Surgery Series: Aortic Arch (2/22/21) 1:00:24-1:01:28 Q:And so and just going back to that brain perfusion right near the end of your talk. You said that mortality was lower if that was done but you didn't give any numbers. People are aski…

Surgery Series: Aortic Arch (2/22/21) 58:03-1:00:23 Q:How long does that surgery take the aortic arch surgery or does it matter which one of, the ones that you showed us. It looks like it looks complicated. 大動脈弓部の手術にはどのくらいの…

Surgery Series: Aortic Arch (2/22/21) 56:17-58:02 Q:So, you know, you talked a lot about the need for aortic arch surgery after somebody presented with dissection. Unless so if it was prophylactic surgery but what are the indications for t…

Surgery Series: Aortic Arch (2/22/21) 50:50-52:34 And with that the left recurrent laryngeal nerve, which hopefully you guys can see this pointer, but off the vaso, vegus the left recurrent laryngeal nerve wraps around the arch and it usua…

Surgery Series: Aortic Arch (2/22/21) 49:05-50:49 Obviously in the post-op setting there's a variety of things that we're looking for. 術後に確認すべき項目は様々です。 We obviously need a monitor for bleeding when we get up to the ICU. We …

Surgery Series: Aortic Arch (2/22/21) 47:25-49:04 As in medicine there's, if there's something good there's always some bad to it so the colder you go the bigger problems you have with bleeding because the proteins that form coagulation or…

Surgery Series: Aortic Arch (2/22/21) 46:41-47:23 So cerebral monitoring is crucial to achieve our task and that is there's a variety. 大動脈弓部の手術において、脳のモニタリングは極めて重要であり、様々な検査法を用いて行われます。 There's B…

Surgery Series: Aortic Arch (2/22/21) 45:31-46:40 One of the ways we can do that, as we showed, is the right axillary perfusion so this is where we're instilling flow usually through a graft from the heart-lung machine. 先ほど順行性脳灌流…

Surgery Series: Aortic Arch (2/22/21) 43:38-45:29 But hypothermia is not the end-all and be-all. You need adjuncts and adjunct is perfusion to the brain and this is a concept that we've has been around and this is kind of like religion in …

Surgery Series: Aortic Arch (2/22/21) 41:09-43:36 So back to the original question, "Why is arch surgery different?" Well, we're balancing perfusion to the heart as well as blood flow to the brain and then blood flow to the rest of the bod…

Surgery Series: Aortic Arch (2/22/21) 39:13-41:07 Here's a picture and some video of a 19-year-old Marfan's patient, who came in a while ago. He had a root aneurysm that hadn't been operated and you can see his initial presentation was a t…

Surgery Series: Aortic Arch (2/22/21) 37:36-39:12 The sun procedure so this is, you know, one thing that's talked about in the aortic community and I gotta say it's a common procedure that a lot of us do for aortic dissections. How that's …

Surgery Series: Aortic Arch (2/22/21) 35:44-37:35 The elephant trunk procedure, this is, this is important for our connective tissue disorder patients, especially Marfan’s and Loeys-Dietzs where they, they have risk for intervention on the…

Surgery Series: Aortic Arch (2/22/21) 33:27-35:42 So with that let's talk a little bit about aortic arch surgery specifically. So there's several different types of arch procedures. I just wanted to make it simpler for everyone so that you…

Surgery Series: Aortic Arch (2/22/21) 30:12-33:26 In May of this year Dr. Cameron and his colleagues presented a very interesting study and this compared the Loeys-Dietz patients with Marfan's patients. This is a busy slide but we're going…

Surgery Series: Aortic Arch (2/22/21) 27:11-30:11 The second study, this was with Dr. Bechet and his colleagues in France. So the purpose was to assess the prevalence, indications, and results of aortic arch replacement in Marfan's patient…

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) 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) 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) 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) 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…