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J Thorac Cardiovasc Surg 2007;133:1481-1482
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Discussion

Dr J. Coselli (Houston, Tex). Dr Roselli, congratulations on an outstanding presentation. You and your colleagues have boldly built upon a successful track record for the endovascular treatment of abdominal aortic aneurysms and a growing experience with the endovascular exclusion of juxtarenal and descending thoracic aneurysms with this innovative approach, allowing now for treatment of those aneurysms traversing the visceral aortic segment. This is indeed a significant contribution to demonstrate the feasibility of this alternative approach to the open operation from which no doubt many patients have benefited. It is notable that you have been able to demonstrate that the endovascular procedure can be carried out in many cases under regional anesthesia.

A few questions. It is a shame that this study could not have been carried out alongside controls, particularly in view of the fact that the data provided regarding the Gore TAG graft is such that at 2 years, there was no demonstrated difference in the survival rates. Additionally, I would like for you to comment on your postoperative anticoagulation regimen for these patients, and if you could, explain to us why you would not recommend the use of cerebrospinal fluid drainage in all of your patients? Because 2 of your spinal cord problems postoperatively were delayed, would you recommend the insertion of a cerebrospinal fluid catheter in such cases? And then, regarding this particular innovative technology, would you comment, based upon your experience, on the requirements for the training and qualifications for the implementation of such therapy?

Again, congratulations.

Dr Eric E. Roselli . . . [Full Text of this Article]

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Endovascular treatment of thoracoabdominal aortic aneurysms

Eric E. Roselli, Roy K. Greenberg, Kathryn Pfaff, Catherine Francis, Lars G. Svensson, and Bruce W. Lytle
J. Thorac. Cardiovasc. Surg. 2007 133: 1474-1482. [Abstract] [Full Text] [PDF]