Surgery Series: Aortic Arch (2/22/21) 24:39-27:10 So one of the questions that kind of comes around in our surge-community is "Should surgeons address the aortic arch at the time of the first operation?" or the index operation. We're going…

Surgery Series: Aortic Arch (2/22/21) 23:11-24:37 So I'd say can, for conventional type A repair when we look at the data from the STS most surgeons are really doing a supra-coronary anastomosis and then what we call a open distal, in the …

Surgery Series: Aortic Arch (2/22/21) 20:41-23:10 So with that we can really focus on some of the acute issues so obviously aortic dissection. With classifications there's the DeBakey classification and the Stanford. では、急性疾患である大…

Surgery Series: Aortic Arch (2/22/21) 19:02-20:40 So why would a person need an aortic arch surgery? This is actually a picture of one of our Marfan's patients, who had had a previous root procedure and she has a very large abnormal arch a…

Surgery Series: Aortic Arch (2/22/21) 17:37-19:01 Obviously you can't just have normal. Normal is normally a three vessel arch branching pattern. 大動脈弓が正常でない場合もあります。正常な大動脈弓とは、弓部から3本血管が出ており、それらから…

Surgery Series: Aortic Arch (2/22/21) 15:52-17:36 So of course we have to talk about history and the first arch aneurysm resection was actually in 1950 in Paris. It was a 20 year old girl, who came in they thought she had tuberculosis beca…

Surgery Series: Aortic Arch (2/22/21) 14:20-15:50 Obviously to understand why arch surgery is different we've got to understand what normal is. Here's a schematic of a heart potentially in the operating room where we have a cannula in the …

Surgery Series: Aortic Arch (2/22/21) 11:59-14:19 And obviously with connective tissue disorder patients Dr. Roselli showed slides like this so I’m gonna go over this pretty quickly. With normal aortic wall it's very organized and therefor…

Surgery Series: Aortic Arch (2/22/21) 10:45-11:57 On the left we see a picture of the entire aorta broken up into different zones. We have these zones now thank you to our STS database and that's really so that we can capture data, talk ab…

Surgery Series: Aortic Arch (2/22/21) 9:43-10:28 Just as a quick outline we'll go over a little introduction. We'll go over some anatomy, some history, we'll look at indications for surgery, we'll go over some concepts that we use in the o…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 1:03:08-1:03:57 Q:Any mortality data past 15 years? 紹介していただいた研究では、手術後15年以降の生存率はどうなっていますか？ A:Yeah, we have patients that are 20 and 25 years out. We j…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 1:01:36-1:02:48 Q:How about in terms of your lifestyle. If somebody has their entire aorta replaced and they have Marfan syndrome does that mean that they can return to "normal" she sa…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 59:15-1:01:35 Q:You mentioned careful follow-up after surgery. What does careful follow-up entail? 大動脈手術後は慎重に経過観察するというお話でしたが、具体的に教えて下さい。 A:Well, it…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 57:29-59:05 Q:So James writes that he has a 3.5 abdominal aneurysm that has grown to this size in the past eight, nine years. Any advice on how to keep the growth under control and he …

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 56:28-57:25 Q:For patients with both, both a compromised aortic root and an abdominal aneurysm is it possible to do the root replacement at the same time as the abdominal aortic repair…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 54:00-56:27 Q:How do you determine how much of the, of the thoracoabdominal aorta to replace? If, if it is all aneurysmal but not all, not all at the surgical threshold you replace at …

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 51:51-53:58 Q:Does the relative size of the true and false lumen have any impact on surgical thresholds and surgical outcomes? 大動脈での真腔と偽腔の大きさの比率は、手術を検討する基準…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 51:51-53:58 Q:Does the relative size of the true and false lumen have any impact on surgical thresholds and surgical outcomes? 大動脈での真腔と偽腔の大きさの比率は、手術を検討する基準…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 50:10-51:40 Q:What's your experience, somebody's asking about PTSD, grief, depression after this surgery. Now that's less than the mechanical part that you're doing but that's definite…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 48:36-50:10 Q:After the surgery what's the recovery like? How long does the pain last? 手術後の回復までの経過と術後の痛みが続く期間について教えて下さい。 A:It's, it's very different fr…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 47:38-48:31 Q:You talked a lot about the size of the aneurysm and how you're watching it and what the size would be and you mentioned something about symptoms. What would symptoms be i…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 47:17-47:35 Q:First of all that's a huge rep, that's a huge surgery. How long does that take the entire abdominal repair? 非常に大掛かりな手術ですが、胸腹部大動脈の修復完了までどのくら…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 47:17-47:35 Q:First of all that's a huge rep, that's a huge surgery. How long does that take the entire abdominal repair? 非常に大掛かりな手術ですが、胸腹部大動脈の修復完了までどのくら…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 44:55-46:50 Patients with Marfan syndrome may need extensive repair but the repair can be done at very low operative risk. Repair should use adjuncts to lessen the risk of paraplegia a…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 41:44-44:54 I'm going to end by just mentioning endovascular stent grafting with regards to the aorta because we hear so much about it these days. 最後に、大動脈に内挿するステントグラ…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 36:41-41:13 This is from a paper we wrote a few years ago, looking at 127 patients with thoracoabdominal aortic aneurysm repair, looking at just patients with Marfan syndrome, just pat…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 35:44-36:40 On occasion the descending thoracic aorta is symptomatic and large and has to be replaced first but we know we're going to have to go back and do the ascending aorta so we …

32:56-35:43 Patients with Marfan syndrome can have ascending, arch, and thoracoabdominal repair and require multiple procedures to have this done and more often than not it's done as a staged operation. Marfan症候群の患者さんの場合、上行大…

Open Thoracoabdominal Repair: Surgery Series (2/16/21) 30:46-32:57 So now we've moved the cross clamp down onto the graft, restoring flow into these intercostal arteries, which is perfusing the spinal cord and then we do the distal anastom…

dOpen Thoracoabdominal Repair: Surgery Series (2/16/21) 27:16-30:45 Once we isolate the aorta approximately between clamps we essentially create a single lumen by removing that wall between the true and the false lumen that we talked about…