Vascular Ring

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Pedro J Del Nido - One of the best experts on this subject based on the ideXlab platform.

  • outcomes following thoracotomy or thoracoscopic Vascular Ring division in children and young adults
    The Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Melissa A Herrin, Pedro J Del Nido, David Zurakowski, Francis Fynnthompson, Christopher W Baird, Sitaram M Emani
    Abstract:

    Abstract Objective To determine the short- and intermediate-term outcomes following Vascular Ring division by video-assisted thoracoscopic (VATS) or thoracotomy approach. Methods This study is a retrospective review of patients with double aortic arch or right aortic arch with aberrant left subclavian artery and left ligamentum (RAA with LSCA/LL) who underwent division via left thoracotomy or VATS approach at a single institution. Outcome measures included operation duration (OR time), hospital length of stay (LOS), postoperative complications, and freedom from reintervention. Results A total of 200 patients underwent Vascular Ring division by VATS (n = 115) or thoracotomy (n = 85). Of 200 patients, 125 (56%) displayed respiratory symptoms at presentation, 29 (11%) displayed digestive tract symptoms, and 41 (32%) displayed both. Median follow-up was 2.1 years (interquartile range: 1 month to 7.1 years). Overall cohort mortality was 1 (0.5%) of 200 at 11 years after surgery. Fifteen (7.5%) experienced immediate postoperative complications. At follow-up visit within 1 month after surgery, 92 (74%) of 125 patients reported improvement in symptoms. Freedom from reintervention was 96% and 90% at 5 years and 10 years, respectively. Among patients with RAA with LSCA/LL (n = 113), VATS was associated with shorter LOS compared with thoracotomy (1.2 vs 3.4 days; P P  = .68). Conclusions Vascular Ring division by either thoracotomy or VATS can be performed with low rates of complication and need for reintervention. Compared with thoracotomy, VATS is associated with shorter operative duration and hospital LOS among patients with RAA with LSCA/LL.

  • totally endoscopic robotic assisted repair of patent ductus arteriosus and Vascular Ring in children
    The Annals of Thoracic Surgery, 2005
    Co-Authors: Yoshihiro Suematsu, Bassem N Mora, Tomislav Mihaljevic, Pedro J Del Nido
    Abstract:

    Background This study reports on our initial experience with robotically assisted patent ductus arteriosus (PDA) closure and Vascular Ring division in children. Methods From April 2002 to May 2004, 15 patients underwent PDA closure (n = 9) and Vascular Ring repair (n = 6) by a totally endoscopic approach, utilizing the Da Vinci robotic system. The mean age of the patients was 8.3 ± 4.7 years (range, 3 to 18) and the mean weight, 35.5 ± 19.0 kg (range, 14.1 to 77.0 kg). Three thoracoscopic trocars were used to accommodate the endoscopic camera and two surgical instruments with an additional small incision for lung retraction. After dissection by the surgeon seated at the master console, PDA ligation with clips or division of the atretic arch and ductal ligament was performed. Results Total operative times were 170 ± 46 minutes (PDA) and 167 ± 48 minutes (Vascular Ring). One patient with Vascular Ring was converted to thoracotomy because of dense adhesions due to previous surgery. Precise and easy surgical maneuver was possible with the articulated surgical instruments and three-dimensional visualization in 14 patients. Intraoperative transesophageal echocardiography confirmed no persistent shunt in all PDA patients. No laryngeal nerve injury and hemorrhage were noted. All patients were extubated in the operating room. Median length of postoperative hospital stay was 1.5 days. Conclusions Robotically assisted PDA closure and Vascular Ring division is a feasible and safe procedure. Future technologic improvement, including smaller instrument size and incorporation of tactile feedback, may permit application of this technique to even younger infants and intracardiac repairs.

  • robotically assisted division of a Vascular Ring in children
    The Journal of Thoracic and Cardiovascular Surgery, 2003
    Co-Authors: Tomislav Mihaljevic, Jeremy W Cannon, Pedro J Del Nido
    Abstract:

    Over the past decade, technical advances, including the evolution of thoracoscopic instruments and high-resolution cameras, have contributed to the widespread use of video-assisted thoracoscopic techniques in the pediatric population. Introduction of robotic surgical systems represents a further step in the evolution of endoscopic instrumentation. These computer-enhanced systems offer 3-dimensional visualization and significantly improved instrumentation, with motion scaling and a wrist mechanism that allow the performance of fine microsurgical tasks by using an endoscopic approach. These specific advantages make the use of this technology potentially beneficial for the treatment of pediatric patients. This report describes the use of a robotic surgical system for the division of a Vascular Ring in 2 patients.

