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An Z, Sun Y, Yang X, Zhou J, Yu Y, Zhang B, Xu Z, Zhu Y, Wang G. Enhanced expression of miR-20a driven by nanog exacerbated the degradation of extracellular matrix in thoracic aortic dissection. Noncoding RNA Res 2024; 9:1040-1049. [PMID: 39022686 PMCID: PMC11254500 DOI: 10.1016/j.ncrna.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/09/2024] [Accepted: 05/19/2024] [Indexed: 07/20/2024] Open
Abstract
Thoracic aortic dissection (TAD) is a life-threatening vascular disease manifested as intramural bleeding in the medial layers of the thoracic aorta. The key histopathologic feature of TAD is medial degeneration, characterized by depletion of vascular smooth muscle cells (VSMCs) and degradation of extracellular matrix (ECM). MicroRNA, as essential epigenetic regulators, can inhibit the protein expression of target genes without modifying the sequences. This study aimed to elucidate the role and underlying mechanism of miR-20a, a member of the miR-17-92 cluster, in regulating ECM degradation during the pathogenesis of TAD. The expression of the miR-17-92 cluster was significantly increased in synthetic VSMCs derived from TAD lesions compared to contractile VSMCs isolated from normal thoracic aortas. Notably, the expression of miR-20a was increased in VSMCs in response to serum exposure and various stimuli. In TAD lesions, the expression of miR-20a was significantly negatively correlated with that of elastin. Elevated expression of miR-20a was also observed in thoracic aortas of TAD mice induced by β-aminopropionitrile fumarate and angiotensin II. Overexpression of miR-20a via mimic transfection enhanced the growth and invasive capabilities of VSMCs, with no significant impact on their migratory activity or the expression of phenotypic markers (α-SMA, SM22, and OPN). Silencing of miR-20a with inhibitor transfection mitigated the hyperactivation of MMP2 in VSMCs stimulated by PDGF-bb, as evidenced by reduced levels of active-MMP2 and increased levels of pro-MMP2. Subsequently, TIMP2 was identified as a novel target gene of miR-20a. The role of miR-20a in promoting the activation of MMP2 was mediated by the suppression of TIMP2 expression in VSMCs. In addition, the elevated expression of miR-20a was found to be directly driven by Nanog in VSMCs. Collectively, these findings indicate that miR-20a plays a crucial role in maintaining the homeostasis of the thoracic aortic wall during TAD pathogenesis and may represent a potential therapeutic target for TAD.
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Affiliation(s)
- Zhao An
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Yangyong Sun
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
- Department of Cardiothoracic Surgery, Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Xiaodong Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jingwen Zhou
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Yongchao Yu
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Boyao Zhang
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guokun Wang
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
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Kim JK, Goh JH, Kim JB, Song JK, Yang DH, Kang JW, Kim SO, Koo HJ. Predictors of Late Adverse Events in Patients with Surgically Treated Type I Aortic Dissection. Eur J Vasc Endovasc Surg 2024; 68:444-453. [PMID: 38719137 DOI: 10.1016/j.ejvs.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/11/2024] [Accepted: 05/01/2024] [Indexed: 06/17/2024]
Abstract
OBJECTIVE Residual aortic dissection (AD) following DeBakey type I AD repair is associated with a high rate of adverse events that need additional intervention or surgery. This study aimed to identify clinical and early post-operative computed tomography angiography (CTA) imaging factors associated with adverse events in patients with type I AD after ascending aorta replacement. METHODS This single centre, retrospective cohort study included consecutive patients with type I AD who underwent ascending aorta replacement from January 2011 to December 2017 and post-operative CTA within three months. The primary outcome was AD related adverse events, defined as AD related death and re-operation due to aortic aneurysm or impending rupture. The location and size of the primary intimal tears, aortic diameter, and false lumen status were evaluated. Regression analyses were performed to identify factors associated with AD related adverse events. A decision tree model was used to classify patients as high or low risk. RESULTS Of 103 participants (55.43 ± 13.94 years; 49.5% male), 24 (23.3%) experienced AD related adverse events. In multivariable Cox regression analysis, connective tissue disease (hazard ratio [HR] 15.33; p < .001), maximum aortic diameter ≥ 40 mm (HR 4.90; p < .001), and multiple (three or more) intimal tears (HR 7.12; p < .001) were associated with AD related adverse events. The three year cumulative survival free from AD related events was lower in the high risk group with aortic diameter ≥ 40 mm and multiple intimal tears (41.7% vs. 90.9%; p < .001). CONCLUSION Early post-operative CTA findings indicating a maximum aortic diameter ≥ 40 mm and multiple intimal tears may predict a higher risk of adverse events. These findings suggest the need for careful monitoring and more vigilant management approaches in these cases.
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Affiliation(s)
- Jin Kyoung Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Jung Hwan Goh
- University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Jae-Kwan Song
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Hyun Jung Koo
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea.
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Coady MA, Hsi DH. Editorial commentary: Uncomplicated type B aortic dissections - Optimizing a window of opportunity for endovascular intervention. Trends Cardiovasc Med 2024; 34:486-487. [PMID: 38246409 DOI: 10.1016/j.tcm.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Michael A Coady
- Chief of Cardiac Surgery & Co-Director, Heart & Vascular Institute, Stamford Hospital, United States
| | - David H Hsi
- Chief of Cardiology & Co-Director, Heart & Vascular Institute, Professor of Clinical Medicine, Columbia University Vagelos College of Physicians & Surgeons, Stamford Hospital, 1 Hospital Plaza, Stamford, CT 06902, United States.
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Kozlov BN, Panfilov DS, Kim EB. Long-term outcomes of frozen elephant trunk for aortic dissection: a single-center experience. J Cardiothorac Surg 2024; 19:559. [PMID: 39354568 DOI: 10.1186/s13019-024-03074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 09/15/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND To date a number of papers analysing outcomes of the frozen elephant trunk (FET) in acute aortic dissection has been published. However, there are limited comparative studies on long-term outcomes of FET in acute and chronic aortic dissection. The objective of the study was to analyze the long-term outcomes after FET procedure for aortic dissection (AD). METHODS Between March 2012 and December 2022, a total of 123 FET had been performed for thoracic aortic disease. Patients with aortic dissection (n = 97) were divided into 2 groups: acute (n = 32, 33%) and chronic aortic dissection (n = 65, 67%). Pre-, intra- and postoperative data were retrospectively collected from electronic patient's records, including follow-up data of the analyzed patients. RESULTS The incidence of stroke was 3.1%. The delirium rate was up to 9.3% in both groups with a prevalence in chronic aortic dissection (CAD) group without significant differences (P = 0.494). Paraplegia was diagnosed only in CAD patients (n = 2). Respiratory failure and the rate of renal replacement therapy were similar in the studied groups. Re-sternotomy was required in one (3.1%) patient with acute AD and 5 (7.7%) patients with chronic AD (P = 0.416). Overall 30-day mortality in the entire cohort, acute and chronic AD was 13 (13.4%), 7 (21.9%) and 6 (9.2%), respectively (P = 0.097). The overall survival rate at 60 months for the entire cohort, acute and chronic AD was 64.1 ± 5.9%, 62.3 ± 9.1%, 66.5 ± 7%, respectively (P = 0.265). Freedom from unintended distal aortic re-intervention at 60 months for the entire cohort of patients, acute and chronic AD was 74.2 ± 1.5%, 100%, 65.3 ± 2%, respectively (P = 0.355). CONCLUSIONS Our experience showed acceptable long-term outcomes after the FET procedure including mortality and re-intervention rate in patients with aortic dissection regardless of acuity of the dissection. TRIAL REGISTRATION The study has been registered in Australian and New Zealand Clinical Trial Registry (ACTRN 12618001329257) on August 7, 2018.
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Affiliation(s)
- Boris N Kozlov
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, 634012, Russian Federation
| | - Dmitri S Panfilov
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, 634012, Russian Federation
| | - Elena B Kim
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, 634012, Russian Federation.
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Sebastian SA, Sethi Y, Mathews AM, Santhosh T, Lorraine Co E, Padda I, Johal G. Cardiovascular complications during pregnancy: Advancing cardio-obstetrics. Dis Mon 2024; 70:101780. [PMID: 38910052 DOI: 10.1016/j.disamonth.2024.101780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
As the incidence of cardiovascular diseases (CVDs) continues to rise among women of childbearing age, the pregnant population with pre-existing heart conditions presents a complex and heterogeneous profile. These women face varying degrees of risk concerning maternal cardiovascular, obstetric, and fetal complications. Effectively managing adverse cardiovascular events during pregnancy presents substantial clinical challenges. The uncertainties surrounding diagnostic and therapeutic approaches create a dynamic landscape with potential implications for maternal and fetal health. Cardio-obstetrics has become increasingly recognized as a vital multidisciplinary field necessitating a collaborative approach to managing cardiovascular conditions during pregnancy. In this review, we aim to provide a thorough and up-to-date examination of the existing evidence, offering a comprehensive overview of strategies and considerations in the management of cardiovascular complications during pregnancy. Special emphasis is placed on the safety assessment of diagnostic procedures and the exploration of treatment options designed to prioritize the well-being of the mother and fetus. We also explore the significance of a multidisciplinary cardio-obstetrics team in providing comprehensive care for women of childbearing age with or at risk for CVD.
