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Spaziani G, Surace FC, Girolami F, Bianco F, Bucciarelli V, Bonanni F, Bennati E, Arcieri L, Favilli S. Hereditary Thoracic Aortic Diseases. Diagnostics (Basel) 2024; 14:112. [PMID: 38201421 PMCID: PMC10795846 DOI: 10.3390/diagnostics14010112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
Advances in both imaging techniques and genetics have led to the recognition of a wide variety of aortic anomalies that can be grouped under the term 'hereditary thoracic aortic diseases'. The present review aims to summarize this very heterogeneous population's clinical, genetic, and imaging characteristics and to discuss the implications of the diagnosis for clinical counselling (on sports activity or pregnancy), medical therapies and surgical management.
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Affiliation(s)
- Gaia Spaziani
- Pediatric and Transition Cardiology, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (F.G.); (E.B.); (S.F.)
| | - Francesca Chiara Surace
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy; (F.C.S.); (F.B.); (V.B.); (L.A.)
| | - Francesca Girolami
- Pediatric and Transition Cardiology, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (F.G.); (E.B.); (S.F.)
| | - Francesco Bianco
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy; (F.C.S.); (F.B.); (V.B.); (L.A.)
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy; (F.C.S.); (F.B.); (V.B.); (L.A.)
| | - Francesca Bonanni
- Department of Experimental and Clinical Medicine, School of Cardiology, Faculty of Medicine, University of Study of Florence, 50121 Florence, Italy;
| | - Elena Bennati
- Pediatric and Transition Cardiology, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (F.G.); (E.B.); (S.F.)
| | - Luigi Arcieri
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy; (F.C.S.); (F.B.); (V.B.); (L.A.)
| | - Silvia Favilli
- Pediatric and Transition Cardiology, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (F.G.); (E.B.); (S.F.)
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ, Faxon DP, Upchurch GR, Aday AW, Azizzadeh A, Boisen M, Hawkins B, Kramer CM, Luc JGY, MacGillivray TE, Malaisrie SC, Osteen K, Patel HJ, Patel PJ, Popescu WM, Rodriguez E, Sorber R, Tsao PS, Santos Volgman A, Beckman JA, Otto CM, O'Gara PT, Armbruster A, Birtcher KK, de Las Fuentes L, Deswal A, Dixon DL, Gorenek B, Haynes N, Hernandez AF, Joglar JA, Jones WS, Mark D, Mukherjee D, Palaniappan L, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Woo YJ. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2023; 166:e182-e331. [PMID: 37389507 PMCID: PMC10784847 DOI: 10.1016/j.jtcvs.2023.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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3
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Mikulski MF, Well A, Mery CM, Johnson G, Gottlieb EA, Fraser CD, Beckerman Z. Outcomes of thoracic aortic interventions in Marfan syndrome in the state of Texas over 11 years. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad128. [PMID: 37584655 PMCID: PMC10438956 DOI: 10.1093/icvts/ivad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/01/2023] [Accepted: 08/14/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVES Marfan syndrome is a heritable connective tissue disorder with significant aortopathy and conveys substantial cardiovascular morbidity. This study characterizes the mortality and morbidities of thoracic aortic interventions (TAI) in the Marfan syndrome population in the state of Texas from 2009 to 2019. METHODS A retrospective review of the Texas Inpatient Discharge Dataset from 1 January 2009 to 31 December 2019. Discharges from acute care hospitals with a Marfan syndrome diagnosis by the International Classification of Diseases 9/10 codes and a procedure code for TAI were analysed utilizing descriptive, univariate and multivariable regression statistics. RESULTS There were 4641 Marfan syndrome discharges identified, of whom 644 (13.9%) underwent TAI. Thoracic or thoraco-abdominal aortic dissection or rupture was noted in 223 (34.6%). Thirty-three (5.1%) had a concomitant coronary artery intervention. There were 30 (4.7%) in-hospital mortalities, 126 (19.6%) diagnoses of acute renal failure (ARF), 52 (8.1%) had mechanical ventilation >96 h and the median length of stay was 10 [interquartile range (IQR) 7-16] days. After adjustment, concomitant coronary artery intervention was associated with in-hospital mortality [odds ratio (OR) 3.69 [IQR 1.15-11.90], P = 0.029] and ARF (OR 2.66 [IQR 1.19-5.94], P = 0.017). Aortic dissections/ruptures were associated with ARF (OR 1.73 [IQR 1.14-2.63], P = 0.010), ventilation >96 h (OR 2.19 [IQR 1.21-3.97], P = 0.010), and 15% longer length of stay (95% confidence interval 2.4-29.1%, P = 0.038). CONCLUSIONS TAI are frequent among the hospitalized Marfan Syndrome population. Concomitant coronary intervention is associated with increased risk of death and aortic dissections/ruptures are associated with increased morbidity. The high prevalence of aortic dissections/ruptures points to a potential target for improving imaging surveillance, adherence to treatment guidelines and preventative management of Marfan syndrome aortopathy.
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Affiliation(s)
- Matthew F Mikulski
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Andrew Well
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Carlos M Mery
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Gregory Johnson
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Erin A Gottlieb
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Charles D Fraser
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Ziv Beckerman
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
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Azogui R, Porto A, Castelli M, Omnes V, De Masi M, Bartoli M, Piquet P, Gariboldi V, Busa T, Jacquier A, Bal L, Gaudry M. In Marfan Syndrome and Related Diseases, STABILISE Technique Should Be Used with Care: Results from a Volumetric Comparative Study of Endovascular Treatment for Aortic Dissection. J Clin Med 2023; 12:4378. [PMID: 37445413 DOI: 10.3390/jcm12134378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives: Aortic dissection in patients with Marfan and related syndromes (HTAD) is a serious pathology whose treatment by thoracic endovascular repair (TEVAR) is still under debate. The aim of this study was to assess the results of the TEVAR for aortic dissection in patients with HTAD as compared to a young population without HTAD. Methods: The study received the proper ethical oversight. We performed an observational exposed (confirmed HTAD) vs. non-exposed (<65 years old) study of TEVAR-treated patients. The preoperative, 1 year, and last available CT scans were analyzed. The thoracic and abdominal aortic diameters, aortic length, and volumes were measured. The entry tears and false lumen (FL) status were assessed. The demographic, clinical, and anatomic data were collected during the follow-up. Results: Between 2011 and 2021, 17 patients were included in the HTAD group and 22 in the non-HTAD group. At 1 year, the whole aortic volume increased by +21.2% in the HTAD group and by +0.2% the non-HTAD groups, p = 0.005. An increase in the whole aortic volume > 10% was observed in ten cases (58.8%) in the HTAD group and in five cases (22.7%) in the non-HTAD group (p = 0.022). FL thrombosis was achieved in nine cases (52.9%) in the HTAD group vs. twenty (90.9%) cases in the non-HTAD group (p < 0.01). The risk factors for unfavorable anatomical evolution were male gender and the STABILISE technique. With a linear model, we observed a significantly different aortic volume evolution between the two groups (p < 0.01) with the STABILISE technique; this statistical difference was not found in the TEVAR subgroup. In the HTAD patients, there was a significant difference in the total aortic volume evolution progression between the patients treated with the STABILISE technique and the patients treated with TEVAR (+160.1 ± 52.3% vs. +47 ± 22.5%, p < 0.01 and +189.5 ± 92.5% vs. +58.6 ± 34.8%, p < 0.01 at 1 year and at the end of follow-up, respectively). Conclusions: TEVAR in the HTAD patients seemed to be associated with poorer anatomical outcomes at 1 year. This result was strongly related to the STABILISE technique which should be considered with care in these specific patients.