Sitaram M Emani - One of the best experts on this subject based on the ideXlab platform.

  • outcomes following thoracotomy or thoracoscopic Vascular Ring division in children and young adults
    The Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Melissa A Herrin, Pedro J Del Nido, David Zurakowski, Francis Fynnthompson, Christopher W Baird, Sitaram M Emani
    Abstract:

    Abstract Objective To determine the short- and intermediate-term outcomes following Vascular Ring division by video-assisted thoracoscopic (VATS) or thoracotomy approach. Methods This study is a retrospective review of patients with double aortic arch or right aortic arch with aberrant left subclavian artery and left ligamentum (RAA with LSCA/LL) who underwent division via left thoracotomy or VATS approach at a single institution. Outcome measures included operation duration (OR time), hospital length of stay (LOS), postoperative complications, and freedom from reintervention. Results A total of 200 patients underwent Vascular Ring division by VATS (n = 115) or thoracotomy (n = 85). Of 200 patients, 125 (56%) displayed respiratory symptoms at presentation, 29 (11%) displayed digestive tract symptoms, and 41 (32%) displayed both. Median follow-up was 2.1 years (interquartile range: 1 month to 7.1 years). Overall cohort mortality was 1 (0.5%) of 200 at 11 years after surgery. Fifteen (7.5%) experienced immediate postoperative complications. At follow-up visit within 1 month after surgery, 92 (74%) of 125 patients reported improvement in symptoms. Freedom from reintervention was 96% and 90% at 5 years and 10 years, respectively. Among patients with RAA with LSCA/LL (n = 113), VATS was associated with shorter LOS compared with thoracotomy (1.2 vs 3.4 days; P P  = .68). Conclusions Vascular Ring division by either thoracotomy or VATS can be performed with low rates of complication and need for reintervention. Compared with thoracotomy, VATS is associated with shorter operative duration and hospital LOS among patients with RAA with LSCA/LL.

Melissa A Herrin - One of the best experts on this subject based on the ideXlab platform.

  • outcomes following thoracotomy or thoracoscopic Vascular Ring division in children and young adults
    The Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Melissa A Herrin, Pedro J Del Nido, David Zurakowski, Francis Fynnthompson, Christopher W Baird, Sitaram M Emani
    Abstract:

    Abstract Objective To determine the short- and intermediate-term outcomes following Vascular Ring division by video-assisted thoracoscopic (VATS) or thoracotomy approach. Methods This study is a retrospective review of patients with double aortic arch or right aortic arch with aberrant left subclavian artery and left ligamentum (RAA with LSCA/LL) who underwent division via left thoracotomy or VATS approach at a single institution. Outcome measures included operation duration (OR time), hospital length of stay (LOS), postoperative complications, and freedom from reintervention. Results A total of 200 patients underwent Vascular Ring division by VATS (n = 115) or thoracotomy (n = 85). Of 200 patients, 125 (56%) displayed respiratory symptoms at presentation, 29 (11%) displayed digestive tract symptoms, and 41 (32%) displayed both. Median follow-up was 2.1 years (interquartile range: 1 month to 7.1 years). Overall cohort mortality was 1 (0.5%) of 200 at 11 years after surgery. Fifteen (7.5%) experienced immediate postoperative complications. At follow-up visit within 1 month after surgery, 92 (74%) of 125 patients reported improvement in symptoms. Freedom from reintervention was 96% and 90% at 5 years and 10 years, respectively. Among patients with RAA with LSCA/LL (n = 113), VATS was associated with shorter LOS compared with thoracotomy (1.2 vs 3.4 days; P P  = .68). Conclusions Vascular Ring division by either thoracotomy or VATS can be performed with low rates of complication and need for reintervention. Compared with thoracotomy, VATS is associated with shorter operative duration and hospital LOS among patients with RAA with LSCA/LL.

Jeng Wei - One of the best experts on this subject based on the ideXlab platform.

