ideXlab platform.
-
Medium-term survival of diffuse coronary Artery disease patients following coronary Artery Reconstruction with the internal thoracic Artery.
Cardiology, 2011Co-Authors: Ahmed Aziz Khalifa, Jean-christophe Cornily, Charles Henri David, Jean-noël Choplain, Grégoire Le Gal, Jean Aubert Barra, Eric BezonAbstract:OBJECTIVE: Diffuse coronary Artery disease makes cardiac surgeons hesitant regarding whether coronary Artery bypass grafting (CABG) surgery is feasible or not. Coronary Artery Reconstruction using the internal thoracic Artery (ITA) allows bypassing of coronary arteries with diffuse atheromatous plaques without systematically resorting to endarterectomy. The aim of the present study was to evaluate the medium-term results of coronary Artery Reconstruction. METHODS: All patients undergoing coronary Artery Reconstruction using the ITA between 1999 and 2002 (233 patients) were included in the study. The mean age was 61.9 ± 9.8 years. Two hundred and eighty-one coronary Artery Reconstructions using the ITA were performed (mean length 3.6 ± 2 cm) for 514 CABGs. Coronary Artery Reconstruction using the ITA was associated with endarterectomy in 48 cases (17%). RESULTS: In-hospital mortality was 2.6%. Follow-up data were compiled in December 2008. Mean follow-up was 73.4 ± 16.7 months. The actuarial survival rate at 7 years was 89.3 ± 2.1%, and 88% of patients were free of major cardiac events at 7 years. CONCLUSIONS: Coronary Artery Reconstruction gives comparable medium-term results to conventional coronary surgery, even though it is indicated for patients with more severe lesions.
-
Medium-term survival of diffuse coronary Artery disease patients following coronary Artery Reconstruction with the internal thoracic Artery.
Cardiology, 2011Co-Authors: Ahmed Aziz Khalifa, Jean-christophe Cornily, Charles Henri David, Jean-noël Choplain, Grégoire Le Gal, Jean Aubert Barra, Eric BezonAbstract:Diffuse coronary Artery disease makes cardiac surgeons hesitant regarding whether coronary Artery bypass grafting (CABG) surgery is feasible or not. Coronary Artery Reconstruction using the internal thoracic Artery (ITA) allows bypassing of coronary arteries with diffuse atheromatous plaques without systematically resorting to endarterectomy. The aim of the present study was to evaluate the medium-term results of coronary Artery Reconstruction. All patients undergoing coronary Artery Reconstruction using the ITA between 1999 and 2002 (233 patients) were included in the study. The mean age was 61.9 ± 9.8 years. Two hundred and eighty-one coronary Artery Reconstructions using the ITA were performed (mean length 3.6 ± 2 cm) for 514 CABGs. Coronary Artery Reconstruction using the ITA was associated with endarterectomy in 48 cases (17%). In-hospital mortality was 2.6%. Follow-up data were compiled in December 2008. Mean follow-up was 73.4 ± 16.7 months. The actuarial survival rate at 7 years was 89.3 ± 2.1%, and 88% of patients were free of major cardiac events at 7 years. Coronary Artery Reconstruction gives comparable medium-term results to conventional coronary surgery, even though it is indicated for patients with more severe lesions. Copyright © 2012 S. Karger AG, Basel.
-
Coronary Artery Reconstruction for extensive coronary disease: 108 patients and two year follow-up
The Annals of thoracic surgery, 2000Co-Authors: Jean Aubert Barra, Eric Bezon, Philippe Mondine, Ahmed Resk, Martine Gilard, Jacques BoshatAbstract:Abstract Background . Surgical coronary Artery Reconstruction for diffuse coronary disease is described and assessed. Methods . A long arteriotomy, internal thoracic Artery graft, and exclusion of atheromatous plaques from the coronary lumen are the bases of the technique. One hundred eighteen Reconstructions were performed in 108 patients with a mean age of 59 years. Stable angina was present in 62% of patients and unstable angina in 22%. Sixteen percent had had a recent myocardial infarction. The Reconstructions involved 94 left anterior descending coronary arteries, 17 marginal, 5 diagonal, and 2 right coronary arteries. Results . The perioperative mortality rate was 3.7% (4 patients). The rate of perioperative myocardial infarction was 6.3%. Mean follow-up was 29 months (standard deviation, 10 months). Two patients were lost to follow-up. Ninety patients were free from angina and cardiac-related events. Five patients sustained a myocardial infarction, 3 were in congestive heart failure, 3 had class II angina, and 1 died of stroke. Seventy-four of the surgical coronary Artery Reconstructions have been angiographically evaluated (29 months): 94.6% of the internal thoracic Artery grafts were completely patent, and 70 of the Reconstructions were patent without restenosis. String signs and occlusions were present in two internal thoracic arteries each. Conclusions . This technique allows revascularization of severely and diffusely diseased coronary arteries with encouraging results.
Frank L. Hanley - One of the best experts on this subject based on the ideXlab platform.