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Affiliation(s)
- Sneha Annie Sebastian
- Department of Internal Medicine, Azeezia Medical College, Kollam, Kerala, India; Research Nexus, Philadelphia, United States.
| | - Yashendra Sethi
- Department of Internal Medicine, Government Doon Medical College, HNB Uttarakhand Medical Education University, Dehradun, India
| | | | - Tony Santhosh
- Department of Internal Medicine, Dr. Somervell Memorial CSI Medical College, KUHS, Kerala, India
| | - Edzel Lorraine Co
- Research Nexus, Philadelphia, United States; Department of Internal Medicine, University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines
| | - Inderbir Padda
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA
| | - Gurpreet Johal
- Department of Cardiology, University of Washington, Valley Medical Center, Seattle, USA
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Paratz ED, Nadel J, Humphries J, Rowe S, Fahy L, La Gerche A, Prior D, Celermajer D, Strange G, Playford D. The aortic paradox: a nationwide analysis of 523 994 individual echocardiograms exploring fatal aortic dissection. Eur Heart J Cardiovasc Imaging 2024; 25:1423-1431. [PMID: 38805749 DOI: 10.1093/ehjci/jeae140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 05/30/2024] Open
Abstract
AIMS Increasing aortic dilation increases the risk of aortic dissection. Nevertheless, dissection occurs at dimensions below guideline-directed cut-offs for prophylactic surgery. Currently, there are no large-scale population imaging data assessing aortic dimensions before dissection. METHODS AND RESULTS Patients within the National Echo Database of Australia were stratified according to absolute, height-indexed, and body surface area (BSA)-indexed aortic dimensions. Fatal thoracic aortic dissections (ICD-10-AM Code I71) were identified via linkage with the National Death Index. A total of 524 994 individuals were assessed, comprising patients with normal aortic dimensions (n = 460 992), mild dilation (n = 53 402), moderate dilation (n = 10 029), and severe dilation (n = 572). A total of 274 992 (52.4%) were males, with a median age of 64 years and a median follow-up time of 6.9 years. Eight hundred and ninety-nine fatal aortic dissections occurred (normal diameter = 610, mildly dilated aorta = 215, moderately dilated = 53, and severely dilated = 21). Using normal aortas as the reference population, odds of fatal dissection increased with aortic diameter [mild = odds ratio (OR) 3.05, 95% confidence interval (CI) 2.61-3.56; moderate = OR 4.0, 95% CI 3.02-5.30; severe = OR 28.72, 95% CI 18.44-44.72]. Due to the much larger number of patients without severe aortic dilation, 97.7% of fatal aortic dissections occurred in non-severely dilated aortas. Following sensitivity analysis, severe aortic dilation was responsible for at most 24.4% of fatal aortic dissections. The results were robust for absolute, height-indexed, or BSA-indexed aortic measurements. CONCLUSION Although severe aortic dilatation is associated with a near-30-fold increase in fatal dissections, severely dilated aortas are implicated in only 2.3-24.4% of fatal dissections. This highlights the 'aortic paradox' and limitations of current guidelines. Future studies should seek to refine risk predictors in patients without severe aortic dilation.
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Affiliation(s)
- Elizabeth D Paratz
- Heart, Exercise & Research Trials, Victor Chang Cardiac Research Institute, 405 Liverpool St, Darlinghurst, NSW 2010, Australia
- Heart, Exercise and Research Trials, St Vincent's Institute, 9 Princes St, Fitzroy, VIC 3065, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia
- Ambulance Victoria, 31 Joseph St, Blackburn North, VIC 3130, Australia
| | - James Nadel
- Department of Cardiology, St Vincent's Hospital Sydney, 390 Victoria St, Darlinghurst, NSW 2010, Australia
- Heart Research Institute, 7 Eliza St, Newtown, NSW 2042, Australia
| | - Julie Humphries
- Advara HeartCare, Newdegate St, Greenslopes, QLD 4120, Australia
- Department of Cardiology, The Prince Charles Hospital, Rode Rd, Chermside, QLD 4032, Australia
| | - Stephanie Rowe
- Heart, Exercise & Research Trials, Victor Chang Cardiac Research Institute, 405 Liverpool St, Darlinghurst, NSW 2010, Australia
- Heart, Exercise and Research Trials, St Vincent's Institute, 9 Princes St, Fitzroy, VIC 3065, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia
| | - Louise Fahy
- Heart, Exercise & Research Trials, Victor Chang Cardiac Research Institute, 405 Liverpool St, Darlinghurst, NSW 2010, Australia
- Heart, Exercise and Research Trials, St Vincent's Institute, 9 Princes St, Fitzroy, VIC 3065, Australia
| | - Andre La Gerche
- Heart, Exercise & Research Trials, Victor Chang Cardiac Research Institute, 405 Liverpool St, Darlinghurst, NSW 2010, Australia
- Heart, Exercise and Research Trials, St Vincent's Institute, 9 Princes St, Fitzroy, VIC 3065, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia
| | - David Prior
- Heart, Exercise and Research Trials, St Vincent's Institute, 9 Princes St, Fitzroy, VIC 3065, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia
| | - David Celermajer
- Heart Research Institute, 7 Eliza St, Newtown, NSW 2042, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW 2050, Australia
- Faculty of Medicine, University of Sydney, Camperdown, NSW 2050, Australia
| | - Geoffrey Strange
- Department of Cardiology, The Prince Charles Hospital, Rode Rd, Chermside, QLD 4032, Australia
- Institute for Health Research, University of Notre Dame, 32 Mouat St, Fremantle, WA 6160, Australia
| | - David Playford
- Institute for Health Research, University of Notre Dame, 32 Mouat St, Fremantle, WA 6160, Australia
- School of Medicine, The University of Notre Dame, 32 Mouat St, Fremantle, WA 6160, Australia
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Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, Bura-Rivière A, De Backer J, Deglise S, Della Corte A, Heiss C, Kałużna-Oleksy M, Kurpas D, McEniery CM, Mirault T, Pasquet AA, Pitcher A, Schaubroeck HAI, Schlager O, Sirnes PA, Sprynger MG, Stabile E, Steinbach F, Thielmann M, van Kimmenade RRJ, Venermo M, Rodriguez-Palomares JF. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J 2024; 45:3538-3700. [PMID: 39210722 DOI: 10.1093/eurheartj/ehae179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Ohashi Y, Washiyama N, Takahashi D, Tsuda K, Hirano M, Shiiya N. Safety and validity of selective cerebrospinal fluid drainage in open and endovascular aortic repair. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02085-z. [PMID: 39325337 DOI: 10.1007/s11748-024-02085-z] [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: 01/26/2024] [Accepted: 09/15/2024] [Indexed: 09/27/2024]
Abstract
OBJECTIVES Although cerebrospinal fluid drainage has been shown to reduce the risk of ischemic spinal cord injury, serious complications have also been reported. We have been using it selectively in a pressure- and volume-regulated method and aimed to evaluate its safety, and its validity in elective thoracic endovascular aortic repair in a propensity-matched cohort. METHODS Among the 450 patients who underwent open surgery (n = 169) or thoracic endovascular aortic repair (n = 281) on the descending or thoracoabdominal aorta, 147 underwent cerebrospinal fluid drainage, which was prophylactic in 135 and therapeutic in 12. Prophylactic drainage was performed in elective open surgery under distal aortic perfusion (n = 67) or in selected patients undergoing thoracic endovascular aortic repair (n = 68). RESULTS Drainage-related complications were observed in 13 (9.6%), one of which was graded severe (0.74%). In patients undergoing prophylactic drainage, spinal cord injury was detected in 2/135 (1.5%). In patients without prophylactic drainage, 15/315 (4.8%) developed spinal cord injury. Therapeutic drainage was performed in 12 of these 15 patients, 10 of whom remained paralytic in varying degree. In the inverse probability weighted analysis of the patients undergoing elective thoracic endovascular aortic repair, the incidence of spinal cord injury was lower with prophylactic drainage (p = 0.028). CONCLUSIONS Pressure- and volume-regulated spinal drainage rarely causes serious complications. Its prophylactic use seems beneficial in selected patients, including those undergoing thoracic endovascular aortic repair with high risk for spinal cord injury.
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Affiliation(s)
- Yuko Ohashi
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Naoki Washiyama
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Daisuke Takahashi
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Kazumasa Tsuda
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Masahiro Hirano
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan.
- Department of Cardiovascular Surgery, NHO Hakodate Medical Center, 18-16 Kawaharacho, Hakodate, 041-8512, Japan.
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Polania-Sandoval CA, Farres H, Lanka SP, Erben Y. Open Surgical Repair in a Patient With Loeys-Dietz Syndrome and Extensive Vascular Compromise: A Case Report and Literature Review. Vasc Endovascular Surg 2024:15385744241284383. [PMID: 39254110 DOI: 10.1177/15385744241284383] [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: 09/11/2024]
Abstract
Loeys-Dietz syndrome (LDS) has been associated with multiple vascular abnormalities involving the entire arterial tree. However, limited reports regarding compromise in the aortoiliac and femoral bifurcation are available. Further, recommendations for optimal approach, thresholds for diameter at the time of surgery, and surveillance are also limited. We present a case of a 67-year-old male patient with LDS and aneurysmal aortoiliac and enlarging common femoral arteries aneurysms, who underwent open surgical repair. His past surgical history included multiple vascular interventions for lower extremity claudication and bilateral hip replacements. The right hip arthroplasty was previously removed due to infection. From the vascular standpoint, the patient underwent staged endovascular left hypogastric artery embolization and open aorto-bi-profunda bypass with a Rifampin-soaked Dacron graft. At 5-month follow-up, he remains asymptomatic with healed incisions and patent bypasses. This case highlights the challenges in managing peripheral aneurysms in LDS patients, emphasizing the need for tailored treatment strategies. While open repair is preferred, endovascular options may be considered in selected cases. Surveillance remains critical with annual cross-sectional imaging. Surgical planning is intricate due to comorbidities, anatomical complexities, and previous surgical infection. Surveillance of these patients must be strict as multiple vascular and non-vascular complications may arise. Therefore, collaborative decision-making is essential for optimal outcomes in this known high-risk population with connective tissue disorders.
