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author:("bertoli, Luca")
1.  Video-atlas of hybrid thoracoabdominal aortic aneurysm repair 
Annals of Cardiothoracic Surgery  2012;1(3):404-405.
Although open surgical repair of thoracoabdominal aortic aneurysm (TAAA) has evolved significantly over the last few decades, technical challenges and current morbidity and mortality of the inclusion technique are still significant, particularly in patients with extensive aneurysms or prior aortic surgery and in poor surgical candidates. Hybrid TAAA repair is an appealing technique and may represent a “bridge” solution as we wait for larger series and reproducible results from the evolving experience with total endovascular TAAA repair with fenestrated and branched endografts.
doi:10.3978/j.issn.2225-319X.2012.08.14
PMCID: PMC3741765  PMID: 23977527
Thoracoabdominal aortic aneurysm (TAAA); extensive aneurysms; total endovascular TAAA repair
2.  Clinical outcomes of hybrid repair for thoracoabdominal aortic aneurysms 
Annals of Cardiothoracic Surgery  2012;1(3):293-303.
Background
Thoracoabdominal aortic aneurysm (TAAA) hybrid repair consists of aortic visceral branch rerouting followed by TAAA endograft exclusion. This technique has been shown to represent a technically feasible strategy in selected patients.
Methods
We analyzed 52 high-risk patients who underwent hybrid TAAA repair between 2001 and 2012 in our centre with a variety of visceral rerouting configurations and of commercially available thoracic endografts. Thirty-seven simultaneous (71.2%) and 15 staged procedures (21.8%) were performed with a four-vessel revascularization in 18 cases (34.6%), a three-vessel revascularization in 11 cases (21.2%) and a two-vessel revascularization in 23 cases (44.2%).
Results
No intraoperative deaths were observed. We recorded a perioperative mortality rate of 13.5% (n=7), including deaths from multiorgan failure (n=2), myocardial infarction (n=2), coagulopathy (n=1), pancreatitis (n=1) and bowel infarction (n=1). Perioperative morbidity rate was 28.8% (n=15), including 2 cases of transient paraparesis and 1 case of permanent paraplegia. Renal failure (n=5), pancreatitis (n=3), respiratory failure (n=3) and dysphagia (n=1) were also observed. At median follow-up of 23.9 months procedure-related mortality rate was 9.6%: two patients died from visceral graft occlusion and three from aortic rupture. There were three endoleaks and one endograft migration, none of which resulted in death. Five patients (9.6%) died as a consequence of unrelated events.
Conclusions
Typical complications of conventional TAAA open surgery have not been eliminated by hybrid repair, and significant mortality and morbidity rates have been recorded. Fate of visceral bypasses and incidence of endoleak and other endograft-related complications needs to be carefully assessed. Hybrid TAAA repair should currently be limited to high-risk surgical patients with unfit anatomy for endovascular repair.
doi:10.3978/j.issn.2225-319X.2012.07.15
PMCID: PMC3741770  PMID: 23977511
Thoracoabdominal; aorta; aneurysm; hybrid; endovascular
3.  Video-atlas of open thoracoabdominal aortic aneurysm repair 
Annals of Cardiothoracic Surgery  2012;1(3):398-403.
Open surgical repair of thoracoabdominal aortic aneurysms has evolved significantly over the last decades thanks to technical improvements, especially in the area of organ protection. However, despite adjunctive strategies, morbidity and mortality rates are still not negligible. Repair of the thoracoabdominal aorta represents a formidable challenge for surgeons, anesthesiologists and patients alike. While operative repair is generally carried out in specialized institutions, knowledge of the state-of-the-art diagnostic, anesthesiologic, surgical and endovascular aspects will certainly be of great value to all physicians involved in the care of these patients at any level. This “How to” video will explain all of these diagnostic, anesthesiologic and surgical aspects in our daily practice.
doi:10.3978/j.issn.2225-319X.2012.08.07
PMCID: PMC3741779  PMID: 23977526
Thoracoabdominal aortic aneurysm; diagnosis; open surgical rapair
4.  Emergent Repair of a Complex Dissecting Aneurysm in the Thoracic Aorta 
Texas Heart Institute Journal  2012;39(5):687-691.
Endovascular treatment of complex thoracic pathologic conditions involving the aortic arch can often be appropriate and safe; however, minimally invasive procedures are not always feasible, especially in emergent cases. We report the case of a 78-year-old woman who emergently presented in hemorrhagic shock with a ruptured chronic dissecting aneurysm that involved the aortic arch. Eight years earlier, she had undergone aortic valve replacement and plication of the ascending aorta, which was complicated a day later by Stanford type B dissection, malperfusion, and ischemia that required an axillobifemoral bypass. At the current admission, we successfully treated her surgically through a left thoracotomy, using moderate hypothermic extracorporeal circulation and advanced organ-protection methods. We discuss the surgical indications and our operative strategy in relation to open surgical repair versus endovascular treatment in patients with complex conditions.
PMCID: PMC3461696  PMID: 23109769
Aneurysm, dissecting/radiography/surgery; aortic aneurysm, thoracic/radiography/surgery; aortic diseases/surgery; aortic rupture/surgery; treatment outcome; vascular surgical procedures
5.  Hybrid Repair of Aortic Aneurysms and Dissections 
Texas Heart Institute Journal  2011;38(6):687-690.
PMCID: PMC3233314  PMID: 22199437
Aneurysm, dissecting/surgery; aortic aneurysm, thoracic/surgery; blood vessel prosthesis implantation; endovascular procedures; stents

Results 1-6 (6)