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Affiliation(s)
- Ron Azogui
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Alizee Porto
- Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Maxime Castelli
- Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France
| | - Virgile Omnes
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Mariangela De Masi
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Michel Bartoli
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Philippe Piquet
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Tiffany Busa
- Department of Genetic, APHM, Timone Hospital, 13005 Marseille, France
| | - Alexis Jacquier
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
- Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France
| | - Laurence Bal
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
- Timone Aortic Center, APHM, Centre de Référence Marfan et Apparentés, 13005 Marseille, France
| | - Marine Gaudry
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
- Timone Aortic Center, APHM, Centre de Référence Marfan et Apparentés, 13005 Marseille, France
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Stern JR, Pham XBD, Lee JT. Reverse Cheese-Wire Septotomy to Create a Distal Landing Zone for Thoracic Endovascular Aortic Repair. J Endovasc Ther 2023; 30:38-44. [PMID: 35018867 DOI: 10.1177/15266028211070966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study is to describe a novel method for creating a distal landing zone for thoracic endovascular aortic repair (TEVAR) in chronic aortic dissection. The technique is described in a patient with prior total arch and descending aortic replacement, with false lumen expansion. TECHNIQUE A cheese-wire endovascular septotomy was desired to create a single lumen above the celiac axis. To avoid dividing the septum caudally across the visceral segment, we performed a modified septotomy in a cephalad direction. Stiff wires were passed into the prior surgical graft, through true lumen on the right and false lumen on the left. An additional wire was passed across an existing fenestration at the level of the celiac axis, and snared and externalized. 7F Ansel sheaths were advanced and positioned tip-to-tip at the fenestration. Using the stiff wires as tracks, the through-wire was pushed cephalad to endovascularly cut the septum. Angiogram demonstrated successful septotomy, and TEVAR was performed to just above the celiac with successful aneurysm exclusion and no endoleak or retrograde false lumen perfusion. Follow-up computed tomography angiogram (CTA) showed continued exclusion without false lumen perfusion. CONCLUSIONS This novel modification in a reverse direction provides an alternative method for endovascular septotomy, when traditional septotomy may threaten the visceral vessels.
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Affiliation(s)
- Jordan R Stern
- Division of Vascular & Endovascular Surgery, Stanford University, Stanford, CA, USA
| | - Xuan-Binh D Pham
- Division of Vascular & Endovascular Surgery, Stanford University, Stanford, CA, USA.,Division of Vascular Surgery, Swedish Hospital, Seattle, WA, USA
| | - Jason T Lee
- Division of Vascular & Endovascular Surgery, Stanford University, Stanford, CA, USA
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2022; 146:e334-e482. [PMID: 36322642 PMCID: PMC9876736 DOI: 10.1161/cir.0000000000001106] [Citation(s) in RCA: 346] [Impact Index Per Article: 173.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Bruce E Bray
- AHA/ACC Joint Committee on Clinical Data Standards liaison
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Y Joseph Woo
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
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7
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Isselbacher EM, Preventza O, Hamilton Black Iii J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80:e223-e393. [PMID: 36334952 PMCID: PMC9860464 DOI: 10.1016/j.jacc.2022.08.004] [Citation(s) in RCA: 114] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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8
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Jonsson M, Blohmé L, Daryapeyma A, Günther A, Lundberg G, Nilsson L, Wahlgren CM, Franco-Cereceda A, Olsson C. Outcomes of descending and thoracoabdominal aortic repair in connective tissue disorder patients. SCAND CARDIOVASC J 2022; 56:352-359. [PMID: 36151718 DOI: 10.1080/14017431.2022.2125174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/17/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Open surgical repair (OSR) of descending and thoracoabdominal aortic aneurysms carries risks of mortality and major complications. Patients with connective tissue disorders (CTD) are younger and require safe, efficient treatment with long-term durability. This study provides current outcome data to help inform treatment decisions. METHODS All OSRs of descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm (TAAA) from January 2011 to July 2021 were included in a retrospective cohort study. Primary outcome measures were early and follow-up mortality and reintervention. Secondary outcome measures were major complications. Kaplan-Meier methods were used to estimate reintervention-free survival. RESULTS A total of 26 OSRs (7 DTAA, 19 TAAA) were performed in 23 patients: 20 (77%) Marfan and 6 (23%) Loeys-Dietz syndrome; median age 43 years. Aortic dissection was present in 100% and 3/26 (12%) were urgent. Early mortality was 1/26 (3.8%). No patient suffered spinal cord ischemia, stroke, vocal cord paralysis, or re-exploration for bleeding. The transient respiratory failure occurred in 19% (5/26) and transient renal replacement therapy in 15% (4/26). Renal function normalized in all patients within 3 months. During follow-up (median 4.6, range 0-11 years) there were no deaths and only one re-intervention on a previously operated aortic segment, resulting in 92% reintervention-free survival at 5 years. CONCLUSIONS In dedicated units, open surgical DTAA and TAAA repair in patients with CTD can be performed with a very low risk of death, severe complications and, late re-intervention. For CTD patients with reasonable risk, OSR should remain the first line of treatment.
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Affiliation(s)
- Magnus Jonsson
- Department of Vascular Surgery, Karolinska University Hospital,, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Linus Blohmé
- Department of Vascular Surgery, Karolinska University Hospital,, Stockholm, Sweden
| | - Alireza Daryapeyma
- Department of Vascular Surgery, Karolinska University Hospital,, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Günther
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Anesthesia, Karolinska University Hospital, Stockholm, Sweden
| | - Göran Lundberg
- Department of Vascular Surgery, Karolinska University Hospital,, Stockholm, Sweden
| | - Lena Nilsson
- Department of Cardiothoracic Anesthesia, Karolinska University Hospital, Stockholm, Sweden
| | - Carl-Magnus Wahlgren
- Department of Vascular Surgery, Karolinska University Hospital,, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Sweden
| | - Christian Olsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Sweden
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9
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Mandigers TJ, Trimarchi S, Piffaretti G. Different connective tissue disorders lead to similar outcomes of aortic disease: Are we missing something? J Card Surg 2022; 37:5445-5446. [PMID: 35979693 DOI: 10.1111/jocs.16856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Tim J Mandigers
- Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Santi Trimarchi
- Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, Università degli Studi di Milano, Milan, Italy
| | - Gabriele Piffaretti
- Vascular Surgery - Department of Medicine and Surgery, University of Insubria, Varese, Italy
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10
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Widenka KJ, Kosiorowska M, Jakob H, Pacini D, Hemmer W, Grabenwoeger M, Sioris T, Moritz A, Tsagakis K. Early and midterm results of frozen elephant trunk operation with Evita open stent-graft in patients with Marfan syndrome: results of a multicentre study. BMC Cardiovasc Disord 2022; 22:333. [PMID: 35883019 PMCID: PMC9317434 DOI: 10.1186/s12872-022-02777-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background Endovascular treatment of patients with Marfan syndrome (MFS) is not recommended. Hybrid procedures such as frozen elephant trunk (FET), which combines stent-graft deployment with an integrated non-stented fabric graft for proximal grafting and suturing, have not been previously evaluated. The aim of this study was to assess the safety and feasibility of FET operation in patients with MFS. Methods Patients enrolled in the International E-vita Open Registry (IEOR) who underwent FET procedure between January 2001 and February 2020 meeting Ghent criteria for MFS were included in the study. Early and midterm results were retrospectively analyzed. Preoperative, postoperative and follow-up computed tomography angiography scans were analysed. Results We analyzed 37 patients [mean age 38 ± 11 years, 65% men]. Acute or chronic aortic dissection was present in 35 (95%) patients (14 and 21 patients respectively). Two (5%) patients had an aneurysm without dissection. Malperfusion syndrome was present in 4 patients. Twenty-nine (78%) patients had history of aortic surgical interventions. The 30-day and in-hospital mortality amounted to 8 and 14% respectively. False lumen exclusion was present in 73% in stented segment in last postoperative CT. The overall 5-year survival was 71% and freedom from reintervention downstream was 58% at 5 years. Of the nine patients who required reintervention for distal aortic disease, one patient died. Conclusions FET operation for patients with MFS can be performed with acceptable mortality and morbidity. In long-term follow-up no reinterventions on the aortic arch were required. FET allows for easier second stage operations providing platform for surgical and endovascular reinterventions.
