DeBAKEy CARDIOvASCuLAR JOuRNAL - Methodist Hospital

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60 50 40 30 20 10 0 Figure 41. Aortic aneurysms Figure 42. Ascending aortic aneurysms with associated procedures Figure 43. Left: Acute type II dissecting aneurysm with subsequent rupture at base of heart. Middle: Method of reconstruction. Right: Postoperative aortogram and depiction following reconstruction. 15 12 9 6 3 0 19 7 2 9.5% 1965-1975 Cases 21 1 12.5% 1965-1975 Cases 8 12 21 2 8.6% 1976-1985 Cases 23 Ascending aneurysms = 153 OP survival = 138 OP death = 15 9.8% 5 29% 1976-1985 Cases 17 Figure 44. Dissecting ascending aortic aneurysms 8 45 8 50% 1986-1995 Cases 16 Dissecting ascending aneurysms = 61 OP survival = 42 OP death = 19 31.1% 8 15% 1986-1995 Cases 53 15 53 3 5.3% 1996-2005 Cases 56 5 25% 1996-2005 Cases 20 Figure 45. Series depicting the reconstruction of a type II dissection with rupture into he right ventricle. 14 vII (1) 2011 | MDCvJ 150 120 90 60 30 0 64 15 18.9% 1965-1975 Cases 79 88 15 14.5% 1976-1985 Cases 103 127 28 18% 1986-1995 Cases 155 122 16 11.5% 1996-2005 Cases 138 Ascending aortic aneurysms with associated procedures = 475 OP survival = 401 OP death = 74 15.5%
15 12 9 6 3 0 10 1 9% 1965-1975 Cases 11 Figure 48. Thoracoabdominal aneurysms 7 2 22% 1976-1985 Cases 9 Figure 46. Patient status post CABG with acute type II dissection with rupture 35 into the right ventricle with fistula. 25 5 Resection of type II dissection and replacement of ascending aorta with Dacron graft, reimplantation of venous bypass grafts, and closure of the fistula to the right ventricle. Thoracic Aneurysms Descending thoracic aortic aneurysms accounted for a lesser number of aneurysms in this patient population, with 142 operated on in this series. Of this number, 37 patients underwent surgery for acute dissection either because of rupture or acute expansion. In those patients operated on for a non-dissecting aortic aneurysm (105), the average mortality rate over the four decades was 14.2% — ranging from 2.6% in the second decade to 31.2% in the first decade (Figure 47). For those operated on for acute dissection of the descending thoracic aorta (37), the 30-day operative mortality ranged from 9–23.5% for the first three decades (Figure 48). There were none performed in the fourth decade, partly due to the development of endovascular interventional techniques with graft 13 4 23.5% 1986-1995 Cases 17 Dissecting descending aneurysms = 37 OP survival = 30 OP death = 7 18.9% 15 0 0% 1996-2005 Cases 0 Figure 47. Thoracic aneurysms Figure 49. Type III dissecting aneurysm of the descending thoracic aorta with post operative reconstruction utilizing a Dacron graft. placement. An example of a type-three dissecting aneurysm of the descending thoracic aorta is seen in Figure 49. Thoracoabdominal Aneurysms Thoracoabdominal aneurysms present the most challenging aspects of aortic surgery. Few surgeons were inclined to make them a routine practice until E. Stanley Crawford at Baylor College of Medicine refined the technical aspects to yield a marked reduction in mortality and spinal cord paralysis. He publicized his principles in his book, Diseases of the Aorta. 1 312 There were 122 patients operated on for thoracoabdominal aneurysms in Dr. Howell’s 40-year series, with the majority performed during the last decade. The mortality and morbidity for this operation has continued to decline (Figure 50). An example of a thoracoabdominal aneurysm reconstruction is seen in Figure 51. MDCvJ | vII (1) 2011 15 40 30 20 10 0 22 10 31% 1965-1975 Cases 32 37 1 2.6% 1976-1985 Cases 38 Descending aneurysms = 105 OP survival = 90 OP death = 15 14.2% 24 2 7.6% 1986-1995 Cases 26 7 2 22% 1996-2005 Cases 9
Page 1 and 2: Volume 7, Number 1 • Jan. - Mar.
Page 3 and 4: W.L. Winters Jr., M.D. EDITOR’S N
Page 5 and 6: Every generation has its heroes. Dr
Page 7 and 8: OTHER CHEST 8.96% Figure 5. Surgica
Page 9 and 10: Baxter Edwards Beall Bjork Shiley C
Page 11 and 12: mitral valve operations. In most ca
Page 13 and 14: Figure 30. Myxoma filling the left
Page 15: Figure 37. Left: Preoperative aorto
Page 19 and 20: Lower Extremity Revascularization R
Page 21 and 22: W.S. Henly, M.D. PRIvATE PRACTICE O
Page 23 and 24: P.A. Stonebridge, Ch.M. Introductio
Page 25 and 26: As a consequence of the above work,
Page 27 and 28: References 1. Buckberg GD. Basic sc
Page 29 and 30: P.E. Sovelius Jr. Overview PLATO’
Page 31 and 32: Figure 4. Plato, in The Republic, B
Page 33 and 34: Figure 9. The Artery of Adamkiewicz
Page 35 and 36: Figure 14. Reconstructed left breas
Page 37 and 38: M.E. Bertrand, M.D. Introduction WH
Page 39 and 40: Vascular Access Complications A num
Page 41 and 42: 6. Segal AZ, Abernethy WB, Palacios
Page 43 and 44: Case Report Clinical course The pat
Page 45 and 46: Figure 6. Surgical view of dual Hea
Page 47 and 48: A.B. Lumsden, M.D. Introduction PuM
Page 49 and 50: one mile below the ocean surface fo
Page 51 and 52: N. Kleiman, M.D. M.J. Reardon Intro
Page 53 and 54: Figure 3. CoreValve (Medtronic, Inc
Page 55 and 56: H.J. Safi, M.D. IN TRIBuTE: ERNEST
Page 57 and 58: MuseuM of tMH MultiModality iMaging
Page 59 and 60: Introduction CT Coronary Angiograph
Page 61 and 62: sequences that offer superior signa
Page 63 and 64: MetHodist de Bakey Heart & VasCular
Page 65 and 66: My yEARS WITH MICHAEL E. DeBAKEy Lo
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poet’s pen WHY I AM NOT A BUDDHIS
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To the Editor: After reading Dr. Be
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6565 Fannin Street Houston, Texas 7
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DeBAKEy CARDIOvASCuLAR JOuRNAL - Methodist Hospital

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