1
|
Koechlin L, Schuerpf J, Bremerich J, Sommer G, Gahl B, Reuthebuch O, Gurke L, Mujagic E, Eckstein F, Berdajs DA. Acute aortic dissection with entry tear at the aortic arch: long-term outcome. Interact Cardiovasc Thorac Surg 2021; 32:89-96. [PMID: 33221851 DOI: 10.1093/icvts/ivaa228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 08/16/2020] [Accepted: 08/31/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The goal was to evaluate outcomes after conservative or surgical treatment of acute aortic arch dissections. METHODS Between January 2009 and December 2018, patients with a diagnosis of acute aortic dissection were analysed. Aortic arch aortic dissection was defined as a dissection with an isolated entry tear at the aortic arch with no involvement of the ascending aorta. RESULTS Aortic arch dissection was diagnosed in 31 patients (age 59 ± 11 years). Surgical intervention was performed in 13 (41.9%) cases. Overall in-hospital mortality was 3% (n = 1), and all deaths occurred in the conservative group (n = 1; 6%), whereas the overall stroke rate was 3% (n = 1), and all strokes occurred in the group treated surgically (n = 1; 8%). Surgical repair was necessary for the following conditions: end-organ malperfusion (n = 9; 69%), impending rupture (n = 3; 23%) and dilatation of the aorta with ongoing pain refractory to medical treatment (n = 1; 8%). Overall survival at the end of the follow-up period was 71%, with 77% in the surgical group and 63% in the conservative group (P = 0.91). Freedom from surgical intervention was 71%, with 82% in the surgical and 63% in the conservative group (P = 0.21), and freedom from a neurological event was 88%, with 89% versus 89% (P = 0.68) in the surgical and conservative groups, respectively. CONCLUSIONS Aortic arch dissection is a rare pathological condition that is one of the most challenging decision-making entities. Patients manifesting an uneventful course not requiring a surgical intervention during a hospital stay were at a higher risk for aorta-related intervention during the follow-up period. The treatment modality had no impact on survival or on the incidence of a neurological event.
Collapse
Affiliation(s)
- Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Julia Schuerpf
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Gregor Sommer
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Lorenz Gurke
- Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland
| | - Edin Mujagic
- Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Denis A Berdajs
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
2
|
Rabin J, Siddiqui A, Gipple J, Taylor B, Scalea TM, Haslach HW. Minor aortic injury may be at risk of progression from uncontrolled shear stress: An in-vitro model demonstrates aortic lesion expansion. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620957426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Non-operative management is considered appropriate treatment for minor aortic injury, while blood pressure and anti-impulse therapy are routinely utilized to prevent higher grade aortic injury progression. However, a universal medical regimen for low grade intimal injuries has not been adopted and risks of low-grade injury progression not well described. The purpose of this study is to determine the fracture response of minimally damaged aortic tissue to the various applied forces. Our hypothesis is that internal circumferential shear within the aortic wall is a primary fracture mode. This knowledge may help guide clinical management to minimize risk of injury progression, including instituting standard medical regimens with anti-impulse therapy and β-blockade for such minor injuries. Methods Human ascending aortic tissue was obtained after aneurysm repair or heart transplant, stored at 4°C and tested within 48 hours. Minor injury was modeled with a small radial notch on the luminal aspect of aortic rings, circumferentially expanded under video acquisition and analyzed to determine lesion propagation. Results 15 rings were obtained from 8 aneurysmal and 4 healthy aortas. All specimens demonstrated circumferential crack propagation. Propagation was longer (8.02 ± 5.92 mm vs 2.70 ± 1.23 mm) and initiation of crack propagation earlier in aneurysmal tissue (1.54 ± 0.17 versus 1.90 ± 0.17 times initial diameter). Conclusions Dilation of minimally injured aortic rings is associated with lesion expansion and injury progression in all specimens including healthy and aneurysmal tissue. This propagation illustrates the mechanical response to increased levels of internal shear, compromising structural integrity and increasing risk of aortic rupture in all injured aortas. Shear forces are routinely generated through normal circumferential aortic expansion with each pulsation, the magnitude of these forces determined by pulse and blood pressure. This suggests minor aortic injuries are not trivial and strategies to reduce shear stress be implemented in all such patients without contraindications to β- blockers.