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Affiliation(s)
- Kazimierz Jan Widenka
- Department of Cardiac Surgery, University of Rzeszow Poland, 60 Lwowska Street 60, 35-301, Rzeszow, Poland.
| | - Monika Kosiorowska
- Department of Cardiac Surgery, University of Rzeszow Poland, 60 Lwowska Street 60, 35-301, Rzeszow, Poland
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, Essen, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Wolfgang Hemmer
- Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart GmbH, Stuttgart, Germany
| | | | - Thanos Sioris
- Tampere University Hospital Heart Center, Tampere, Finland
| | - Anton Moritz
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, Essen, Germany
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MacGillivray TE, Gleason TG, Patel HJ, Aldea GS, Bavaria JE, Beaver TM, Chen EP, Czerny M, Estrera AL, Firestone S, Fischbein MP, Hughes GC, Hui DS, Kissoon K, Lawton JS, Pacini D, Reece TB, Roselli EE, Stulak J. The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection. J Thorac Cardiovasc Surg 2022; 163:1231-1249. [PMID: 35090765 DOI: 10.1016/j.jtcvs.2021.11.091] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 01/16/2023]
Affiliation(s)
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Tex
| | | | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Md
| | - Davide Pacini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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12
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MacGillivray TE, Gleason TG, Patel HJ, Aldea GS, Bavaria JE, Beaver TM, Chen EP, Czerny M, Estrera AL, Firestone S, Fischbein MP, Hughes GC, Hui DS, Kissoon K, Lawton JS, Pacini D, Reece TB, Roselli EE, Stulak J. The Society of Thoracic Surgeons/American Association for Thoracic Surgery Clinical Practice Guidelines on the Management of Type B Aortic Dissection. Ann Thorac Surg 2022; 113:1073-1092. [PMID: 35090687 DOI: 10.1016/j.athoracsur.2021.11.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | | | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Davide Pacini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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13
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Le Huu A, Olive JK, Cekmecelioglu D, Chatterjee S, Amarasekara HS, Green SY, Coselli JS, Preventza O. Endovascular therapy for patients with heritable thoracic aortic disease. Ann Cardiothorac Surg 2022; 11:31-36. [PMID: 35211383 PMCID: PMC8807421 DOI: 10.21037/acs-2021-taes-109] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/04/2021] [Indexed: 02/13/2024]
Abstract
BACKGROUND Patients with genetic or heritable aortic conditions and thoracic aortic aneurysm syndrome often develop cardiovascular abnormalities originating at the aortic root and affecting the entire thoracoabdominal aorta. Although thoracic endovascular aortic repair (TEVAR) is usually avoided in these patients, TEVAR may be worthwhile for those at high risk for surgical complications and in certain emergency circumstances. We explored indications for TEVAR in patients with suspected or confirmed genetic or heritable aortic conditions and investigated early and mid-term outcomes. METHODS Our institutional aortic surgery database was queried for patients with suspected or confirmed Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome, Turner syndrome, neurofibromatosis, or familial aortic aneurysm and dissection who underwent TEVAR between February 1, 2002 and October 31, 2020. We extracted operative details and in-hospital, follow-up, and survival data. RESULTS Thirty-seven patients who underwent 40 endovascular interventions met the inclusion criteria; 25 previously underwent ascending aorta or aortic root surgery, and 21 previously underwent open thoracoabdominal surgery. Postoperative complications included respiratory failure (24.3%), cardiac complications (16.2%), renal failure (13.5%), tracheostomy (8.1%), and spinal cord ischemia (paraplegia/paraparesis) (8.1%). Follow-up ranged from 1.3 to 8.5 years (median: 3.6 years), with 15 deaths overall (three early/in-hospital). Thirteen patients (35.1%) had 22 repeat interventions (open and endovascular) post-TEVAR; five had the endograft removed. CONCLUSIONS Despite consensus that thoracic aneurysms in patients with genetic or heritable aortic conditions should be treated with conventional open surgery, the outcomes from our study suggest that TEVAR might be suitable in emergency settings or for patients in this population who are not candidates for open surgery, who are at high risk for reintervention, or who have a previously implanted Dacron graft. Nonetheless, lifelong surveillance is important for these patients after TEVAR to monitor for new dissection at distal or proximal landing zones, as repeat interventions are frequent.
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Affiliation(s)
- Alice Le Huu
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jacqueline K. Olive
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Davut Cekmecelioglu
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
| | - Subhasis Chatterjee
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
| | - Hiruni S. Amarasekara
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Susan Y. Green
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Joseph S. Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
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14
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Kölbel T, Eleshra A, Aldag M, Rohlffs F, Debus SE, Honig S, Detter C, von Kodolitsch Y, Tsilimparis N, Panuccio G. Endovascular Treatment of Aortic Pathologies in Patients With Marfan Syndrome: Single-Center Experience. J Endovasc Ther 2021; 29:602-610. [PMID: 34969304 DOI: 10.1177/15266028211067733] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To study the outcome of endovascular treatment of aortic pathologies in patients with Marfan syndrome (MFS) at a single institution. METHODS Consecutive MFS patients who underwent endovascular repair or hybrid procedures for aortic pathologies from January 2010 to May 2020 were identified. Several endovascular and hybrid strategies have been used. Technical success, short- and mid-term survival, complications, and re-interventions were retrospectively analyzed. RESULTS During the study period, 24 patients with MFS (median age, 48 [13-78] years; 58% males) were treated. Indications for intervention were chronic aortic dissection with aneurysm degeneration in 16 patients (67%), acute type B aortic dissection in 4 patients (17%), aortic aneurysm without any dissection in 3 patients (13%), and aortic intramural hematoma in 1 patient (4%). Most patients were asymptomatic (83%), three (13%) were symptomatic and one (4%) had a contained rupture. The median aneurysm diameter was 56 (35-86) mm. Hybrid procedures were performed in 7 (29%) patients. Thoracic endovascular repair was performed in 12 (50%) patients, a fenestrated or branched endovascular aortic repair in 4 (17%) patients, and placement of an iliac artery stent-graft in 1 (4%) patient. Procedures were staged in 12 (50%) patients. Technical success was achieved in all patients. The median intensive care unit stay was 6 (range, 1-30) days, and the median hospital stay was 23 (range, 3-112) days. Early mortality was reported in 1 (4%) patient. Wound infection was seen in 7 (29%) patients and gastrointestinal complications in 3 (13%) patients. The median follow-up was 42 (range, 1-127) months. The cumulative survival rate was 87% at 24 months. The cumulative freedom from re-intervention was 77% at 12 months. CONCLUSIONS Endovascular treatment of aortic pathologies in patients with MFS appears feasible with acceptable early and mid-term outcomes in terms of mortality and re-intervention rates. Endovascular therapy plays an increasing role in MFS patients with aortic pathology.