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Affiliation(s)
| | - Houssam Farres
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Santh Prakash Lanka
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
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10
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Mosbahi S, Berezowski M, Bavaria JE, Kelly JJ, Goel N, Jiang F, Yildiz M, Zhao Y, Szeto WY, Desai ND. Long-Term Outcomes of Antegrade Thoracic Stent Grafting During Repair of Acute DeBakey I Dissection. Ann Thorac Surg 2024:S0003-4975(24)00683-0. [PMID: 39182554 DOI: 10.1016/j.athoracsur.2024.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/24/2024] [Accepted: 07/29/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND We aim to evaluate the impact of antegrade stenting of the distal arch and proximal descending aorta combined with non-total arch procedures in acute type A aortic dissection. METHODS From 2005 to 2022, 733 nonsyndromic patients presented with acute DeBakey type I aortic dissection and underwent non-total arch procedure. Ninety-five patients underwent antegrade stenting and 638 did not. Propensity-score analysis was performed, and 95 optimal pairs were created. Survival was estimated using the Kaplan-Meier method and cumulative incidence of reintervention with death as a competing event was calculated and compared using Gray's method. RESULTS Survival estimates at 10 years after propensity score matching were similar between both groups, 58.9% (95% CI, 46.5%-74.5%) vs 58.4% (95% CI, 48.3%-70.6%) (P = .6) in the non-stented vs stented group. Cumulative incidence of reintervention with competing risk of death at 10 years after propensity matching was 27% (95% CI, 17%-37%) vs 22% (95% CI, 14%-32%) (P = .44), respectively. CONCLUSIONS Antegrade thoracic endovascular aortic repair may be beneficial for remodeling and facilitating future endovascular reinterventions and reduces the occurrence of reintervention for malperfusion.
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Affiliation(s)
- Selim Mosbahi
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Mikolaj Berezowski
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John J Kelly
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas Goel
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fei Jiang
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Murat Yildiz
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Yu Zhao
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
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11
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Stephens EH, Dearani JA, Pochettino A, Vricella LA, Sundt TM, David TE, Bavaria JE, Cameron DE. Valve-Sparing Aortic Root Replacement State-of-the-Art Review, Part I: Anatomy and Physiology. Ann Thorac Surg 2024; 118:729-735. [PMID: 38360340 DOI: 10.1016/j.athoracsur.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/03/2023] [Accepted: 12/09/2023] [Indexed: 02/17/2024]
Abstract
Aortic valve disease is common, and valve-preserving operations are preferred whenever possible. Valve-sparing aortic root replacement has become an important tool for managing aortic root pathology in children and adults. The learning curve for this operation is challenging, but with increasing experience and technical modifications, early and late outcomes continue to improve. Durable long-term results vary based on the underlying anatomy, pathology, and patient selection, as well as surgeon expertise. The first installment of this Valve-Sparing Aortic Root Replacement State-of-the-Art Review article addresses patient anatomy and physiology as it relates to candidacy for VSRR.
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Affiliation(s)
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| | | | - Luca A Vricella
- Division of Pediatric Cardiovascular Surgery, Department of Surgery, Advocate Children's Heart Institute, Chicago, Illinois
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Tirone E David
- Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Duke E Cameron
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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12
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Stephens EH, Feins EN, Karamlou T, Anderson BR, Alsoufi B, Bleiweis MS, d'Udekem Y, Nelson JS, Ashfaq A, Marino BS, St Louis JD, Najm HK, Turek JW, Ahmad D, Dearani JA, Jacobs JP. The Society of Thoracic Surgeons Clinical Practice Guidelines on the Management of Neonates and Infants With Coarctation. Ann Thorac Surg 2024; 118:527-544. [PMID: 38904587 DOI: 10.1016/j.athoracsur.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/06/2024] [Accepted: 04/22/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Although coarctation of the aorta without concomitant intracardiac pathology is relatively common, there is lack of guidance regarding aspects of its management in neonates and infants. METHODS A panel of experienced congenital cardiac surgeons, cardiologists, and intensivists was created, and key questions related to the management of isolated coarctation in neonates and infants were formed using the PICO (Patients/Population, Intervention, Comparison/Control, Outcome) Framework. A literature search was then performed for each question. Practice guidelines were developed with classification of recommendation and level of evidence using a modified Delphi method. RESULTS For neonates and infants with isolated coarctation, surgery is indicated in the absence of obvious surgical contraindications. For patients with risk factors for surgery, medical management before intervention is reasonable. For those stable off prostaglandin E1, the threshold for intervention remains unclear. Thoracotomy is indicated when arch hypoplasia is not present. Sternotomy is preferable when arch hypoplasia is present that cannot be adequately addressed through a thoracotomy. Sternotomy may also be considered in the presence of a bovine aortic arch. Antegrade cerebral perfusion may be reasonable when the repair is performed through a sternotomy. Extended end-to-end, arch advancement, and patch augmentation are all reasonable techniques. CONCLUSIONS Surgery remains the standard of care for the management of isolated coarctation in neonates and infants. Depending on degree and location, arch hypoplasia may require a sternotomy approach as opposed to a thoracotomy approach. Significant opportunities remain to better delineate management in these patients.
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Affiliation(s)
| | - Eric N Feins
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery and the Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brett R Anderson
- Division of Pediatric Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Bahaaldin Alsoufi
- Cardiovascular Surgery, Norton Children's Hospital, University of Louisville, Louisville, Kentucky
| | - Mark S Bleiweis
- Congenital Heart Center, Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida; Congenital Heart Center, Division of Cardiovascular Surgery, Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Yves d'Udekem
- Children's National Heart Institute, Children's National Hospital, Washington, DC
| | - Jennifer S Nelson
- Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, Florida
| | - Awais Ashfaq
- Division of Cardiovascular Surgery, Department of Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio
| | | | - James D St Louis
- Departent of Surgery, Children's Hospital of Georgia, Augusta, Georgia; Departent of Surgery, Inova L.J. Murphy Children's Hospital, Falls Church, Virginia
| | - Hani K Najm
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph W Turek
- Duke Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, North Carolina
| | - Danial Ahmad
- Cardiac Surgery Research Laboratory, Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey P Jacobs
- Congenital Heart Center, Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida; Congenital Heart Center, Division of Cardiovascular Surgery, Department of Pediatrics, University of Florida, Gainesville, Florida.
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13
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Dux-Santoy L, Ruiz-Muñoz A, Guala A, Galian-Gay L, Fernandez-Galera R, Valente F, Casas G, Oliveró R, Ferrer-Cornet M, Bragulat-Arévalo M, Carrasco-Poves A, Garrido-Oliver J, Morales-Galán A, Johnson KM, Wieben O, Ferreira-González I, Evangelista A, Rodriguez-Palomares J, Teixidó-Turà G. Impact of valve-sparing aortic root replacement on aortic fluid dynamics and biomechanics in patients with syndromic heritable thoracic aortic disease. J Cardiovasc Magn Reson 2024:101088. [PMID: 39214465 DOI: 10.1016/j.jocmr.2024.101088] [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: 02/05/2024] [Revised: 08/08/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES Patients with syndromic heritable thoracic aortic diseases (sHTAD) who underwent prophylactic aortic root replacement are at high risk of distal aortic events, but the underlying mechanisms are poorly understood. This prospective, longitudinal study aims to assess the impact of valve-sparing aortic root replacement (VSARR) on aortic fluid dynamics and biomechanics in these patients, and to examine whether they present altered haemodynamics or biomechanics prior to surgery compared to sHTAD patients with no indication for surgery (sHTAD-NSx) and healthy volunteers (HV). METHODS Sixteen patients with Marfan or Loeys-Dietz syndrome underwent two 4D flow CMR studies before (sHTAD-preSx) and after VSARR (sHTAD-postSx). Two age, sex and BSA matched cohorts of 40 HV and 16 sHTAD-NSx patients with available 4D flow CMR, were selected for comparison. In-plane rotational flow (IRF), systolic flow reversal ratio (SFRR), wall shear stress (WSS), pulse wave velocity (PWV) and aortic strain were analysed in the ascending (AscAo) and descending aorta (DescAo). RESULTS All patients with sHTAD presented altered haemodynamics and increased aortic stiffness (p<0.05) compared to HV, both in the AscAo (median PWV 7.4 in sHTAD-NSx; 6.8 in sHTAD-preSx; 4.9m/s in HV) and DescAo (median PWV 9.1 in sHTAD-NSx; 8.1 in sHTAD-preSx; 6.3m/s in HV). Patients awaiting VSARR had markedly reduced in-plane (median IRF -2.2 vs 10.4 cm2/s in HV, p=0.001), but increased through-plane flow rotation (median SFRR 7.8 vs 3.8% in HV, p=0.002), and decreased WSS (0.36 vs 0.47N/m2 in HV, p=0.004) in the proximal DescAo. After VSARR, proximal DescAo in-plane rotational flow (p=0.010) and circumferential WSS increased (p=0.011), no longer differing from HV, but through-plane rotational flow, axial WSS and stiffness remained altered. Patients in which aortic tortuosity was reduced after surgery showed greater post-surgical increase in IRF compared to those in which tortuosity increased (median IRF increase 18.1 vs 3.3cm²/s, p=0.047). Most AscAo flow alterations were restored to physiological values after VSARR. CONCLUSIONS In patients with sHTAD, VSARR partially restores downstream fluid dynamics to physiological levels. However, some flow disturbances and increased stiffness persist in the proximal DescAo. Further longitudinal studies are needed to evaluate whether persistent alterations contribute to post-surgical risk.