  • midterm results of Vascular Ring connector in open surgery for aortic dissection
    The Journal of Thoracic and Cardiovascular Surgery, 2012
    Co-Authors: Jeng Wei, Chung-yi Chang, Yi-cheng Chuang, Sung-how Sue, Kuo-chen Lee, Chenghsi Chang
    Abstract:

    Objectives This study observed midterm results of Vascular Ring connectors in surgery for aortic dissection. Methods Vascular Ring connectors were used as stents in Vascular grafts to achieve quick, sutureless anastomoses. Tapes were used to secure Ringed Vascular grafts from outside the aorta. Results From November 2007 to February 2011, 113 consecutive patients with aortic dissection, except 3 in preoperative profound shock, underwent open surgery. All underwent aortic reconstruction with Vascular grafts and Vascular Ring connectors: ascending aorta in 29, descending thoracic aorta in 20, distal hemiarch plus descending thoracic aorta in 22, total arch in 14, ascending aorta plus total arch in 12, total arch plus descending thoracic aorta in 7, ascending aorta plus arch plus descending thoracic aorta in 8, and thoracoabdominal aorta in 1. Concomitant operations were 19 Bentall procedures, 14 coronary bypasses, 2 mitral valve replacements, 1 aortic valve replacement, and 1 heart transplant. We used sternotomy to repair 77% of type B dissections, 83% with elephant trunks. Time to extubation was 9.0 ± 6.2 hours. Average blood loss was 345 ± 195 mL. Half the patients needed no blood transfusion. In-hospital mortality was 5.3%; late mortality was 2.7%. Conclusions Use of Vascular Ring connectors in surgical repair for aortic dissection might reduce risks and improve early and midterm results. With addition of elephant trunk, most type B dissections could be repaired through sternotomy. With the improved surgical results, we can suggest open repair for most uncomplicated type B dissections; however, more long-term follow-up is needed.

  • A new Vascular Ring connector in surgery for aortic dissection
    The Journal of Thoracic and Cardiovascular Surgery, 2009
    Co-Authors: Jeng Wei, Chung-yi Chang, Yi-cheng Chuang, Sung-how Sue, Kuo-chen Lee, David Y. Tung
    Abstract:

    Objective To improve the surgical results of aortic dissection, we used a novel Vascular Ring connector for anastomosis. Methods The Vascular Ring connector is a titanic Ring used as a stent in the Vascular graft to achieve a quick, blood-sealed, and sutureless anastomosis. From November 2007 to December 2008, 19 consecutive patients (age range 36–77 years; 16 male and 3 female) with aortic dissection underwent open surgery. All patients received aortic reconstruction with Vascular grafts (including 5 cases of arch replacement). The combined procedures were 5 Bentall and 4 coronary artery bypass graft operations. Results There were no significant blood leaks from the anastomotic sites. The time required for each anastomosis was 1 to 2 minutes. All patients were discharged uneventfully and are still doing well after a follow-up period of 1 to 12 months. Conclusion The Vascular Ring connector may improve the early surgical results of aortic dissection by reducing both the time for anastomosis and the risk of bleeding and may be an alternative technique for aortic reconstruction. Its usefulness in the routine treatment of aortic dissection warrants further evaluation.

Chenghsi Chang - One of the best experts on this subject based on the ideXlab platform.

  • midterm results of Vascular Ring connector in open surgery for aortic dissection
    The Journal of Thoracic and Cardiovascular Surgery, 2012
    Co-Authors: Jeng Wei, Chung-yi Chang, Yi-cheng Chuang, Sung-how Sue, Kuo-chen Lee, Chenghsi Chang
    Abstract:

    Objectives This study observed midterm results of Vascular Ring connectors in surgery for aortic dissection. Methods Vascular Ring connectors were used as stents in Vascular grafts to achieve quick, sutureless anastomoses. Tapes were used to secure Ringed Vascular grafts from outside the aorta. Results From November 2007 to February 2011, 113 consecutive patients with aortic dissection, except 3 in preoperative profound shock, underwent open surgery. All underwent aortic reconstruction with Vascular grafts and Vascular Ring connectors: ascending aorta in 29, descending thoracic aorta in 20, distal hemiarch plus descending thoracic aorta in 22, total arch in 14, ascending aorta plus total arch in 12, total arch plus descending thoracic aorta in 7, ascending aorta plus arch plus descending thoracic aorta in 8, and thoracoabdominal aorta in 1. Concomitant operations were 19 Bentall procedures, 14 coronary bypasses, 2 mitral valve replacements, 1 aortic valve replacement, and 1 heart transplant. We used sternotomy to repair 77% of type B dissections, 83% with elephant trunks. Time to extubation was 9.0 ± 6.2 hours. Average blood loss was 345 ± 195 mL. Half the patients needed no blood transfusion. In-hospital mortality was 5.3%; late mortality was 2.7%. Conclusions Use of Vascular Ring connectors in surgical repair for aortic dissection might reduce risks and improve early and midterm results. With addition of elephant trunk, most type B dissections could be repaired through sternotomy. With the improved surgical results, we can suggest open repair for most uncomplicated type B dissections; however, more long-term follow-up is needed.