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Affiliation(s)
- Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Ahmed Eleshra
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Mustafa Aldag
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Sebastian E Debus
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Susanne Honig
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Christian Detter
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Giuseppe Panuccio
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart & Vascular Center Hamburg, Hamburg, Germany
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15
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Delaney CL, Milner R, Loa J. The Impact of Degenerative Connective Tissue Disorders on Outcomes Following Endovascular Aortic Intervention in the Global Registry for Endovascular Aortic Treatment. Ann Vasc Surg 2021; 79:81-90. [PMID: 34644638 DOI: 10.1016/j.avsg.2021.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Endovascular therapy for the management of aortic pathology in patients with degenerative connective tissue disorder (DCTD) is controversial. Current guidelines are based on a paucity of literature and registry data are lacking. This study reports on medium term outcomes of patients with diagnosed DCTD compared to those without DCTD who were included in the W.L. Gore Global Registry for Endovascular Aortic Treatment (GREAT). METHODS Patients included in the GREAT registry who underwent treatment for any thoracic or abdominal aortic pathology were included and grouped according to the presence or absence of a DCTD. Baseline demographic and procedural data were collected as well as data relating to key outcomes within 5 years follow-up, including all-cause mortality, aortic-related mortality, reinterventions and serious adverse events (SAE). Multivariable Cox proportional hazards models were built to determine if any association existed between the presence of DCTD and any key outcomes. RESULTS The analysis included 92 (1.9%) with DCTD and 4741 (98.1%) without DCTD. Patients with DCTD were more likely to be female (34.8% vs. 18.5%, P < .0001) and younger (66.8 [15.1] vs. 71.7 [10.3] years, P = .013) than those without DCTD. They were also more likely to have had prior aortic intervention (22.8% vs. 13.9%, P = .015) and an associated branch vessel procedure with the index operation (30.3% vs. 18.6%, P = .005). The majority of reinterventions in both groups occurred within the first 2 years and multivariable models demonstrated that the presence of DCTD was not predictive of all-cause mortality, aortic-related mortality, reinterventions or SAE within 5 years. CONCLUSIONS Within the limitations of registry data, this work demonstrates the medium term safety and durability of endovascular stent-grafts across a spectrum of aortic pathology in some patients with DCTD. More work is required to determine the applicability of these findings to specific sub-types of DCTD and aortic pathology.
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Affiliation(s)
- Christopher L Delaney
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia.
| | - Ross Milner
- Division of Vascular Surgery and Endovascular Therapy, University of Chicago Pritzker School of Medicine, Chicago
| | - Jack Loa
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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16
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Brahmandam A, Vallabhajosyula P. Novel fibrillin-1 mutation with variable presentation as a thoracic aortic aneurysm and intramural hematoma. JTCVS Tech 2020; 6:39-41. [PMID: 34318135 PMCID: PMC8300566 DOI: 10.1016/j.xjtc.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Anand Brahmandam
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
- Address for reprints: Anand Brahmandam, MBBS, Division of Vascular Surgery, Yale University School of Medicine, 330 Cedar St BB204, New Haven, CT 06510.
| | - Prashanth Vallabhajosyula
- Division of Cardiothoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
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17
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Chung JCY, Ouzounian M, Chu MWA, El-Hamamsy I. The Evolving Role of Hybrid Arch Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:506-512. [PMID: 33108237 DOI: 10.1177/1556984520967007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jennifer C-Y Chung
- 7938 Division of Cardiovascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, ON, Canada
| | - Maral Ouzounian
- 7938 Division of Cardiovascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, ON, Canada
| | - Michael W A Chu
- 70384 Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada
| | - Ismail El-Hamamsy
- 526004 Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, NY, USA
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18
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Soler RJ, Bartoli MA, Bourenne J, Riberi A, Lagier D, Amabile P, Sarlon-Bartoli G, Magnan PE. STABILISE Technique for a Non-A Non-B Acute Aortic Dissection in Marfan Syndrome. Ann Vasc Surg 2020; 70:569.e5-569.e10. [PMID: 32920025 DOI: 10.1016/j.avsg.2020.08.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/21/2020] [Accepted: 08/18/2020] [Indexed: 01/16/2023]
Abstract
A 35-year-old man, with a deep pectus excavatum due to a Marfan syndrome treated 9 years before for an acute type A dissection involving only the aortic arch, by a Bentall surgery, was admitted for acute chest pain. Computed tomography (CT) scan showed an acute type non-A non-B dissection extending to the iliac. After 5 days with strict arterial blood pressure management, the patient had recurrent refractory chest pain and a hybrid technique associating full supra-aortic vessels debranching and STABILISE technique during the same procedure was performed. The patient had an uneventful recovery with CT scan showing complete aortic arch aneurysm exclusion.
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Affiliation(s)
- Raphael J Soler
- Aix-Marseille Université, APHM, Hôpital de la Timone, Service de Chirurgie Vasculaire, Marseille, France
| | - Michel A Bartoli
- Aix-Marseille Université, APHM, Hôpital de la Timone, Service de Chirurgie Vasculaire, Marseille, France.
| | - Jeremy Bourenne
- Aix-Marseille Université, APHM, Hôpital de la Timone, Service de Réanimation, Marseille, France
| | - Alberto Riberi
- Aix-Marseille Université, APHM, Hôpital de la Timone, Service de Chirurgie Cardiaque, Marseille, France
| | - David Lagier
- Aix-Marseille Université, APHM, Hôpital de la Timone, Service de Réanimation, Marseille, France
| | - Philippe Amabile
- Aix-Marseille Université, APHM, Hôpital de la Timone, Service de Chirurgie Vasculaire, Marseille, France
| | - Gabrielle Sarlon-Bartoli
- Aix-Marseille Université, APHM, Hôpital de la Timone, Service de Chirurgie Vasculaire, Marseille, France
| | - Pierre-Edouard Magnan
- Aix-Marseille Université, APHM, Hôpital de la Timone, Service de Chirurgie Vasculaire, Marseille, France
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19
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Cook JR, Desmarais TJ, Jim J. Multi-stage open surgical and endovascular treatment of progressive aortic degeneration in a patient with Marfan syndrome. Vascular 2020; 29:196-201. [PMID: 32883184 DOI: 10.1177/1708538120953661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic interventions in patients with underlying connective tissues disorders present a unique challenge. The inevitable degeneration of the native aorta can lead to the need for multiple staged interventions with significant risk of complications associated with reoperative aortic procedures. We present a challenging case of progressive aortic degeneration in a patient with Marfan syndrome treated with multi-staged open surgical and endovascular procedures.