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Affiliation(s)
| | - Aroa Ruiz-Muñoz
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.
| | - Laura Galian-Gay
- CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Filipa Valente
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Guillem Casas
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ruperto Oliveró
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | - Kevin M Johnson
- Departments of Medical Physics & Radiology, University of Wisconsin. WI, USA
| | - Oliver Wieben
- Departments of Medical Physics & Radiology, University of Wisconsin. WI, USA
| | - Ignacio Ferreira-González
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Arturo Evangelista
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón. Quirónsalud-Teknon. Barcelona, Spain
| | - Jose Rodriguez-Palomares
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Gisela Teixidó-Turà
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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14
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Katsaros O, Ktenopoulos N, Korovesis T, Benetos G, Apostolos A, Koliastasis L, Sagris M, Milaras N, Latsios G, Synetos A, Drakopoulou M, Tsalamandris S, Karanasos A, Tsioufis K, Toutouzas K. Bicuspid Aortic Valve Disease: From Pathophysiology to Treatment. J Clin Med 2024; 13:4970. [PMID: 39274183 PMCID: PMC11396317 DOI: 10.3390/jcm13174970] [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: 06/13/2024] [Revised: 08/10/2024] [Accepted: 08/18/2024] [Indexed: 09/16/2024] Open
Abstract
The Bicuspid Aortic Valve (BAV) is the most common congenital anomaly in adults, with a global incidence of 1.3%. Despite being well documented, BAV presents significant clinical challenges due to its phenotypic heterogeneity, diverse clinical manifestations, and variable outcomes. Pathophysiologically, BAV differs from tricuspid valves in calcification patterns and hemodynamic effects, leading to increased shear stress and aortic root dilatation, while it is influenced by genetic and hemodynamic factors. This is why therapeutically, BAV presents challenges for both surgical and transcatheter interventions, with surgical approaches being traditionally preferred, especially when aortopathy is present. However, transcatheter aortic valve implantation (TAVI) has emerged as a viable option, with studies showing comparable outcomes to surgery in selected patients, while advancements in TAVI and a better understanding of BAV's genetic and pathophysiological nuances are expanding treatment options. The choice between mechanical and bioprosthetic valves also presents considerations, particularly regarding long-term durability and the need for anticoagulation. Future research should focus on long-term registries and genetic studies to refine therapeutic strategies and improve patient outcomes. This review aims to evaluate current approaches in the surgical and interventional management of BAV, focusing on its anatomy, pathogenesis, pathophysiology, and therapeutic strategies.
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Affiliation(s)
- Odysseas Katsaros
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Theofanis Korovesis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Georgios Benetos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Leonidas Koliastasis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Marios Sagris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Nikias Milaras
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - George Latsios
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Andreas Synetos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
- Medical School, European University of Cyprus, Nicosia 1516, Cyprus
| | - Maria Drakopoulou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Sotirios Tsalamandris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Antonios Karanasos
- Department of Cardiology, Patras University Hospital, 26504 Patras, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
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15
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Walter C, Leinweber ME, Mlekusch I, Assadian A, Hofmann AG. Temporal Pattern Analysis of Ultrasound Surveillance Data in Vascular Connective Tissue Disorders. Diagnostics (Basel) 2024; 14:1749. [PMID: 39202237 PMCID: PMC11354072 DOI: 10.3390/diagnostics14161749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/25/2024] [Accepted: 08/06/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Ehlers-Danlos syndrome (EDS), Marfan syndrome (MFS), and Loeys-Dietz syndrome (LDS) are connective tissue disorders frequently associated with vascular aneurysm formation, dissections, and subsequent major complications. Regular imaging surveillance is recommended for these conditions. However, no guidelines currently exist regarding imaging modality or surveillance intervals. METHODS This retrospective single-center observational study analyzed clinical and imaging data of patients attending an outpatient clinic for vascular connective tissue disorders between August 2008 and January 2024. Imaging (1424 data points in total) and clinical data were extracted from electronic health records. Analysis primarily included a comparison of vessel diameter progression across imaging modalities, with an additional review of the clinical history of vascular events. RESULTS In total, 19 patients with vascular connective tissue disorders (vCTDs) underwent consultations at our outpatient clinic. Nine (47.4%) patients experienced vascular events, while two (10.5%) passed away during the study period. Multimodal imaging surveillance revealed a tendency towards arterial diameter increase. Consistent ultrasound monitoring provided more reliable diameter progression data for the same arterial segment than a combination of imaging modalities. Temporal analysis indicated a tendency for the continuous growth of the abdominal aorta, the common and internal carotid artery, and the common femoral and popliteal artery. CONCLUSION The study highlights the importance of standardized, modality-specific imaging protocols in monitoring patients with vCTDs. The variability in disease progression among these patients further complicates surveillance strategies, contemplating the need for individualized approaches. Further research and prospective multicenter studies are required to refine and improve monitoring protocols.
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Affiliation(s)
| | | | | | | | - Amun Georg Hofmann
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, 1160 Vienna, Austria
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16
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Ijiri A, Suyama Y, Ishida O, Sumi K, Tsutsumi K, Shinmoto H. Transarterial embolization for an infected internal iliac artery aneurysm without recurrence for a long period: A case report. Radiol Case Rep 2024; 19:3118-3121. [PMID: 38770390 PMCID: PMC11103356 DOI: 10.1016/j.radcr.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/22/2024] Open
Abstract
We report an 85-year-old man who underwent transarterial embolization (TAE) for an infected internal iliac artery aneurysm. The patient presented with fever and left lower abdominal pain. Computed tomography (CT) revealed the expansion of a left internal iliac artery aneurysm. We planned surgical treatment for an infected internal iliac artery aneurysm; however, the patient's age and general condition made the surgery high-risk. Therefore, we performed emergency TAE. The patient was administered antibiotics for 4 weeks and discharged on day 33 after the procedure with good progression. A 3-year follow-up CT scan showed aneurysm reduction and no recurrent infections. This case report highlights that TAE can be a treatment option for patients with an infected artery aneurysm.
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Affiliation(s)
- Atsuhiro Ijiri
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Yohsuke Suyama
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Osamu Ishida
- Department of Cardiovascular Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Koji Sumi
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Koji Tsutsumi
- Department of Cardiovascular Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
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17
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Tran EM, Wai KM, Kossler AL, Mruthyunjaya P, Rahimy E, Koo EB. Association of Ocular Manifestations of Marfan Syndrome With Cardiovascular Complications. Am J Ophthalmol 2024; 264:85-89. [PMID: 38403098 DOI: 10.1016/j.ajo.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To evaluate associations between ocular manifestations of Marfan syndrome and cardiovascular complications. DESIGN Retrospective cohort study. METHODS The TriNetX Analytics platform, a federated health research network of aggregated deidentified electronic health record data of more than 119 million patients, was used to identify patients diagnosed with Marfan syndrome. Univariate logistic regression models were used to evaluate the association of ocular manifestations of Marfan syndrome (such as retinal tears/detachment, lens dislocation, and myopia), with cardiovascular comorbidities. Additional sensitivity analyses were performed using propensity matching. Odds ratios and 95% CIs were calculated for incidence of cardiovascular comorbidities (including aortic dissection, valvular disease, and arrhythmias) following diagnosis of Marfan syndrome. RESULTS A total of 19,105 patients were identified who were diagnosed with Marfan disease without ocular manifestations, and an additional 3887 Marfan patients with ocular comorbidities. Patients who were diagnosed with ocular disease included 883 with ectopic lens, 417 with retinal tear or detachment, 683 with aphakia, 534 with pseudophakia, and 2465 with myopia. Patients with any ocular manifestations of Marfan were significantly more likely to be diagnosed with all cardiovascular comorbidities modeled including aortic aneurysm and dissection (OR 2.035; P < .0001), mitral valve prolapse (OR 2.725; P < .0001), tricuspid valve disorders (OR 2.142; P < .0001), cardiac arrhythmias (OR 1.836; P < .0001), and all cardiovascular outcomes combined (OR 2.194; P < .0001). CONCLUSIONS In a large and diverse cohort of patients with Marfan syndrome, ocular manifestations of the disorder appear strongly associated with cardiovascular comorbidities.
