case overview aortic live 2016 · patient case 3. diagnosis . 62 y/o female, 62 kg, 174 cm, log. es...
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3rd Aortic Live Symposium
Case Overview
AORTIC LIVE 2016
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3rd Aortic Live Symposium
Case 1 [ Essen ] Aortic Valve Stenosis –
Ozaki – Procedure
Surgery: Ozaki, Yamashita, Wendt, Pasa
Anesthesia: Peters, Dirkmann, Beining | Perfusionist: Alabowicz
Nurses: Arndt, Bentler-Wolf, Allerhut | Anesthesia nurse: Jagusch
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Patient Case 1
Diagnosis
67 y/o male, 69 kg, 178 cm, log. ES 0.61%,
STS-Score 0.8%
Severe AS (mPG 56 mmHg, AVA 0.62 cm²,
Vmax 4.72 m/s)
Moderate AR (PHT 447s)
LVEF 52%
Symptoms & history
Dyspnea on effort, NYHA II, fatigue
aFib (since 2000)
s/p high frequency catheter ablation
(2001+2007)
Surgical strategy
Ozaki-Procedure (autologous pericardium)
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3rd Aortic Live Symposium
Case 2 [ Essen ] MAVD + Aortic aneurysm + CAD –
Trileaflet repair + mod. Yacoub + CABG
Surgery: Benedik, Mourad, Himpel
Anesthesia: Dirkmann, Stöppler, Arafa | Perfusionist: v. Manstein
Nurses: Köster, Tomas, Scholz | Anesthesia nurse: Börskens
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Diagnosis
62 y/o male, 95 kg, 178 cm, log. ES 1.83%
AS/AR (VC 1.2 cm, PHT 234s, severe cusps
calcification, LCC+RCC fusion)
Asc. aortic aneurysm (47mm)
2VD, s/p PCI 1stOM (2015) + RCA (2005)
RCA restenosis (2016)
Surgical strategy
Trileaflet repair + modified Yacoub + CABG
Patient Case 2
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3rd Aortic Live Symposium
Case 3 [ Essen ] TAAA –
Thoracoabdominal aortic replacement
Surgery: Safi, Estrera,Tsagakis, Dohle
Anesthesia: Sheinbaum, Frey, Omer, Geis, Cox
Perfusionist: Naylor, Wiese
Nurses: Vilela, Meyer-Christian, Halfer | Anesthesia Nurse: Pohl-Hassan
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Patient Case 3
Diagnosis
62 y/o female, 62 kg, 174 cm, log. ES 41.6%
Generalized aortic aneurysm
History
NSCLC with left LL-resection 06/2015
COPD (FEV1 1.32 L/s, VC 2.04 L, FEV1/VC 64.47%)
No renal impairment (Crea 0.83)
Treatment strategy
First stage (04/2016):
FET (Zone 2-E-vita Open, 30 x 130 mm),
LSA-Bypass, TVR
Second stage (today):
Thoracoabdominal aortic replacement
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Patient Case 3
maximum diameter :
• at stentgraft level 66 mm
• thoracoabdominal 44 mm
• SMA level 34 mm
• bifurcation 20 mm
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3rd Aortic Live Symposium
Case 4 [ Berlin ] TF - TAVI
Surgery: J. Kempfert
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3rd Aortic Live Symposium
Case 5 [ Essen ] AVR + Aortic Root Aneurysm + CAD –
Bentall as Re-Operation + CABG
Surgery: Jakob, El Gabry, Mourad, Lubarski
Anesthesia: Dirkmann, Bokums | Perfusionist: Deus
Nurse: Limberg, Allerhut | Anesthesia Nurse: Kröner
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Patient Case 5
Diagnosis
67y/o male, 88 kg, 186 cm, log. ES 18.46%
AR II-III°
Giant Aortic root aneurysm
Residual chronic type B aortic dissection
(stable)
CAD (3VD)
Mild renal insufficiency (Crea 1.31 mg/dl)
History
Supracoronary ascending repl. for acute
type I aortic dissection (2009, elsewhere)
Surgical strategy
Bentall procedure (BioIntegral-Conduit) as
Redo + CABG
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Patient Case 5
maximum diameter:
• Root 77 x 54 mm
• Arch, TBC level 34 x 36 mm
• Desc. Ao 28 mm
TL: CT, SMA, RRA
FL: LRA, IMA
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Patient Case 5
CAG:
• short LM
• multiple sig. LAD stenosis
• CX stenosis • prox. RCA stenosis
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3rd Aortic Live Symposium
Case 6 [ Essen ] Aortic Arch Aneurysm + CAD –
FET + CABG
Surgery: Tsagakis, Dohle, Pasa
Anesthesia: Moldzio, Stöppler | Perfusionist: Schön
Nurse: Berg, Corkadi, Feislachen | Anesthesia Nurse: Koschinski
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Patient Case 6
Diagnosis
77 y/o male, 92 kg, 180 cm
PAU of aortic arch