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Affiliation(s)
- Jason R Cook
- Section of Vascular Surgery, Department of Surgery, Washington University in St Louis, St Louis, MO, USA
| | | | - Jeffrey Jim
- Section of Vascular & Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
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20
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Lovato L, Cefarelli M, Gatta E, Di Eusanio M, Fattori R. Devices for thoracic endovascular aortic repair of type B aortic dissection: is there any chance for Marfan syndrome? Expert Rev Med Devices 2020; 17:683-696. [DOI: 10.1080/17434440.2020.1782735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Luigi Lovato
- Cardio-Thoracic-Vascular Department, Cardiovascular Radiology Unit and Marfan Center; S.Orsola-Malpighi Hospital; University of Bologna, Italy
| | - Mariano Cefarelli
- Cardiovascular Department, Cardiac Surgery Unit and Marfan Center; Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Emanuele Gatta
- Cardiovascular Department, Vascular Surgery Unit and Marfan Center; Lancisi Cardiovascular Center, Ancona, Italy
| | - Marco Di Eusanio
- Cardiovascular Department, Cardiac Surgery Unit and Marfan Center; Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Rossella Fattori
- Cardiovascular Department, Marfan Center; Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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21
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Qato K, Conway A, Lu E, Tran NN, Giangola G, Carroccio A. Outcomes of Thoracic Endovascular Aneurysm Repair (TEVAR) in Patients With Connective Tissue Disorders. Vasc Endovascular Surg 2020; 54:676-680. [DOI: 10.1177/1538574420945070] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Thoracic endovascular aortic repair (TEVAR) remains controversial in patients with connective tissue disorders given the concern for durability. We report on the largest series to date on outcomes of patients with thoracic aortic disease and connective tissue disorders treated with TEVAR. Methods: The Vascular Quality Initiative registry identified 12 207 patients treated with TEVAR from January 2010 to December 2018, including 102 with Marfans, Ehlers-Danlos, or Loey-Dietz syndrome. Outcomes were analyzed per the Society for Vascular Surgery reporting standards. Results: Median age was 50.6 years (interquartile range: 57.0-75.0), and 62 (60.7%) were male. Eighty-eight (86.3%) patients had Marfan, 9 (8.8%) had Ehlers-Danlos, and 5 (4.9%) had Loey-Dietz syndrome. Twenty-six (25.5%) patients were treated for degenerative aneurysmal disease and 76 (74.5%) patients for type B dissections (33 acute, 31 chronic). Most common indications for interventions in patients with type B dissection were pain (n = 41), aneurysmal degeneration (n = 16), and malperfusion (n = 8), with 3 patients who presented ruptured. There was no significant difference in perioperative complications between acute/chronic dissections and aneurysms ( P = .14). Percutaneous access was utilized in 61.7% of patients, with a 2.9% rate of arterial injury requiring reintervention. Follow-up data were available for 75 (73.3%) patients at a mean follow-up of 15.6 months. Overall mortality was 5.3%. There were 30 patients with follow-up endoleak data, and 8 (26.7%) endoleaks were identified. All endoleaks were in patients treated for acute type B dissection, and all resolved after a mean of 2.1 reinterventions. Three patients treated for acute Type B Aortic Dissection (TBAD) had retrograde dissections requiring intervention. Discussion: Thoracic endovascular aortic repair for patients with connective tissue disorders can be performed with low perioperative mortality, spinal cord ischemia, or Cerebrovascular Accident (CVA). On follow-up, acute type B aortic dissections represent a higher risk subgroup with increased rates of endoleak and retrograde dissection. Closer follow-up for these patients and early reintervention may be beneficial.
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Affiliation(s)
- Khalil Qato
- Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Allan Conway
- Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Eileen Lu
- Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | | | - Gary Giangola
- Northwell Health, Lenox Hill Hospital, New York, NY, USA
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22
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Nakanishi Y, Yuzaki M, Honda K, Kaneko M, Funahashi R, Nishimura Y. Staged hybrid aortic procedure for chronic type B aortic dissection in two patients with Marfan syndrome. Gen Thorac Cardiovasc Surg 2020; 68:1472-1474. [PMID: 32006249 DOI: 10.1007/s11748-020-01296-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/17/2020] [Indexed: 01/24/2023]
Abstract
We here report two patients with Marfan syndrome treated by a combination of surgical grafting and endovascular repair in our hospital. One was a 32-year-old woman who underwent thoracoabdominal aortic replacement for a Crawford type III dissected aortic aneurysm. Subsequently, the Bentall procedure and total arch replacement was performed for an aortic root and arch aneurysm. Finally, thoracic endovascular aortic repair bridging implanted grafts was performed. The second was a 67-year-old woman with Stanford type A acute aortic dissection who underwent the Bentall procedure and total arch replacement at the age of 64. Subsequently, she underwent thoracoabdominal replacement for a dilated dissected aortic aneurysm and finally, bridging endovascular aortic repair was performed. This procedure is less invasive than open repair for patients with Marfan syndrome.
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Affiliation(s)
- Yasuka Nakanishi
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Kimiidera, Wakayama, Wakayama, Japan.
| | - Mitsuru Yuzaki
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Kimiidera, Wakayama, Wakayama, Japan
| | - Kentaro Honda
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Kimiidera, Wakayama, Wakayama, Japan
| | - Masahiro Kaneko
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Kimiidera, Wakayama, Wakayama, Japan
| | - Ryosuke Funahashi
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Kimiidera, Wakayama, Wakayama, Japan
| | - Yoshiharu Nishimura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Kimiidera, Wakayama, Wakayama, Japan
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23
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Harky A, Iqbal R, Giordano V, Al-Adhami A. Aortic endovascular stenting in patients with systemic connective tissue disorders: does the prohibitive dogma still stand tall? J Int Med Res 2019; 48:300060519863963. [PMID: 31354092 PMCID: PMC7579328 DOI: 10.1177/0300060519863963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Endovascular repair of thoracic aortic diseases can provide satisfactory
outcomes in elective and certain emergency cases involving the
descending thoracic and aortic arch. However, open repair remains the
gold standard method of aortic root pathologies and certain aortic
arch pathologies, such as extended dissection. Nevertheless, the use
of endovascular stenting in patients with connective tissue disorders
has not been fully explored because the aortic tissues are fragile and
the likelihood of keeping the stent in place is low because of its
progressive dilatation and subsequent requirement for open repair at a
later stage when the stent graft fails. Our brief review focuses on
current evidence of the use of stents in patients with connective
tissue disorders and whether such practice can be expanded
further.
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Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
| | - Rizwan Iqbal
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Vincenzo Giordano
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ahmed Al-Adhami
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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24
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Conway AM, Qato K, Anand G, Mondry L, Giangola G, Carroccio A. Endovascular abdominal aortic aneurysm repair in patients with Marfan syndrome. Vascular 2019; 28:48-52. [DOI: 10.1177/1708538119858045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objectives Marfan syndrome patients are at risk for aortic degeneration. Repair is traditionally performed with open surgery as this is deemed more durable. Endovascular aneurysm repair remains controversial. We report on the outcomes of Marfan syndrome patients with abdominal aortic aneurysms undergoing endovascular aneurysm repair. Methods The Vascular Quality Initiative registry identified 35,889 patients, including 29 with Marfan syndrome, treated with endovascular aneurysm repair from January 2003 to December 2017. Outcomes were analyzed per the Society for Vascular Surgery reporting standards. Results Median age was 70.0 years (IQR, 57.0–75.0), and 22 (75.9%) were male. Median aneurysm diameter was 5.3 cm (IQR, 4.9–6.3 cm), with an aortic neck length and diameter of 2.0 cm (IQR, 1.6–2.8 cm) and 2.5 cm (IQR, 2.2–2.8 cm), respectively. Twenty-one (72.4%) patients were asymptomatic, seven (24.1%) symptomatic, and one (3.4%) presented with rupture. Ten (34.5%) patients had prior aortic surgery. Six (20.7%) were unfit for open surgical repair. Length of stay was 2.0 days (IQR, 1.0–3.0 days). Percutaneous femoral access was performed in 15 (51.7%) patients with no complications. A type IA endoleak was present in one (3.4%), type IB in one (3.4%), and type II endoleak in two (6.9%) patients. There were no postoperative pulmonary, cardiac, or neurological complications. In-hospital mortality occurred in one (3.4%) patient who presented with a rupture and had been deemed unfit for open repair. A conversion to open repair was required. The patient expired on post-operative day 0. Early clinical success was achieved in 26 (89.7%) patients. Follow-up was available for 15 (51.7%) patients at a median time of 766 days (IQR, 653–937). There were no reinterventions or mortalities. Change in sac diameter was −0.6 cm (IQR, −1.1 to −0.2 cm), with no type I or III endoleaks. Discussion Endovascular aneurysm repair for patients with Marfan syndrome is feasible, and can be performed safely. Mid-term outcomes suggest this technique is durable. More robust long-term follow-up is needed.