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Affiliation(s)
- Elaine M Tran
- Byers Eye Institute at Stanford (E.M.T., K.M.W., A.L.K., P.M., E.R., E.B.K.), Palo Alto, California
| | - Karen M Wai
- Byers Eye Institute at Stanford (E.M.T., K.M.W., A.L.K., P.M., E.R., E.B.K.), Palo Alto, California
| | - Andrea L Kossler
- Byers Eye Institute at Stanford (E.M.T., K.M.W., A.L.K., P.M., E.R., E.B.K.), Palo Alto, California
| | - Prithvi Mruthyunjaya
- Byers Eye Institute at Stanford (E.M.T., K.M.W., A.L.K., P.M., E.R., E.B.K.), Palo Alto, California
| | - Ehsan Rahimy
- Byers Eye Institute at Stanford (E.M.T., K.M.W., A.L.K., P.M., E.R., E.B.K.), Palo Alto, California; Department of Ophthalmology, Palo Alto Medical Foundation (E.R.), Palo Alto, California, USA
| | - Euna B Koo
- Byers Eye Institute at Stanford (E.M.T., K.M.W., A.L.K., P.M., E.R., E.B.K.), Palo Alto, California.
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18
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Wang Z, Yu X, Ding S, Zhang W, Liang C, Chen H. Management and outcomes of aortic dissection type B in late pregnancy: A retrospective case series. BJOG 2024. [PMID: 39075929 DOI: 10.1111/1471-0528.17923] [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: 12/10/2023] [Revised: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE Pregnancy complicated with type B aortic dissection is a rare but devastating condition. Guidelines for managing this condition are lacking. We present our observation and experiences in managing five pregnant women with complicated type B aortic dissection in the second or third trimesters, aiming to gain insights that can aid in proposing an appropriate management strategy. DESIGN A retrospective study. SETTING Zhongnan Hospital of Wuhan University. POPULATION Pregnant women with complicated type B aortic dissection. METHODS Clinical data of five pregnant women with complicated type B aortic dissection admitted to Zhongnan Hospital of Wuhan University from January 2022 to June 2023 were collected. The clinical characteristics, treatment strategies, and corresponding maternal and infant outcomes were retrospectively analysed. MAIN OUTCOME MEASURES Survival of mothers and foetuses. RESULTS All five study participants were diagnosed with complicated type B aortic dissection by computed tomography angiography (CTA). The range of gestational weeks at admission was 27 weeks + 3 days to 36 weeks + 6 days. The first patient, planning a caesarean section (C-section) followed by thoracic endovascular aortic repair (TEVAR), died of aortic dissection rupture during C-section. Her neonate was successfully rescued. In contrast, the remaining four patients who underwent TEVAR first survived. Among them, three patients underwent single-stage aortic repair and delivery, while one patient received C-section 31 days after TEVAR. Three preterm live births were recorded among these surviving mothers. Neonatal death occurred in one case with a gestational age of 29 weeks + 5 days, who had foetal distress before surgery. During the follow-up period of up to 3 months, no maternal or infant death occurred. No device-related or systemic complications were observed in the surviving mothers after discharge. Routine physical examinations of the four live births showed no abnormalities. CONCLUSIONS For pregnant women with thoracic back pain and high suspicion of aortic dissection, CTA should be conducted promptly to prevent missed or delayed diagnosis. Maternal survival should be prioritised over foetal outcome once diagnosed. TEVAR was demonstrated to be safe and feasible for such patients. For women with complicated type B aortic dissection in late pregnancy, TEVAR followed by C-section may be a promising treatment strategy.
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Affiliation(s)
- Zhen Wang
- Department of Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, Hubei, China
| | - Xuechen Yu
- Department of Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, Hubei, China
| | - Shuai Ding
- Department of Cardiovascular Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chuan Liang
- Department of Cardiovascular Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huijun Chen
- Department of Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, Hubei, China
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19
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Rezaeitaleshmahalleh M, Lyu Z, Mu N, Wang M, Zhang X, Rasmussen TE, McBane Ii RD, Jiang J. Computational Hemodynamics-Based Growth Prediction for Small Abdominal Aortic Aneurysms: Laminar Simulations Versus Large Eddy Simulations. Ann Biomed Eng 2024:10.1007/s10439-024-03572-3. [PMID: 39020077 DOI: 10.1007/s10439-024-03572-3] [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: 03/04/2024] [Accepted: 06/27/2024] [Indexed: 07/19/2024]
Abstract
Prior studies have shown that computational fluid dynamics (CFD) simulations help assess patient-specific hemodynamics in abdominal aortic aneurysms (AAAs); patient-specific hemodynamic stressors are frequently used to predict an AAA's growth. Previous studies have utilized both laminar and turbulent simulation models to simulate hemodynamics. However, the impact of different CFD simulation models on the predictive modeling of AAA growth remains unknown and is thus the knowledge gap that motivates this study. Specifically, CFD simulations were performed for 70 AAA models derived from 70 patients' computed tomography angiography (CTA) data with known growth status (i.e., fast-growing [> 5 mm/yr] or slowly growing [< 5 mm/yr]). We used laminar and large eddy simulation (LES) models to obtain hemodynamic parameters to predict AAAs' growth status. Predicting the growth status of AAAs was based on morphological, hemodynamic, and patient health parameters in conjunction with three classical machine learning (ML) classifiers, namely, support vector machine (SVM), K-nearest neighbor (KNN), and generalized linear model (GLM). Our preliminary results estimated aneurysmal flow stability and wall shear stress (WSS) were comparable in both laminar and LES flow simulations. Moreover, computed WSS and velocity-related hemodynamic variables obtained from the laminar and LES simulations showed comparable abilities in differentiating the growth status of AAAs. More importantly, the predictive modeling performance of the three ML classifiers mentioned above was similar, with less than a 2% difference observed (p-value > 0.05). In closing, our findings suggest that two different flow simulations investigated did not significantly affect outcomes of computational hemodynamics and predictive modeling of AAAs' growth status, given the data investigated.
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Affiliation(s)
- Mostafa Rezaeitaleshmahalleh
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
- Joint Center for Biocomputing and Digital Health, Health Research Institute, and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA
| | - Zonghan Lyu
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
- Joint Center for Biocomputing and Digital Health, Health Research Institute, and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA
| | - Nan Mu
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
- Joint Center for Biocomputing and Digital Health, Health Research Institute, and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA
- Sichuan Normal University, Chengdu, Sichuan, China
| | - Min Wang
- Department of Management Science and Statistics, The University of Texas at San Antonio, San Antonino, TX, USA
| | - Xiaoming Zhang
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Todd E Rasmussen
- Department of Vascular Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Jingfeng Jiang
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA.
- Joint Center for Biocomputing and Digital Health, Health Research Institute, and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA.
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA.
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20
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Forneris A, Hassanabad AF, Appoo JJ, Di Martino ES. Predicting Aneurysmal Degeneration in Uncomplicated Residual Type B Aortic Dissection. Bioengineering (Basel) 2024; 11:690. [PMID: 39061772 PMCID: PMC11274148 DOI: 10.3390/bioengineering11070690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
The formation of an aneurysm in the false lumen (FL) is a long-term complication in a significant percentage of type B aortic dissection (AD) patients. The ability to predict which patients are likely to progress to aneurysm formation is key to justifying the risks of interventional therapy. The investigation of patient-specific hemodynamics has the potential to enable a patient-tailored approach to improve prognosis by guiding disease management for type B dissection. CFD-derived hemodynamic descriptors and geometric features were used to retrospectively assess individual aortas for a population of residual type B AD patients and analyze correlations with known outcomes (i.e., rapid aortic growth, death). The results highlight great variability in flow patterns and hemodynamic descriptors. A rapid aortic expansion was found to be associated with a larger FL. Time-averaged wall shear stress at the tear region emerged as a possible indicator of the dynamics of flow exchange between lumens and its effect on the evolution of individual aortas. High FL flow rate and tortuosity were associated with adverse outcomes suggesting a role as indicators of risk. AD induces complex changes in vessel geometry and hemodynamics. The reported findings emphasize the need for a patient-tailored approach when evaluating uncomplicated type B AD patients and show the potential of CFD-derived hemodynamics to complement anatomical assessment and help disease management.
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Affiliation(s)
- Arianna Forneris
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada;
- R&D Department, ViTAA Medical Solutions, Montreal, QC H2K 1M6, Canada
| | - Ali F. Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (A.F.H.); (J.J.A.)
| | - Jehangir J. Appoo
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (A.F.H.); (J.J.A.)
| | - Elena S. Di Martino
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada;
- R&D Department, ViTAA Medical Solutions, Montreal, QC H2K 1M6, Canada
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21
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Zamirpour S, Gulati A, Xuan Y, Leach JR, Saloner DA, Guccione JM, Boskovski MT, Ge L, Tseng EE. Temporal evolution of ascending aortic aneurysm wall stress predicts all-cause mortality. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae116. [PMID: 38913870 PMCID: PMC11229433 DOI: 10.1093/icvts/ivae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/29/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
OBJECTIVES Diameter-based risk stratification for elective repair of ascending aortic aneurysm fails to prevent type A dissection in many patients. Aneurysm wall stresses may contribute to risk prediction; however, rates of wall stress change over time are poorly understood. Our objective was to examine aneurysm wall stress changes over 3-5 years and subsequent all-cause mortality. METHODS Male veterans with <5.5 cm ascending aortic aneurysms and computed tomography at baseline and 3- to 5-year follow-up underwent three-dimensional aneurysm model construction. Peak circumferential and longitudinal wall stresses at systole were calculated using finite element analysis. Temporal trends were assessed by mixed-effects modelling. Changes in aortic wall stresses, diameter and length over time were evaluated as predictors of subsequent 3-year all-cause mortality by Cox proportional hazards modelling. RESULTS Sixty-two male veterans were included in the study. Yearly changes in geometric and biomechanical measures were 0.12 mm/year (95% confidence interval, 0.04-0.20) for aortic diameter, 0.41 mm/year (0.12-0.71) for aortic length, 1.19 kPa/year -5.94 to 8.33) for peak circumferential stress, and 0.48 kPa/year (-3.89 to 4.84) for peak longitudinal stress. Yearly change in peak circumferential stress was significantly associated with hazard of death-hazard ratio for peak circumferential stress growth per 10 kPa/year, 1.27 (95% CI, 1.02-1.60; P = 0.037); hazard ratio for peak circumferential stress growth ≥ 32 kPa/year, 8.47 (95% CI, 2.42-30; P < 0.001). CONCLUSIONS In this population of nonsurgical aneurysm patients, large temporal changes in peak circumferential stress, but not aortic diameter or length, was associated with all-cause mortality. Biomechanical stress and stress changes over time may be beneficial as additional risk factors for elective surgery in small aneurysms.