RIVA stenosis with myocardial bridge
1VD: s/p PCI RCA 2014
Surgical strategy
Z2 FET (E-vita open) + CABG
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Patient Case 6
Diameter: Ao asc. 34 mm, LCA level 30 mm (prox. LZ), LSA level (PAU) 46x30 mm,
prox desc. 28 mm (distal LZ), SMA level 24 mm, bifurcation 19 mm
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3rd Aortic Live Symposium
Case 7 [ Essen ] Aortic Valve Stenosis –
Sutureless Valve Replacement
Surgery: Glauber, Wendt, Himpel
Anesthesia: Frey, Höch | Perfusionist: v. Manstein
Nurse: Tomas, Mannarapryil | Anesthesia Nurse: Schulze
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Patient Case 7
Diagnosis
58 y/o female, 63 kg, 165 cm
Severe AS (Pmean 63mmHg , Pmax 97mmHg,
AVA 0.85 cm², Vmax 4.95 m/s)
AR I, MR 0-I, LVEF 60%
COPD I (FEV1/VC 64%, on medical TX)
Surgical strategy
Perceval sutureless AVR
via a MIC-ART approach
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3rd Aortic Live Symposium
Case 8 [ Berlin ] TAAA Open
Surgery: R. Hammerschmidt
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3rd Aortic Live Symposium
Case 9 [ Hamburg ] TAAA Endo Branched
Surgery: N. Tsilimparis
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3rd Aortic Live Symposium
Case 10 [ Essen ] Aortic Arch Aneurysm + CAD –
FET (Thoraflex) + CABG
Surgery: Shrestha, Martens, Weißenberger
Anesthesia: Dirkmann, Beckert | Perfusionist: Wiese
Nurse: Arndt, Allerhut | Anesthesia Nurse: Jagusch, Maczek
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Patient Case 10
Diagnosis
70 y/o male, 85 kg, 172 cm, log ES 24.25%
Aortic arch aneurysm (59 mm)
CAD (2VD)
LVEF 61%, MR I, TR I
COPD II (FEV1 1.94 L/s, VC 3.65 L, FEV1/VC 53%,
on medical TX)
PVD IIb (lower leg-Type)
Surgical strategy
FET (Thoraflex) + CABG
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Patient Case 10
Diameter:
• asc ao 48 mm
• LSA level 53x55 mm
• prox desc ao 57x62 mm
• distal desc ao 30 mm
(distal LZ)
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Patient Case 10
CAG:
• LAD/RD1 bifurcation stenosis
• CX stenosis • no sign. RCA stenosis
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3rd Aortic Live Symposium
Case 11 [ Essen ] CBAD + Arch Aneurysm + CAD –
FET (E-vita Open) + CABG
Surgery: Jakob, Tsagakis, Dohle
Anesthesia: Frey, Bokums | Perfusionist: Deus
Nurse: Tomas, Berg, Halfer | Anesthesia Nurse: Godde, Schulze
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Patient Case 11
Diagnosis
56 y/o male, 92 kg, 179 cm, log. ES 7.39%
Chronic type B aortic dissection (FD 2012)
Aortic arch aneurysm (63mm)
CAD (2VD)
COPD GOLD I
Renal insufficiency (Crea 1.44 mg/dl)
Symptoms
Dyspnea, back pain
Surgical strategy
FET-E-vita open plus + CABG
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Patient Case 11
Diameter:
• asc ao 35 mm
• prox arch 56 mm
• LCA level 60 mm
• desc ao 40 mm
TL:CT, SMA, RRA
FL: LRA
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Patient Case 11
CAG:
• RCX stenosis • RCA stenosis
• RPD stenosis
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3rd Aortic Live Symposium
Case 12 [ Essen ] Aortic Aneurysm + AR (I)-II –
David-Procedure
Surgery: De Paulis, Benedik, Mourad
Anesthesia: Moldzio, Beining | Perfusionist: Lijesic
Nurse: Köster, Mannarapryil | Anesthesia Nurse: Koschinski, Maczek
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Patient Case 12
Diagnosis
69y/o male, 117 kg, 187 cm, log. ES 8.67%
Aortic root + ascending aneurysm
AR (I)-II , TR I, LVEF 59%
No COPD (FEV1/VC 78%)
No renal insufficiany (Crea 1.14 mg/dl)
No CAD
Symptoms
Incidential finding, no symtoms
Surgical strategy
David-Procedure
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Patient Case 12
maximum diameter:
• asc ao 55 mm
• ao root 49 mm
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3rd Aortic Live Symposium
Case 13 [ Hamburg ] Arch Endovascular
Surgery: N. Tsilimparis
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3rd Aortic Live Symposium
Case 14 [ Regensburg ] AAA Endovascular
Surgery: P. Kasprzak
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3rd Aortic Live Symposium
Thank You
And
Enjoy
AORTIC LIVE 2016