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Affiliation(s)
- Allan Marc Conway
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Khalil Qato
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Gautam Anand
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Laurie Mondry
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Gary Giangola
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Alfio Carroccio
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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25
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Hughes GC. Stent graft–induced new entry tear (SINE): Intentional and NOT. J Thorac Cardiovasc Surg 2019; 157:101-106.e3. [DOI: 10.1016/j.jtcvs.2018.10.060] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 11/29/2022]
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26
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Salem MM, Ascanio LC, Kicielinski KP, Cambria RP, Ogilvy CS, Alturki AY. Endovascular Trapping of Large Cervical Carotid Pseudoaneurysm in Marfan Syndrome Presenting with Progressive Respiratory Distress. World Neurosurg 2018; 123:323-327. [PMID: 30590218 DOI: 10.1016/j.wneu.2018.12.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Isolated cervical pseudoaneurysms of the internal carotid artery (ICA) in patients with Marfan syndrome are extremely rare. CASE DESCRIPTION A 73-year-old female with Marfan syndrome and history of multiple aortic aneurysms presented to an outside hospital with dysphagia, a mass in her neck, dizziness, nausea, and vomiting. A computed tomography angiogram showed bilateral cervical ICA pseudoaneurysms, more significant on the right side. A laryngoscopy demonstrated edematous vocal cords and a significant mass effect on the right side. She suffered from significant respiratory distress and aspiration, for which she had to be intubated and transferred to our institution for definitive care. The patient was taken for angiography for carotid artery test occlusion and endovascular trapping with coils and onyx embolization of the carotid pseudoaneurysm. The hospital course was complicated with femoral closure device failure, leading to groin hematoma, pneumonia, and respiratory failure requiring tracheostomy and percutaneous endoscopic gastrostomy. The patient was discharged to rehabilitation 34 days after admission. Stable exclusion of the large right pseudoaneurysm was observed at 3 months' follow-up with computed tomography angiography, as well as significant improvement in the last clinical follow-up obtained 6 months after the procedure. CONCLUSION Pseudoaneurysms of the cervical ICA associated with Marfan syndrome are rare. Carotid test occlusion and endovascular permanent embolization are possible in a patient with life-threatening symptoms. Cautious use of vascular closure devices, especially collagen plug-based ones, are required in such patients, given their abnormal extracellular matrix structure.
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Affiliation(s)
- Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Luis C Ascanio
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly P Kicielinski
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard P Cambria
- Division of Vascular and Endovascular Surgery, St. Elizabeth's Medical Center, Brighton, Massachusetts, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Abdulrahman Y Alturki
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, The National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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27
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Pyeritz RE. Marfan syndrome: improved clinical history results in expanded natural history. Genet Med 2018; 21:1683-1690. [DOI: 10.1038/s41436-018-0399-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/29/2018] [Indexed: 11/09/2022] Open
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Waterford SD, Moon MR. Stent grafting in Marfan syndrome? We are not convinced. J Thorac Cardiovasc Surg 2018; 156:1773-1775. [DOI: 10.1016/j.jtcvs.2018.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 01/16/2023]
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29
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Reflection of pioneers: redo thoracoabdominal aortic aneurysm repair controversies in thoracic aortic aneurysm surgery. Gen Thorac Cardiovasc Surg 2018; 67:168-174. [PMID: 30069676 DOI: 10.1007/s11748-018-0978-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
Reoperative thoracoabdominal aortic aneurysm repair is frequently necessary and brings with it a unique set of challenges. Typically, most reoperative repairs are necessitated by aortic disease progressing into previously healthy aortic tissue from a replaced section of the aorta (an extension of the previous repair) or, to a lesser degree, because of a late complication of prior distal aortic repair (an open or endovascular repair failure). Characterizing the reason for the reoperation as well as the location of prior repair is the first step towards anticipating major outcomes following such repair. Since the introduction of endovascular repair for aortic aneurysms, indications for open repair have become more specific and limited; many centers have justified using endovascular approaches in patients with prior open aortic repair by deeming these patients "high risk" because of their previous incision. Our analysis found that reoperative repairs were not typically subject to worse early outcomes than patients without prior distal aortic repair, except for the more complicated types of reoperation, which involve infection.
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Minatoya K, Inoue Y, Seike Y, Omura A, Uehara K, Sasaki H, Matsuda H, Kobayashi J. Thoracoabdominal aortic replacement in patients aged 50 and younger. Gen Thorac Cardiovasc Surg 2018; 67:53-58. [PMID: 29611032 DOI: 10.1007/s11748-018-0917-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/19/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Open repair of a thoracoabdominal aortic aneurysm (TAAA) has been regarded as one of the most invasive procedures in cardiovascular surgery. Conversely, endovascular technology currently enables the repair of the thoracoabdominal aorta, and this approach is less invasive. However, the long-term durability of this method of endovascular repair remains unknown. This investigation retrospectively analyzed the long-term durability of thoracoabdominal aorta repair in patients aged 50 and younger. PATIENTS AND METHODS Since 1995, 100 patients aged 50 and younger underwent thoracoabdominal aortic replacement at our institution. There were 63 males, and the average age was 38 ± 7. Ninety-six had aortic dissection as an aortic pathology. Marfan syndrome was found in 61 patients, Loeys-Dietz in 10, Acta 2 mutations in 4, aortitis in 2, and Ehlers-Danlos syndrome in 1. There were 2 patients with a type I TAAA, 56 with a type II, 33 with a type III, and 9 with a type IV. RESULTS There were 3 hospital deaths (3%), of which 2 were emergent cases. Spinal cord injury occurred in 1 patient (1%). Two patients (2%) had wound complications. Three patients suffered cerebral hemorrhage and 1 had an intramedullary infection, of which all were associated with cerebrospinal fluid drainage. The 3-year survival rate after the operation was 94%, that of 5 years was 94%, and that of 10 years was 91%. CONCLUSIONS Results of thoracoabdominal aortic replacement in patients aged 50 and younger were favorable. While spinal cord complications were rare, cerebrospinal drainage revealed several complications in this series. Evolving endovascular repair needs to be compared with these results, especially in patients aged 50 and younger.
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Affiliation(s)
| | - Yosuke Inoue
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Atsushi Omura
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kyokun Uehara
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroaki Sasaki
- National Cerebral and Cardiovascular Center, Suita, Japan
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Open descending thoracic or thoracoabdominal aortic approaches for complications of endovascular aortic procedures: 19-year experience. J Thorac Cardiovasc Surg 2018; 155:10-18. [DOI: 10.1016/j.jtcvs.2017.08.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/20/2017] [Accepted: 08/11/2017] [Indexed: 11/19/2022]
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Abstract
Marfan syndrome (MFS) is an inherited connective tissue disorder that is associated with arterial fragility and aortic pathologies. The endovascular treatment of patients with MFS is controversial. Published series suggest that while endovascular intervention can be carried out with a low rate of immediate morbidity and mortality, midterm follow up demonstrates sizeable numbers of complications. However, in certain situations-such as rupture, reintervention for patch aneurysms, and elective interventions in which the landing zone is within a previously placed graft-endovascular interventions are appropriate. We present a review of the literature and our institutional perspective on this complex topic.