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Affiliation(s)
- Siavash Zamirpour
- Department of Surgery, University of California San Francisco and San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Arushi Gulati
- Department of Surgery, University of California San Francisco and San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Yue Xuan
- Department of Surgery, University of California San Francisco and San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Joseph R Leach
- Department of Radiology, University of California San Francisco and San Francisco VA Healthcare System, San Francisco, CA, USA
| | - David A Saloner
- Department of Radiology, University of California San Francisco and San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Julius M Guccione
- Department of Surgery, University of California San Francisco and San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Marko T Boskovski
- Department of Surgery, University of California San Francisco and San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Liang Ge
- Department of Surgery, University of California San Francisco and San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Elaine E Tseng
- Department of Surgery, University of California San Francisco and San Francisco VA Healthcare System, San Francisco, CA, USA
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22
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Akutsu K, Ozaki K, Oshima S, Sakurai S, Hirokami T, Hirai Y, Okiyama M, Kishinami G, Ishiko K, Yamaguchi K, Yamamoto S. Successful redo open thoracoabdominal aortic aneurysm surgery in a patient with vascular Ehlers-Danlos syndrome: A case report. J Cardiol Cases 2024; 30:16-19. [PMID: 39007042 PMCID: PMC11245757 DOI: 10.1016/j.jccase.2024.03.002] [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: 09/07/2023] [Revised: 01/16/2024] [Accepted: 03/05/2024] [Indexed: 07/16/2024] Open
Abstract
We report a case of a 63-year-old woman diagnosed with vascular Ehlers-Danlos syndrome (vEDS) who survived two prophylactic surgeries for the dilatation of a thoracoabdominal aortic aneurysm. She initially developed acute type B aortic dissection at the age of 44 years. Five years later, her dissected descending aorta was enlarged to 54 mm; thus, the descending aorta was replaced as the first surgery. Fortunately, the intra- and post-operative courses were uneventful. Fourteen years post her first surgery, the dissected thoracoabdominal aorta distal to the graft expanded to 53 mm; however, no anastomotic leakage was observed. Genetic testing revealed a COL3A1 abnormality, confirming the diagnosis of vEDS. Thoracoabdominal aorta replacement using deep hypothermia circulatory arrest was performed because of the high risk of aortic aneurysm rupture. The second surgery was performed without complications, and no complications were observed 13 months post-surgery. The major reason for a successful surgery in this patient was the relatively low vascular fragility associated with vEDS. This case demonstrates that there may be considerable individual differences in vascular fragility in patients with vEDS. Thus, surgical repair, along with endovascular therapy, might still be a beneficial option for patients with vEDS having large aortic aneurysms and a high risk of rupture. Learning objective Prophylactic surgery for vascular lesions in Ehlers-Danlos syndrome (vEDS) is generally not recommended because of its high vascular fragility. However, if a patient with vEDS has an aortic aneurysm that is at a very high risk of rupture, aggressive treatment is a plausible option as there may be considerable individual differences in vascular fragility among patients with vEDS.
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Affiliation(s)
- Koichi Akutsu
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kensuke Ozaki
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Susumu Oshima
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Shigeru Sakurai
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Tomohiro Hirokami
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yuki Hirai
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Makoto Okiyama
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Goro Kishinami
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Kazumasa Ishiko
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Ko Yamaguchi
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Shin Yamamoto
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
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23
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Zhu K, Lv F, Hou X, Wang F, Pang L, Zhong M. Thrombosis in vasculitis: An updated review of etiology, pathophysiology, and treatment. Heliyon 2024; 10:e30615. [PMID: 38975109 PMCID: PMC11225688 DOI: 10.1016/j.heliyon.2024.e30615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction Thromboembolic disease is a complication of many vasculitides. A common observation is that thromboembolic events coincide with the period of vasculitic disease, but the mechanism by which this occurs remains unclear. Inflammatory thrombosis is now recognized as a symptom of arteritis rheumatic, and vasculitides such as Behçet's syndrome (BS), and anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) or giant cell arteritis (GCA). This systematic review aimed to explain recent findings related to etiology, pathophysiology, and treatment methods for BS, AAV, and medium/large-vessel vasculitis. Methods A comprehensive literature search on English sources from PubMed, Scopus, MEDLINE, Science Direct, ProQuest, AIM, CINAHIL, and ELDIS databases was used to find the relevant articles and reports. The relevant papers (having full text) were obtained until June 2023. Two independent reviewers screened the titles and abstracts of the obtained articles, and a third arbitrator resolved disputes between the reviewers. Results and conclusion It is becoming increasingly clear that certain systemic inflammatory diseases, like vasculitis, are linked to a higher risk of both venous and arterial thrombosis. An increased incidence of thromboembolic disease in AAV has been noted, particularly during times of active disease. Growing evidence supports the use of immunosuppression in the management of venous thrombosis in vasculitis. These patients also have a higher risk of developing ischemic disease.
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Affiliation(s)
- Kai Zhu
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Feng Lv
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Xiangqian Hou
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Feng Wang
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Linbin Pang
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Miqian Zhong
- Department of Hematopathology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, 2530000, China
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24
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Ren S, Essat M, Pandor A, Goodacre S, Ren S, Clowes M, Bima P, Toyofuku M, McLatchie R, Bossone E. Diagnostic accuracy of the aortic dissection detection risk score alone or with D-dimer for acute aortic syndromes: Systematic review and meta-analysis. PLoS One 2024; 19:e0304401. [PMID: 38905181 PMCID: PMC11192411 DOI: 10.1371/journal.pone.0304401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/11/2024] [Indexed: 06/23/2024] Open
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of the aortic dissection detection risk score (ADD-RS) used alone or in combination with D-dimer for detecting acute aortic syndrome (AAS) in patients presenting with symptoms suggestive of AAS. METHODS We searched MEDLINE, EMBASE, and the Cochrane Library from inception to February 2024. Additionally, the reference lists of included studies and other systematic reviews were thoroughly searched. All diagnostic accuracy studies that assessed the use of ADD-RS alone or with D-Dimer for diagnosing AAS compared with a reference standard test (e.g. computer tomographic angiography (CTA), ECG-gated CTA, echocardiography, magnetic resonance angiography, operation, or autopsy) were included. Two reviewers independently selected and extracted data. Risk of bias was appraised using QUADAS-2 tool. Data were synthesised using hierarchical meta-analysis models. RESULTS We selected 13 studies from the 2017 citations identified, including six studies evaluating combinations of ADD-RS alongside D-dimer>500ng/L. Summary sensitivities and specificities (95% credible interval) were: ADD-RS>0 94.6% (90%, 97.5%) and 34.7% (20.7%, 51.2%), ADD-RS>1 43.4% (31.2%, 57.1%) and 89.3% (80.4%, 94.8%); ADD RS>0 or D-Dimer>500ng/L 99.8% (98.7%, 100%) and 21.8% (12.1%, 32.6%); ADD RS>1 or D-Dimer>500ng/L 98.3% (94.9%, 99.5%) and 51.4% (38.7%, 64.1%); ADD RS>1 or ADD RS = 1 with D-dimer>500ng/L 93.1% (87.1%, 96.3%) and 67.1% (54.4%, 77.7%). CONCLUSIONS Combinations of ADD-RS and D-dimer can be used to select patients with suspected AAS for imaging with a range of trade-offs between sensitivity (93.1% to 99.8%) and specificity (21.8% to 67.1%).