Collapse
Affiliation(s)
- Joseph Rabin
- R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ahmed Siddiqui
- University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Mechanical Engineering, University of Maryland, College Park, Baltimore, MD, USA
| | - Jenna Gipple
- Department of Mechanical Engineering, University of Maryland, College Park, Baltimore, MD, USA
| | - Bradley Taylor
- University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Henry W Haslach
- Department of Mechanical Engineering, University of Maryland, College Park, Baltimore, MD, USA
| |
Collapse
|
3
|
Gode S, Akinci O, Ustunısık CT, Sen O, Kadirogulları E, Aksu T, Ersoy B, Gurbak I, Duman ZM, Erentug V. The role of the angle of the ascending aortic curvature on the development of type A aortic dissection: ascending aortic angulation and dissection. Interact Cardiovasc Thorac Surg 2020; 29:615-620. [PMID: 31203369 DOI: 10.1093/icvts/ivz144] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/29/2019] [Accepted: 05/14/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Type A aortic dissection (TAD), which consists of an intimal tear in the aorta, necessitates emergency surgery. Various risk factors related to aortic dissection have been defined in the literature. According to our hypothesis, a narrower angle of ascending aortic curvature (AAAC) may be an additional risk factor in relation to aortic dissection due to the increased force applied to the aortic wall. METHODS Patients undergoing ascending aortic surgery due to an ascending aortic aneurysm (AsAA) (n = 105) and patients undergoing such surgery because of the occurrence of TAD (n = 101) were enrolled in this study. The AAAC was measured using Cobb's method; the measurements were made on all patients by just 1 cardiovascular radiologist using 3-dimensional computerized tomographic imaging. This measurement was made indirectly by using the aortic valve and brachiocephalic artery to avoid obtaining misleading data as a result of distortions due to dissection. A statistical comparison was also performed relating the traditional risk factors for TAD to other clinical and echocardiographic parameters: the diameter of the ascending aorta and the AAAC. RESULTS The AAAC was found to be narrower statistically in the TAD group (α = 76.2° ± 17.5°) than it was in the AsAA group (α = 92.9° ± 13°) (P < 0.001). Furthermore, mean ascending aortic diameter (P = 0.019), the presence of a bicuspid aorta (P = 0.007) and aortic valve stenosis (P = 0.005) were higher in the AsAA group. According to multivariable analyses, a narrower AAAC is a significant predictor for the development of TAD (odds ratio 0.93, 95% confidence interval 0.91-0.95; P < 0.001). Overall hospital mortality from various causes including stroke, myocardial infarction, bleeding or renal failure was 13% in the TAD group and 7% in the AsAA group. CONCLUSIONS According to this study, the AAAC was significantly smaller in aortic dissection patients than in aortic aneurysm patients. This may be related to higher shear stress and elevated pressure on the ascending aorta in patients with a narrower AAAC. Thus, a narrower AAAC may be an additional risk factor in the development of TAD. Therefore, we may need to be more careful in terms of looking for the development of aortic dissection in patients with narrower AAAC.
Collapse
Affiliation(s)
- Safa Gode
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Okan Akinci
- Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cigdem Tel Ustunısık
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Onur Sen
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ersin Kadirogulları
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Timucin Aksu
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Burak Ersoy
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ismail Gurbak
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zihni Mert Duman
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Vedat Erentug
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
4
|
Koechlin L, Kaufmann J, Macius E, Bremerich J, Sommer G, Gahl B, Schurr U, Grapow M, Reuthebuch O, Eckstein F, Berdajs DA. Impact of Modified Frozen Elephant Trunk Procedure on Downstream Aorta Remodeling in Acute Aortic Dissection: CT Scan Follow-Up. World J Surg 2020; 44:1648-1657. [DOI: 10.1007/s00268-020-05374-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
5
|
Moradi M, Mirfasihi RS. Is there any association between aortic root rotation angle and aortic dissection? Indian J Thorac Cardiovasc Surg 2019; 36:181-185. [PMID: 33061123 DOI: 10.1007/s12055-019-00859-2] [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: 05/03/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022] Open
Abstract
Introduction Thoracic aortic dissection is a probable fatal condition that requires early diagnosis and management. The underlying etiology of this disorder is an important issue that has not been completely responded yet. In the current study, the association between aortic root rotation and ascending aortic dissection has been assessed. Methods This is a non-randomized retrospective case-control study conducted on twenty-five cases referring with ascending aortic dissection and seventy-five controls that underwent computed tomography (CT) angiography for reasons other than aortic dissection. Aortic root rotation angle and aortic diameter for both cases and controls were measured and then compared. Results There was no significant difference regarding age and gender distribution (P value = 0.22 and 0.38 respectively) between patients in case and control groups. The mean values of aortic root rotation angle and aortic diameter in cases were 22.5 ± 10.5° and 43.1 ± 12.5 mm versus 15.7 ± 10.7° and 30.7 ± 5.3 mm in controls (P value = 0.007 and 0.001 respectively). Direct relation was found between aortic root rotation angle and aortic diameter (P value = 0.007, r = 0.276). Mean of aortic root rotation angle was significantly higher in females (P value = 0.02). No association between cases' age with either aortic root rotation angle or aortic diameter was found (P value = 0.33, r = 0.098, and P value = 0.085, r = 0.173 respectively). Conclusion Based on the findings of the current study, aortic root rotation angle was independently in direct association with thoracic aortic dissection. In addition, females had higher aortic root rotation angles.
