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“Background: The combined open surgical and endovascular approach for the treatment of aortic arch aneurysms has emerged as a safe treatment modality. This platform may have an especially important role in treating patients of old age and with a greater comorbid burden. We describe our institutional experience Idasanutlin purchase with the hybrid aortic arch
approach, with midterm outcomes.
Methods: From 2005 to the present, 685 patients have undergone thoracic endovascular repair (TEVAR); 104 had a hybrid arch repair (open plus endovascular approach). Of these, 47 patients had treatment for an aortic arch aneurysm with or without a proximal ascending aortic aneurysm. All these patients had a median sternotomy approach for arch vessel debranching and MEK162 concentration antegrade with or without retrograde TEVAR stent grafting of the arch. Results from a prospectively maintained database are reported.
Results: Twenty-eight patients had type I repair, 8 patients had type II
repair, and 11 patients had type III arch hybrid repair. Those with type III repair were excluded from the analysis. Stent graft deployment rate was 100% after arch vessel debranching. Mean age was 71 +/- 8 years. Fourteen percent of cases involved a redo sternotomy. Average cardiopulmonary bypass time was 215 +/- 64 minutes, with a crossclamp time of 70 +/- 55 minutes and a circulatory arrest time of 19 +/- 10 minutes. The paraplegia rate was 5.5% (n = 2), with a stroke rate of 8% (n = 3). In-hospital mortality was 8% (n = 3). There were no postoperative endoleaks. The mean length of stay was 17.2 +/- 14 days. The median follow-up was 30 +/- 21 months. Freedom from all-cause mortality was 71%, 60%, and 48% at 1, 3, and 5 years, respectively. The aortic reoperation rate was 2.7% (n = 1). No patient has a type 1 or 3 endoleak at latest follow-up.
Conclusions: The hybrid approach to aortic arch
aneurysm involving a zone 0 stent graft landing can be safely adopted with good midterm results in a cohort of old patients with significant comorbidity. This procedure can be performed with no type 1 or 3 endoleaks and may represent a technical advancement in the field of aortic arch surgery. (J Thorac Cardiovasc Surg 2013;145:S85-90)”
“Objectives: To examine whether the psychometric properties of the effort-reward imbalance (ERI) at AMPK activator work scales could be replicated with post-myocardial infarction (post-MI) patients and to measure the criterion validity through its association with psychological distress. Methods: A cross-sectional survey was conducted among 814 patients (739 men and 75 women) who had returned to work after their first MI and who were followed up by telephone at an average of 2.2 years after their baseline interview (1998-2000). The psychological demands scale of the Karasek Job Content Questionnaire was used to measure effort. Reward was measured with nine items from the original reward scale by Siegrist plus two proxy items.