-
pulmonary Artery Reconstruction after failed pulmonary Artery stents
The Annals of Thoracic Surgery, 2020Co-Authors: Richard D. Mainwaring, Kirstie L. Macmillen, Thomas R Collins, Michal Palmon, Frank L. HanleyAbstract:Background Pulmonary Artery stents are widely deployed in patients with stenoses in the branch pulmonary arteries. However, stents do not address more peripheral sites of stenosis and invariably develop in-stent restenosis. The purpose of this study was to review our experience with pulmonary Artery Reconstruction after failed pulmonary Artery stents. Methods This was a retrospective study of 56 patients who underwent pulmonary Artery Reconstruction after failed pulmonary Artery stents. These patients had undergone a median of 2 (range, 0-5) previous surgical procedures and 2 (range, 1-4) pulmonary Artery stents. Results The median age at stent surgery was 5 (range, 0.3-23.6) years. The majority of stents (79%) were completely removed and patch augmented. The minority of stents (21%) were felt to be unremovable and thus were split longitudinally and reconstructed using a pulmonary Artery homograft. There was 1 (1.8%) operative mortality. The mean pulmonary Artery-to-aortic pressure ratio decreased from a preoperative value of 0.91 ± 0.21 to a postoperative value of 0.31 ± 0.07 (P Conclusions Pulmonary Artery Reconstruction resulted in a significant decrease in pulmonary Artery-to-aortic pressure ratios. The subsequent need for reintervention on the pulmonary arteries has been relatively low (11% to date). These results suggest that patients with pulmonary Artery stents can be successfully treated with surgical Reconstruction.
-
Pulmonary Artery Reconstruction After Failed Pulmonary Artery Stents
The Annals of thoracic surgery, 2020Co-Authors: Richard D. Mainwaring, R. Thomas Collins, Kirstie L. Macmillen, Michal Palmon, Frank L. HanleyAbstract:Pulmonary Artery stents are widely deployed in patients with stenoses in the branch pulmonary arteries. However, stents do not address more peripheral sites of stenosis and invariably develop in-stent restenosis. The purpose of this study was to review our experience with pulmonary Artery Reconstruction after failed pulmonary Artery stents. This was a retrospective study of 56 patients who underwent pulmonary Artery Reconstruction after failed pulmonary Artery stents. These patients had undergone a median of 2 (range, 0-5) previous surgical procedures and 2 (range, 1-4) pulmonary Artery stents. The median age at stent surgery was 5 (range, 0.3-23.6) years. The majority of stents (79%) were completely removed and patch augmented. The minority of stents (21%) were felt to be unremovable and thus were split longitudinally and reconstructed using a pulmonary Artery homograft. There was 1 (1.8%) operative mortality. The mean pulmonary Artery-to-aortic pressure ratio decreased from a preoperative value of 0.91 ± 0.21 to a postoperative value of 0.31 ± 0.07 (P < .001). The median hospital length of stay was 10 days. The median duration of follow-up was 1.8 years. There has been no midterm mortality. Six patients have undergone balloon dilation postoperatively for residual pulmonary Artery stenosis. Pulmonary Artery Reconstruction resulted in a significant decrease in pulmonary Artery-to-aortic pressure ratios. The subsequent need for reintervention on the pulmonary arteries has been relatively low (11% to date). These results suggest that patients with pulmonary Artery stents can be successfully treated with surgical Reconstruction. Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
-
Outcomes of Pulmonary Artery Reconstruction in Williams Syndrome.
The Annals of thoracic surgery, 2019Co-Authors: R. Thomas Collins, Richard D. Mainwaring, Kirstie L. Macmillen, Frank L. HanleyAbstract:Background The study sought to evaluate the short-term and midterm outcomes of surgical pulmonary Artery Reconstruction in patients with Williams syndrome (WS). Methods We performed a retrospective cohort study of all patients with WS who underwent surgical pulmonary Artery Reconstruction at Lucile Packard Children’s Hospital between January 2001 and May 2018. Results There were 25 WS patients (52% female) who underwent pulmonary Artery Reconstruction during the study period. Median age at surgery was 2.4 (interquartile range [IQR], 0.9 to 4.5) years. Median preoperative right ventricular (RV) pressure was 80 (IQR, 70 to 90) mm Hg and aortic pressure was 96 (IQR, 90 to 107) mm Hg, with an RV-to-aortic pressure ratio of 0.8 (IQR, 0.7 to 1.0). The median number of pulmonary arterioplasty patches was 16.5 (IQR, 6.5 to 24). Median postoperative RV pressure was 27 (IQR 20 to 31) mm Hg and aortic pressure was 90 (IQR, 87 to 105) mm Hg, with an RV-to-aortic pressure ratio of 0.27 (IQR, 0.22 to 0.35). The postoperative RV pressure and RV-to-aortic pressure ratio were significantly lower than preoperative RV pressure and RV-to-aortic pressure ratio (p Conclusions Multilevel, surgical pulmonary Artery Reconstruction addressing severe extrapericardial stenoses is highly effective in patients with WS. This technique results in immediate normalization of RV pressure and has a low rate of reintervention in midterm follow-up.
-
Complex Pulmonary Artery Reconstruction
Operative Techniques in Thoracic and Cardiovascular Surgery, 2019Co-Authors: Olaf Reinhartz, Richard D. Mainwaring, Frank L. HanleyAbstract:Complex Pulmonary Artery Reconstruction evolved through our long-term clinical experience in the surgical management of patients with major aortopulmonary collateral arteries. A midline sternotomy approach, utilizing novel techniques for exposure and mobilization, enables access to the distal pulmonary Artery tree to the segmental and subsegmental levels. This allows reconstructive procedures to address both discrete stenoses and areas of long-segment hypoplasia, to reduce pulmonary hypertension and improve and/or preserve right ventricular function. We have utilized this technique in over 70 patients, with our most recent analysis demonstrating one operative mortality, no operative reintervention, and improvement in right to left ventricular pressure ratio from 0.94 (0.72-1.30) to 0.36 (0.19-0.54) with durable 4 ± 3 year follow-up.