Collapse
Affiliation(s)
- Maryam Moradi
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raheleh Sadat Mirfasihi
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
6
|
Koechlin L, Macius E, Kaufmann J, Gahl B, Reuthebuch O, Eckstein F, Berdajs DA. Aortic root and ascending aorta dimensions in acute aortic dissection. Perfusion 2019; 35:131-137. [DOI: 10.1177/0267659119858848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objectives: Aim of this study was to evaluate ascending aorta and aortic root dimension at acute type A dissection (acute aortic dissection) and to identify demographics elements being allied to the acute event. Methods: In a period between 2009 and 2017, 225 (n = 71, 32% female, mean age = 63 ± 12 years) patients eligible for analysis of ascending aorta and 223 (n = 70, 31% female, mean age = 63 ± 13 years) of aortic root were included in this study. Aortic diameter was assessed in preoperative computed tomography scan. The predissection diameters were modeled from the diameters obtained at diagnosis, assuming 30% augmentation of the diameter at acute event. Results: The mean diameter of the ascending aorta at dissection was 46 ± 8 mm and the modeled diameter was 32.3 ± 5.7 mm. The diameter of the aortic root at dissection was 42 ± 8 mm and modeled diameter was 29.5 ± 5.6 mm. In multivariate analysis, female gender (p = 0.026) and history of cerebrovascular event (p = 0.001) were associated with acute aortic dissection in small aortic root. Patient age (p < 0.001) and history of inguinal hernia (p = 0.001) in ascending aorta <55 mm correlated with acute aortic dissection. Conclusion: Modeling indicates that more than 90% of patients had aortic root and ascending aorta diameter <45 mm. It seems that the aortic diameter expansion over the 55 mm in development of acute aortic dissection is overestimated. Parameters other than aortic size were identified, which may be considered when patients at high risk for dissection were identified.
Collapse
Affiliation(s)
- Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Evelina Macius
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Josefin Kaufmann
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Denis A Berdajs
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
7
|
Yu S, Han J, Gao S, Ruan Y, Gu X, Sun L, He Y. Echocardiographic features of interventricular septal dissection in patients with Behçet's disease. Echocardiography 2018; 36:394-400. [DOI: 10.1111/echo.14235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/24/2018] [Accepted: 11/27/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Shaomei Yu
- Department of UltrasoundBeijing Anzhen HospitalCapital Medical University Beijing China
| | - Jiancheng Han
- Department of UltrasoundBeijing Anzhen HospitalCapital Medical University Beijing China
| | - Shuang Gao
- Department of UltrasoundBeijing Anzhen HospitalCapital Medical University Beijing China
| | - Yanping Ruan
- Department of UltrasoundBeijing Anzhen HospitalCapital Medical University Beijing China
| | - Xiaoyan Gu
- Department of UltrasoundBeijing Anzhen HospitalCapital Medical University Beijing China
| | - Lin Sun
- Department of UltrasoundBeijing Anzhen HospitalCapital Medical University Beijing China
| | - Yihua He
- Department of UltrasoundBeijing Anzhen HospitalCapital Medical University Beijing China
| |
Collapse
|