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Affiliation(s)
- Bruce Tjaden
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Ali Azizzadeh
- Division of Vascular Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Abstract
The frequency of endovascular stent grafting procedures to treat various conditions of the thoracic aorta has increased dramatically over the past three decades. Stent grafting has been applied on a limited basis in patients with Marfan syndrome and other connective tissue disorders, despite recommendations from current guidelines and expert consensus statements against its use in this setting. A review of publications reporting outcomes after stent grafting of the descending thoracic aorta in Marfan patients with acute or chronic aortic dissection indicates that these procedures can be accomplished with rates of early mortality, stroke and spinal cord ischemic injury that are comparable to those observed in patients who do not have Marfan syndrome. However, the rates of primary treatment failure (principally endoleak), secondary treatment failure, need for open repair and late death among the Marfan patients are substantially higher than those observed in patients without this condition. In addition, the rates of retrograde aortic dissection and development of stent-graft induced new entry (SINE), are also greater among patients with Marfan syndrome. All of these findings argue strongly against the routine use of endovascular grafts in Marfan patients with type B or residual type A dissection. Few data are available to assess the role of endografting in Marfan patients with aneurysmal disease, but the progressive aortic dilatation noted in these patients argues strongly against its use in this setting as well. At present, the available data indicate that there is no justification for elective stent grafting in Marfan patients with aortic dissection or aneurysm. The only reasonable indications for primary aortic stent grafting are in the setting of acute aortic dissection or rupture, where the intervention is considered life-saving and rarely, considering the relatively young age of these patients, where the risk of open operation is considered to be prohibitive.
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Affiliation(s)
- Nicholas T Kouchoukos
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St. Louis, Missouri, USA
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34
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de Beaufort HWL, Trimarchi S, Korach A, Di Eusanio M, Gilon D, Montgomery DG, Evangelista A, Braverman AC, Chen EP, Isselbacher EM, Gleason TG, De Vincentiis C, Sundt TM, Patel HJ, Eagle KA. Aortic dissection in patients with Marfan syndrome based on the IRAD data. Ann Cardiothorac Surg 2017; 6:633-641. [PMID: 29270375 DOI: 10.21037/acs.2017.10.03] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Between January 1996 and May 2017, the International Registry on Acute Aortic Dissections has collected information on a total of 6,424 consecutive patients with acute aortic dissection, including 258 individuals with a diagnosis of Marfan syndrome. Patients with Marfan syndrome presented at a significantly younger age compared to patients without Marfan syndrome (38.2±13.2 vs. 63.0±14.0 years; P<0.001) and in general had fewer comorbidities, although they more frequently had a known aortic aneurysm and history of prior cardiac surgery. We noted significantly larger diameters of the aortic annulus and root in the Marfan syndrome cohort, but no larger diameters more distally. The in-hospital mortality in type A dissection was not significantly different in patients with or without Marfan syndrome, despite the differences in age and comorbidities and the lower incidence of aortic rupture in the Marfan syndrome cohort. In contrast, the in-hospital mortality of Marfan syndrome patients with type B dissection appears to be lower than that of patients without Marfan syndrome. The Marfan syndrome cohort that was treated with open surgery for type B dissection seemed to do especially well, with a 0% mortality rate (n=27). Follow-up data for type A and B dissections combined show an estimated five-year survival rate of 80.1% and an estimated reintervention rate of 55.3% in patients with Marfan syndrome. Such a high rate of reinterventions highlights the need for careful surveillance and treatment for patients with Marfan syndrome surviving the acute phase of aortic dissection.
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Affiliation(s)
- Hector W L de Beaufort
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, San Donato Milanese, Italy
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, San Donato Milanese, Italy
| | - Amit Korach
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Marco Di Eusanio
- Department of Cardiac Surgery, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Dan Gilon
- Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Daniel G Montgomery
- Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Arturo Evangelista
- Department of Cardiology, Hospital General Universitari Vall d'Hebron, Barcelona, Spain
| | - Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University of Medicine, Saint Louis, MO, USA
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
| | - Eric M Isselbacher
- Thoracic Aortic Center and Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas G Gleason
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Carlo De Vincentiis
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, San Donato Milanese, Italy
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Himanshu J Patel
- Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Kim A Eagle
- Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
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Han Q, Zhang W, Liu C, Zhou M, Ran F, Yi L, Sun X, Liu Z. Whole exome sequencing identifies FBN1 mutations in two patients with early‑onset type B aortic dissection. Mol Med Rep 2017; 16:6620-6625. [PMID: 28901506 PMCID: PMC5865794 DOI: 10.3892/mmr.2017.7410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 07/14/2017] [Indexed: 01/11/2023] Open
Abstract
The etiology of thoracic aortic aneurysm and dissection (TAAD) is complex and heterogeneous. Emerging evidence has demonstrated that genetic causes may be a consideration in early‑onset TAAD. Owing to overlapping clinical phenotypes and the genetic heterogeneity of TAAD, it is challenging for clinicians to make a molecular diagnosis of TAAD, particularly in those who present with non‑specific syndromic features. In order to identify the causative mutation in two young patients with acute type B aortic dissection without syndromic features, whole exome sequencing (WES) was performed in the present study. A missense mutation (c.G6953A:p.C2318Y) and a nonsense mutation (c.C4786T:p.R1596X) were identified in the fibrillin 1 gene in patients T287 and T267, respectively. The present study emphasized the necessity of genetic testing for young patients with type B aortic dissection. WES is a timely, robust and inexpensive technique for molecular diagnosis, particularly for TAAD caused by numerous genes. Genetic diagnosis of Marfan syndrome could aid in periodic surveillance, prophylactic surgical measures, and genetic counseling.
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Affiliation(s)
- Qian Han
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Wenwen Zhang
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Changjian Liu
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Min Zhou
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Feng Ran
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Long Yi
- Center for Translational Medicine, Nanjing University Medical School, Nanjing, Jiangsu 210093, P.R. China
| | - Xitai Sun
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Zhao Liu
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
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36
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Coselli JS, Amarasekara HS, Green SY, Price MD, Preventza O, de la Cruz KI, Zhang Q, LeMaire SA. Open Repair of Thoracoabdominal Aortic Aneurysm in Patients 50 Years Old and Younger. Ann Thorac Surg 2017; 103:1849-1857. [DOI: 10.1016/j.athoracsur.2016.09.058] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 09/06/2016] [Accepted: 09/12/2016] [Indexed: 11/27/2022]
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37
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Pantaleo A, Jafrancesco G, Buia F, Leone A, Lovato L, Russo V, Di Marco L, Di Bartolomeo R, Pacini D. Distal Stent Graft-Induced New Entry: An Emerging Complication of Endovascular Treatment in Aortic Dissection. Ann Thorac Surg 2016; 102:527-32. [DOI: 10.1016/j.athoracsur.2016.02.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/01/2016] [Accepted: 02/01/2016] [Indexed: 11/16/2022]
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38
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Yamane Y, Uchida N, Mochizuki S, Furukawa T, Yamada K. Endovascular Repair by Graft-to-Graft Bridging in a Patient with Marfan Syndrome. Ann Vasc Dis 2016; 9:111-3. [PMID: 27375805 DOI: 10.3400/avd.cr.16-00005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/25/2016] [Indexed: 11/13/2022] Open
Abstract
We report a case of chronic aortic dissection in a patient with Marfan syndrome in which we performed thoracic endovascular repair after aortic root replacement, total arch replacement with open stent grafting and thoracoabdominal aortic repair. We consider that endovascular repair of the dissected descending aorta in a patient with Marfan syndrome can be effective when graft-to-graft bridging is performed as the "finishing procedure".