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Affiliation(s)
- Sa Ren
- School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Munira Essat
- School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Abdullah Pandor
- School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Steve Goodacre
- School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Shijie Ren
- School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Mark Clowes
- School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Paolo Bima
- Department of Medical Science, University of Turin, Turin, Italy
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Rachel McLatchie
- Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Eduardo Bossone
- Department of Public Health, University of Naples “Federico II”, Naples, Italy
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25
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Herzig MS, McIlvaine S, Feinberg L, Spiel MH, Carroll BJ. Outcomes of Bicuspid Aortic Valve in Pregnancy. Am J Cardiol 2024; 221:74-76. [PMID: 38697454 DOI: 10.1016/j.amjcard.2024.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Matthew S Herzig
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Susan McIlvaine
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Loryn Feinberg
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Melissa H Spiel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Brett J Carroll
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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26
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Mannina C, Kini A, Carbone A, Neibart E, Bossone E, Prandi FR, Tadros R, Esposito G, Erbel R, Sharma SK, Lerakis S. Management of Systemic Inflammatory Response Syndrome After Cardiovascular Interventions. Diagnostic, Prognostic, and Therapeutic Implications. Am J Cardiol 2024; 221:84-93. [PMID: 38649128 DOI: 10.1016/j.amjcard.2024.04.007] [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: 02/06/2024] [Revised: 03/11/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
A substantial number of patients may experience systemic inflammatory response syndrome (SIRS) and related adverse events after transcatheter aortic valve implantation and endovascular aortic aneurysm repair. Although a clear etiology has not been established, endothelial disruption and tissue-ischemic response secondary to the foreign material may represent the trigger events. A latency period (0 to 48 hours) may occur between the initial injury and onset of symptoms mirroring an initial local response followed by a systemic response. Clinical presentation can be mild or severe depending on external triggers and characteristics of the patient. Diagnosis is challenging because it simulates an infection, but lack of response to antibiotics, negative cultures are supportive of SIRS. Increased in-hospital stay, readmissions, major cardiovascular events, and reduced durability of the device used are the main complications. Treatment includes non-steroidal anti-inflammatory drugs or corticosteroids. In conclusion, further studies are warranted to fully explore pathophysiologic mechanisms underpinning SIRS and the possibility of enhancing device material immune compatibility to reduce the inflammatory reaction of the host tissue.
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Affiliation(s)
- Carlo Mannina
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, the Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Andreina Carbone
- Unit of Cardiology, University Hospital "Luigi Vanvitelli", Naples, Italy; Department of Public Health, Federico II University, Naples, Italy
| | - Eric Neibart
- The Zena and Michael A. Wiener Cardiovascular Institute, the Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Eduardo Bossone
- Department of Public Health, Federico II University, Naples, Italy
| | - Francesca Romana Prandi
- The Zena and Michael A. Wiener Cardiovascular Institute, the Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Rami Tadros
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, the Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, the Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York.
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27
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Grewal N, Idhrees M, Velayudhan B, Klautz RJM, Grewal S. Practical Considerations of Remote Care in Thoracic Aortopathy in India. J Clin Med 2024; 13:3327. [PMID: 38893041 PMCID: PMC11172736 DOI: 10.3390/jcm13113327] [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: 04/25/2024] [Revised: 05/26/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Thoracic aortopathy includes conditions like aortic aneurysms and dissections, posing significant management challenges. In India, care delivery is complicated by geographic vastness, financial constraints, and healthcare resource disparities. Telemedicine and digital health technologies offer promising solutions. Methods: A comprehensive review of literature and clinical experiences was conducted to explore the implementation of remote care strategies for thoracic aortopathy in India. The review included studies from 2000 to 2023 and insights from cardiothoracic specialists. Results: Remote care benefits include improved access to specialized expertise, enhanced patient engagement, and optimized resource utilization. Telemedicine enables consultations without travel, and remote monitoring facilitates early intervention. However, challenges like technology integration, digital literacy, patient engagement, privacy concerns, and regulatory compliance need addressing. Discussion: Telemedicine offers significant advantages but requires overcoming challenges to ensure effective, secure care. Careful planning for technology integration, patient education, robust privacy measures, and supportive regulatory policies are essential. Addressing these issues can bridge the healthcare access gap and improve outcomes in India's diverse landscape.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105AZ Amsterdam, The Netherlands;
- Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 Leiden, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, 2333 Leiden, The Netherlands
| | - Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai 600083, India; (M.I.); (B.V.)
| | - Bashi Velayudhan
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai 600083, India; (M.I.); (B.V.)
| | - Robert J. M. Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105AZ Amsterdam, The Netherlands;
- Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 Leiden, The Netherlands
| | - Simran Grewal
- Department of Orthopaedic Surgery, Amsterdam University Medical Center, 1105 Amsterdam, The Netherlands;
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28
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Verzini F. In the endless search of the holy grail of "level 1 evidence". THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:179-180. [PMID: 39007551 DOI: 10.23736/s0021-9509.24.13102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Affiliation(s)
- Fabio Verzini
- Unit of Vascular Surgery, Department of Surgical Sciences, Città della Salute e della Scienza di Torino University Hospital, University of Turin, Turin, Italy -
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29
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Zeng CR, Gao JW, Wu MX, You S, Chen ZT, Gao QY, Cai ZX, Liu PM, Cai YW, Liang XT, Cai JW, Liao GH, Chen N, Huang ZG, Wang JF, Zhang HF, Chen YX. Dietary vitamin C and vitamin E with the risk of aortic aneurysm and dissection: A prospective population-based cohort study. Nutr Metab Cardiovasc Dis 2024; 34:1407-1415. [PMID: 38664127 DOI: 10.1016/j.numecd.2024.01.024] [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: 09/28/2023] [Revised: 12/24/2023] [Accepted: 01/19/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND AND AIMS The associations between dietary vitamin C (VC), vitamin E (VE) intake and aortic aneurysm and dissection (AAD) remain unclear. This study aimed to prospectively investigate the associations between dietary VC and VE with the incident risk of AAD. METHODS AND RESULTS A total of 139 477 participants of UK Biobank cohort were included in the analysis. Dietary VC and VE consumptions were acquired through a 24-h recall questionnaire. Cox proportional regression models were used to examine the associations between VC, VE intake and the risk of AAD. Incident AAD was ascertained through hospital inpatient records and death registers. During a median follow-up of 12.5 years, 962 incident AAD events were documented. Both dietary VC [adjusted hazard ratio (HR), 0.77; 95 % confidence intervals (CI), 0.63-0.93; P-trend = 0.008] and VE (adjusted HR, 0.70; 95 % CI, 0.57-0.87; P-trend = 0.002) were inversely associated with incident AAD when comparing the participants in the highest quartile with those in the lowest. In subgroup analyses, the associations were more pronounced in participants who were over 60 years old, participants with smoking history, hypertension or hyperlipidemia, who were under the high risk of AAD. CONCLUSION Higher dietary VC and VE intakes are associated with reduced risk of AAD. Our study emphasizes the importance of diet adjustment strategies targeted on VC and VE to lower the incidence rate of AAD especially in the high-risk population.
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Affiliation(s)
- Chuan-Rui Zeng
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-Wei Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mao-Xiong Wu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Si You
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhi-Teng Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qing-Yuan Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhao-Xi Cai
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pin-Ming Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yang-Wei Cai
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Tian Liang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie-Wen Cai
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guang-Hong Liao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Nuo Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ze-Gui Huang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-Feng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Hai-Feng Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Yang-Xin Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Lee YJ, Aghayev A, Azene EM, Bhatti S, Ewell JC, Hedgire SS, Kendi AT, Kim ESH, Kirsch DS, Nagpal P, Pillai AK, Ripley B, Tannenbaum A, Thiessen MEW, Thomas R, Woolsey S, Steigner ML. ACR Appropriateness Criteria® Screening for Abdominal Aortic Aneurysm. J Am Coll Radiol 2024; 21:S286-S291. [PMID: 38823950 DOI: 10.1016/j.jacr.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Abdominal aortic aneurysm (AAA) is a significant vascular disease found in 4% to 8% of the screening population. If ruptured, its mortality rate is between 75% and 90%, and it accounts for up to 5% of sudden deaths in the United States. Therefore, screening of AAA while asymptomatic has been a crucial portion of preventive health care worldwide. Ultrasound of the abdominal aorta is the primary imaging modality for screening of AAA recommended for asymptomatic adults regardless of their family history or smoking history. Alternatively, duplex ultrasound and CT abdomen and pelvis without contrast may be appropriate for screening. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Yoo Jin Lee
- University of California, San Francisco, San Francisco, California.
| | - Ayaz Aghayev
- Panel Chair, Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Salman Bhatti
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Society for Cardiovascular Magnetic Resonance
| | - Joshua C Ewell
- Rutgers, New Jersey Medical School, Newark, New Jersey; Committee on Emergency Radiology-GSER
| | - Sandeep S Hedgire
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | - Esther S H Kim
- Atrium Health, Sanger Heart and Vascular Institute, Charlotte, North Carolina; American Society of Echocardiography
| | | | - Prashant Nagpal
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anil K Pillai
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Beth Ripley
- VA Puget Sound Health Care System and University of Washington, Seattle, Washington
| | | | - Molly E W Thiessen
- Denver Health Medical Center, Denver, Colorado and University of Colorado School of Medicine, Aurora, Colorado; American College of Emergency Physicians
| | - Richard Thomas
- Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Sarah Woolsey
- Association for Utah Community Health, Salt Lake City, Utah; American Academy of Family Physicians
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31
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Roselli EE. Author Reply to Commentary: Don't miss the forest for the trees. J Thorac Cardiovasc Surg 2024; 167:2062. [PMID: 36610882 DOI: 10.1016/j.jtcvs.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart Vascular and Thoracic Institute, Cleveland, Ohio; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
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Lv L, Wang C, Lang X, Lu F, Tian Y, Zhao Y, Zhi A. Impact of pulmonary artery intramural hematoma on patients with acute type A aortic dissection. Eur Radiol 2024:10.1007/s00330-024-10747-y. [PMID: 38777904 DOI: 10.1007/s00330-024-10747-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/13/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To investigate the short-term/long-term impact of pulmonary artery intramural hematoma (PA-IMH) in patients with acute Stanford type A aortic dissection (ATAAD) following surgical repair. MATERIALS AND METHODS Consecutive patients with ATAAD who received surgical repair at Beijing and Yunnan Fuwai Hospital in 2010-2021 were retrospectively reviewed. Patients with hemorrhage extending along the PA were identified as the PA-IMH group. Multivariable logistics regression was used to obtain the odds ratio (OR), and the Kaplan-Meier method was used to estimate the survival rate. RESULTS Of the 2046 ATAAD patients, 324 (15.8%) patients were identified with PA-IMH, and 1722 (84.2%) were without PA-IMH. PA-IMH had a higher prevalence in patients with older age, female gender, aortic IMH, and type II aortic dissection. PA-IMH patients incurred excess early mortality compared with non-PA-IMH patients (9.3% vs. 5.6%, OR = 1.86, 95%CI 1.19-2.91, p = 0.006). The results were stable in the subgroup analysis, with an increased risk in older (> 70 years) or DeBakey type II ATAAD patients. Notably, an increase in the degree and extent of PA-IMH exacerbated the risk of early mortality. However, after landmark analysis at 30-day postsurgery, no significant difference was noted in the long-term outcomes between PA-IMH and non-PA-IMH groups (p = 0.440). The 5-year survival rates were 87.1% (95%CI: 83.3%, 91.1%) and 90.1% (95%CI: 88.5%, 91.7%), respectively. CONCLUSIONS The presence of PA-IMH in ATAAD patients is common and is independently associated with increased early mortality after surgical repair, especially in those with older age (> 70) or type II dissection. However, such detrimental effects do not persist in the long-term follow-up among patients who survived hospital discharge. CLINICAL RELEVANCE STATEMENT We confirmed that PA-IMH significantly increases early postoperative mortality in patients with acute type A aortic dissection, especially in older patients or DeBakey type II dissection. This should prompt further investigation of the incremental role of PA-IMH in this pathology. KEY POINTS Acute type A aortic dissection mortality gets worse when pulmonary artery intramural hematoma is present. Pulmonary artery-intramural hematoma increased the risk of early mortality but not affect long-term prognosis. Further research should investigate the effects of pulmonary artery intramural thrombus on aortic dissection.
