Controversies in Aortic Dissection and Aneurysmal Disease

20 Pages·2014·0.15 MB·English

Controversies in Aortic Dissection
and Aneurysmal Disease

Robert S. Bonser (cid:129) Domenico P agano
Axel Haverich (cid:129) Jorge Mascaro
Editors
Controversies in Aortic
Dissection and
Aneurysmal Disease
Editors
Robert S. Bonser, FRCS, FRCP Axel Haverich, MD
University Hospitals Birmingham Thoracic and Cardiovascular
Queen Elizabeth Hospital Surgery Department
Birmingham Hannover Medical School
United Kingdom Hannover
Germany
Domenico Pagano, MD, FRCS
University Hospitals Birmingham Jorge Mascaro, MD, FRCSed
Queen Elizabeth Hospital University Hospitals Birmingham
Birmingham Queen Elizabeth Hospital and Centre
United Kingdom Birmingham
United Kingdom
ISBN 978-1-4471-5621-5 ISBN 978-1-4471-5622-2 (eBook)
DOI 10.1007/978-1-4471-5622-2
Springer London Heidelberg New York Dordrecht
Library of Congress Control Number: 2014948091
© Springer-Verlag London 2014
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About the Editors
P rofessor Robert S. Bonser, FRCS, FRCP (1953–2012), was a Consultant
Cardiothoracic Surgeon and Director of the Heart and Lung Transplant Unit
at the Queen Elizabeth Hospital, Birmingham, UK. Professor Bonser also
performed numerous national roles, including a term as Chairman of the
Cardiothoracic Advisory Group in Transplantation.
Professor Domenico Pagano, MD, FRCS (Eng; C-Th), FESC, is a
Consultant Cardiothoracic Surgeon and Clinical Director of the Quality and
Outcomes Research Unit at the University Hospital Birmingham, UK.
Professor Pagano is Chair of the Quality Improvement Programme at the
European Association for Cardio-Thoracic Surgery.
Professor Axel Haverich, MD, is Head of the Department of Cardiothoracic,
Transplantation and Vascular Surgery (HTTG) at Hannover Medical School.
In 1995, he was awarded the prestigious Leibniz Research Prize and, on this
basis, founded the Leibniz Laboratories for Biotechnology and Artifi cial
Organs (LEBAO) in 1996. Professor Haverich is coordinator and spokesper-
son of the REBIRTH Cluster of Excellence for research in regenerative
medicine.
J orge Mascaro, MD, FRCSed, is a Consultant Cardiothoracic Surgeon at
the Queen Elizabeth Hospital Birmingham, UK. Mr Mascaro is Director of
End Stage Cardiac and Respiratory Services and Senior Lecturer at the
University of Birmingham, UK.
v

Pref ace
In recent years there has been an increasing recognition of patients with aortic
diseases. This is becoming a growing problem not just for cardiac surgeons
but also for doctors in emergency departments, anesthetists and other health
professionals who are dealing with patients with other co-morbidities. There
has been an increasing understanding of the ethiology of aortic diseases and
this has become more relevant in conditions with a genetic substrate like
Marfan and Loeys-Dietz syndrome. The better understanding of the natural
history has assisted in improving the clinical management in the stable
patients, allowing a proactive approach that permits anticipating the potential
devastating complications of the disease. Leading researchers and clinicians
in the fi eld will illustrate the reader with the most recent views.
Despite the advances in management and understanding of the aortic
pathology, there is a large fi eld of topics that remain controversial and where
further research is required. Such is the case of patients suffering with con-
nective tissue disorders where a more aggressive approach has been adopted
and even a proposal for prophylactic operations has been suggested. The
treatment and management of type A dissection is more or less established.
However the advent of more novel techniques as valve sparing root especially
in younger patients has brought fresh discussion to the management of this
condition. There remains uncertainty or lack of clarity on how the distal false
lumen in DeBakey type I aortic dissection should be treated when this is pres-
ent. The rapid development of endovascular repair has also brought a new
vision on what to do with the thoracic aorta and type B dissections and the
reader will be able to fi nd in this book a concentration of the current
practice.
The present book is not intended to cover all the aspects of the pathology
of the aorta. Instead, it aims to give the reader an update of the state of the art
in the more common conditions and to awaken interest for research and
investigating further reading.
Birmingham, UK Robert S. Bonser, FRCS, FRCP
Birmingham, UK Domenico Pagano, MD, FRCS
Hannover, Germany Axel Haverich, MD
Birmingham, UK Jorge Mascaro, MD, FRCSed

vii

Acknowledgement
Robert Bonser was a surgeon fully dedicated to his patients who would spend
endless hours by the operating table and by patients’ bedside to give them
outstanding care. His dedication to the fi eld went beyond the patient and
extended into research and teaching. His passion was aortic surgery, to which
he dedicated his life. He conceived the idea of this book with the intention of
providing a state-of-the-art review of research and clinical practice in the
challenging area of aortic dissection. Sadly, Professor Bonser passed away
and could not see this book fi nished.
To his memory and to his family we dedicate this book.
ix