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Affiliation(s)
- Yoshitaka Yamane
- Department of Cardiovascular Surgery, Cardiovascular Center, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Hiroshima, Japan
| | - Naomichi Uchida
- Department of Cardiovascular Surgery, Cardiovascular Center, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Hiroshima, Japan
| | - Shingo Mochizuki
- Department of Cardiovascular Surgery, Cardiovascular Center, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Hiroshima, Japan
| | - Tomokuni Furukawa
- Department of Cardiovascular Surgery, Cardiovascular Center, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Hiroshima, Japan
| | - Kazunori Yamada
- Department of Cardiovascular Surgery, Cardiovascular Center, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Hiroshima, Japan
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39
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Open aortic surgery after thoracic endovascular aortic repair. Gen Thorac Cardiovasc Surg 2016; 64:441-9. [DOI: 10.1007/s11748-016-0658-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/13/2016] [Indexed: 01/10/2023]
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40
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Results of Open Surgical Repair in Patients With Marfan Syndrome and Distal Aortic Dissection. Ann Thorac Surg 2016; 101:2193-201. [DOI: 10.1016/j.athoracsur.2015.11.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 12/16/2022]
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41
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Jessurun CAC, Bom DAM, Franken R. An update on the pathophysiology, treatment and genetics of Marfan syndrome. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1184083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ghanta RK, Green SY, Price MD, Arredondo CC, Wainwright D, Preventza O, de la Cruz KI, Aftab M, LeMaire SA, Coselli JS. Midterm Survival and Quality of Life After Extent II Thoracoabdominal Aortic Repair in Marfan Syndrome. Ann Thorac Surg 2016; 101:1402-9; discussion 1409. [DOI: 10.1016/j.athoracsur.2015.10.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 08/27/2015] [Accepted: 10/09/2015] [Indexed: 11/28/2022]
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Isekame Y, Gati S, Aragon-Martin JA, Bastiaenen R, Kondapally Seshasai SR, Child A. Cardiovascular Management of Adults with Marfan Syndrome. Eur Cardiol 2016; 11:102-110. [PMID: 30310455 DOI: 10.15420/ecr/2016:19:2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Marfan syndrome (MFS) is a disease in which connective tissue becomes weak secondary to fibrillin-1 mutations, resulting in aortic dilatation, aneurysm formation, aortic dissection, aortic regurgitation and mitral valve prolapse. This autosomal dominantly inherited condition, which was first reported in 1895 and was more fully described in 1931, is characterised by abnormal Fibrillin-1 protein (FBN1) (discovered in 1990), which is encoded by the FBN1 gene (reported in 1991). In the 1970s, the life expectancy of people with MFS was 40-50 years, mainly due to increased risk of aortic dissection or heart failure from aortic or mitral regurgitation. However, due to advances in medical and surgical therapy, life expectancy has improved dramatically and is now comparable to that of the general population. We discuss the cardiac manifestations of MFS, the incidence of arrhythmia in this population, the standard of medical care for arrhythmia and valve insufficiency, and a new use of preventive medication to preserve the integrity of the aortic wall in patients with MFS.
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Affiliation(s)
- Yukiko Isekame
- Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK
| | - Sabiha Gati
- Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK
| | | | - Rachel Bastiaenen
- Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK
| | | | - Anne Child
- Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK
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Overview of current surgical strategies for aortic disease in patients with Marfan syndrome. Surg Today 2015; 46:1006-18. [DOI: 10.1007/s00595-015-1278-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/02/2015] [Indexed: 01/16/2023]
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45
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Affiliation(s)
- Nathan J Aranson
- From Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston
| | - Michael T Watkins
- From Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston.
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46
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Numata S, Tsutsumi Y, Ohashi H. Complications and surgical conversion after total aortic repair using endovascular repair in patients with Marfan syndrome. Eur J Cardiothorac Surg 2015; 47:e155-7. [DOI: 10.1093/ejcts/ezu517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dzsinich C, Vaszily M, Vallus G, Dzsinich M, Berek P, Barta L, Darabos G, Nyiri G, Teknős D. ["Debranching" -- a new surgical option for the aortic arch and thoracoabdominal aorta hybrid interventions]. Magy Seb 2014; 67:353-61. [PMID: 25500642 DOI: 10.1556/maseb.67.2014.6.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Endovascular techniques in vascular surgery are frequently applied to treat aortic diseases. These minimally invasive procedures changed aortic interventions remarkably. We have to be familiar with new terminology and methods. METHOD New and old surgical procedures gained new role in preparation of endograft implantations. Transforming anatomy of aortic branches - "debranching" - is aimed to create a sufficient fixation of the endografts at safe "landing zones". CONCLUSIONS Knowing the option of hybrid procedures is a fundamental requirement for the vascular surgeon. Equally important is to know the biomechanical characteristics of the available endografts, the possible complications during and after implantation and the treatment options. We have to be aware of the limitations of these new methods and the role of traditional open surgery in the new era. Our intention in this paper is to summarize methods of debranching.
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Affiliation(s)
- Csaba Dzsinich
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Miklós Vaszily
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Gábor Vallus
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Máté Dzsinich
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Péter Berek
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - László Barta
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Gábor Darabos
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Gabriella Nyiri
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Dániel Teknős
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
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Affiliation(s)
- Robert M Radke
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Helmut Baumgartner
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
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Surgical treatment and thoracic endovascular aortic repair in type A aortic dissection in a pregnant patient with Marfan syndrome. Ann Vasc Surg 2013; 28:1317.e7-10. [PMID: 24365078 DOI: 10.1016/j.avsg.2013.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 10/22/2013] [Accepted: 10/24/2013] [Indexed: 11/21/2022]
Abstract
We report an acute aortic dissection type Stanford A extending down to both iliac arteries affecting a 32-year-old woman suspected to have Marfan syndrome during week 37 of pregnancy. In a multidisciplinary approach, and emergency Cesarean section was performed followed by an abdominal hysterectomy and a valve-sparing aortic root replacement using a reimplantation technique. The aorta was replaced up to the hemi arch. Because of the high suspicion of visceral ischemia as confirmed ex juvantibus, an endovascular stent graft was implanted. Molecular testing revealed a frameshift mutation and confirmed the diagnosis of Marfan syndrome. Both the patient and her healthy child underwent an uneventful recovery.
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Miyairi T, Miyata H, Taketani T, Sawaki D, Suzuki T, Hirata Y, Shimizu H, Motomura N, Takamoto S. Risk Model of Cardiovascular Surgery in 845 Marfan Patients Using the Japan Adult Cardiovascular Surgery Database. Int Heart J 2013; 54:401-4. [DOI: 10.1536/ihj.54.401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takeshi Miyairi
- Department of Cardiovascular Surgery, St. Marianna University, School of Medicine
| | - Hiroaki Miyata
- Department of Helthcare Quality Assessment, Graduate School of Medicine, University of Tokyo
| | | | - Daigo Sawaki
- Department of Cardiology, Graduate School of Medicine, University of Tokyo
| | - Tohru Suzuki
- Department of Ubiquitous Preventive Medicine, Graduate School of Medicine, University of Tokyo
| | - Yasunobu Hirata
- Department of Cardiology, Graduate School of Medicine, University of Tokyo
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Graduate School of Medicine, Keio University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, University of Tokyo
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