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Affiliation(s)
- Lizhi Lv
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiovascular Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming, 650102, China
| | - Cheng Wang
- Department of Cardiovascular Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming, 650102, China
- Department of Structural Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xinyue Lang
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, the National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 102300, China
| | - Fawen Lu
- Department of Pediatric Intensive Care Unit, Yunnan Fuwai Cardiovascular Hospital, Kunming, 650102, China
| | - Yidan Tian
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yong Zhao
- Department of Cardiovascular Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming, 650102, China
| | - Aihua Zhi
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
- Department of Radiology, Yunnan Fuwai Cardiovascular Hospital, Kunming, 650102, China.
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Than LX, Quang NN, Hung PM. Aortic Balloon Occlusion in Repair of Ruptured Abdominal Aortic Aneurysm. JACC Case Rep 2024; 29:102331. [PMID: 38601839 PMCID: PMC11002862 DOI: 10.1016/j.jaccas.2024.102331] [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: 09/11/2023] [Revised: 11/07/2023] [Accepted: 11/20/2023] [Indexed: 04/12/2024]
Abstract
This case report details a novel technique implemented in Vietnam. When full equipment is unavailable, we adapt it by using aortic balloon occlusion to enhance the patient's hemodynamics and mitigate the risk of intraprocedural exsanguination. This approach effectively addresses the rupture of abdominal aortic aneurysms in patients with unstable hemodynamic conditions.
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Affiliation(s)
- Le Xuan Than
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Pham Manh Hung
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
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Wang Y, Wang B, Qiu C. TEVAR with fenestrations of all supra-aortic branches for traumatic aortic pseudoaneurysm: Case report and systematic review. Vascular 2024:17085381241254427. [PMID: 38739928 DOI: 10.1177/17085381241254427] [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: 05/16/2024]
Abstract
OBJECTIVES Blunt thoracic aortic injuries (BTAIs) involving the aortic arch are a challenging condition. Thoracic endovascular aortic repair (TEVAR) with fenestration, which expands the proximal landing zone, is able to exclude the injury while preserving blood flow in supra-aortic branches. METHODS Here we report a case of TEVAR with fenestrations of all supra-aortic branches for traumatic aortic pseudoaneurysm and perform a systematic review. RESULTS A 24-year-old man suffering a blunt thoracic injury and a left femoral fracture was sent to our hospital. A pseudoaneurysm was found in the aortic arch between the brachiocephalic artery and the left common carotid artery. The patient underwent emergent TEVAR with fenestrations of all supra-aortic branches, which excluded the pseudoaneurysm and preserved the patency of all branches. The orthopedic team then treated the femoral fracture. The patient's recovery was unremarkable. We performed a systematic review on TEVAR with fenestrations for BTAI. Six patients (75%) received TEVAR with single fenestration, 1 patient (12.5%) received TEVAR with two fenestrations, and 1 patient (12.5%) had fenestrations of all supra-aortic branches. Except one patient died in the perioperative, other patients survived without stent-related complications in the short-term follow-up. CONCLUSIONS TEVAR with fenestration is feasible for treating BTAI involving the aortic arch in selected patients.
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Affiliation(s)
- Yashi Wang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bing Wang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Ferrera C, Vilacosta I, Rodríguez Palomares JF, Calvo Iglesias F, Barros-Membrilla AJ, Azqueta Molluna M, Mosquera V, Tarrío R, Revilla Orodea A, Toral Sepúlveda D, Ramos González-Cristóbal I, Maroto Castellanos L, Sao A, Evangelista A. Prognostic impact of shock in patients with type A acute aortic syndrome. Results of a nationwide multicenter study. Hellenic J Cardiol 2024:S1109-9666(24)00109-X. [PMID: 38729346 DOI: 10.1016/j.hjc.2024.05.005] [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: 02/24/2024] [Revised: 04/01/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE To evaluate the clinical characteristics, imaging findings, treatment, and prognosis of patients with type A acute aortic syndrome (AAS-A) presenting with shock. To assess the impact of surgery on this patient population. METHODS The study included 521 patients with A-AAS enrolled in the Spanish Registry of Acute Aortic Syndrome (RESA-III) from January 2018 to December 2019. The RESA-III is a prospective, multicenter registry that contains AAS data from 30 tertiary-care hospitals. Patients were classified into two groups according to their clinical presentation, with or without shock. Shock was defined as persistent systolic blood pressure <80 mmHg despite adequate volume resuscitation. RESULTS 97 (18.6%) patients with A-AAS presented with shock. Clinical presentation with syncope was much more common in the Shock group (45.4% vs 10.1%, p = 0.001). Patients in the Shock group had more complications at diagnosis and before surgery: cardiac tamponade (36.2% vs 9%, p < 0.001), acute renal failure (28.9% vs 18.2%, p = 0.018), and need for orotracheal intubation (40% vs 9.1%, p < 0.001). There were no significant differences in aortic regurgitation (51.6% vs 46.7%, p = 0.396) between groups. In-hospital mortality was higher among patients with shock (48.5% vs 27.4%, p < 0.001). Surgery was associated with a significant mortality reduction both in patients with and without shock. Surgery had an independent protective effect on mortality (OR 0.03, 95% CI (0.00-0.32)). CONCLUSION Patients with AAS-A admitted with shock have a heavily increased risk of mortality. Syncope and pericardial effusion at diagnosis are strongly associated with shock. Surgery was independently associated with a mortality reduction in patients with AAS-A and shock.
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Affiliation(s)
- Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - Víctor Mosquera
- Servicio de Cirugía Cardiaca, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Rubén Tarrío
- Servicio de Cirugía Cardiaca, Hospital Son Espases, Palma de Mallorca, Spain
| | - Ana Revilla Orodea
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - David Toral Sepúlveda
- Servicio de Cirugía Cardiaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Augusto Sao
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Artur Evangelista
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Morjan M, Mestres CA, Savic V, Gerçek M, Van Hemelrijck M, Sromicki J, Dzemali O, Reser D. Indications and outcomes of second aortic procedures after acute type A dissection repair. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae076. [PMID: 38688455 DOI: 10.1093/icvts/ivae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/23/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES Aortic arch or aortic root replacement is not performed in all cases of acute type A aortic dissection (ATAD), and a second aortic procedure will become necessary over time for some patients. Indications and outcomes, of second aortic procedures have not been studied extensively. METHODS Characteristics and in-hospital outcomes of all patients undergoing surgical repair for type A acute aortic dissection were analysed and patients needing second aortic procedure during follow-up were identified. The latter group was divided in 2 subgroups: on-pump includes patients operated on using cardiopulmonary bypass and off-pump without cardiopulmonary bypass. RESULTS A total of 638 patients underwent surgery for ATAD; 8% required a second aortic procedure. The most frequent indication for the second aortic procedure was dehiscence of suture lines (44%), followed by arch dilatation (24%). In-hospital mortality was 12%. Isolated ascending aorta replacement at the first surgery was associated with higher incidence of second aortic procedure (P = 0.006). Most patients in the on-pump group underwent a proximal reoperation (75%), with a mortality rate of 14.2%. In-hospital mortality of patients in the off-pump group was 7.7%. Long-term survival analysis showed no difference between groups (P = 0,526), Off-pump patients have greater likelihood of a second intervention during follow-up (P = 0.004). CONCLUSIONS Extended aortic root surgery and customized aortic arch repair in ATAD could be reasonable to reduce the incidence and mortality of high-risk second aortic procedures.
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Affiliation(s)
- Mohammed Morjan
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
- Department of Cardiovascular Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany
| | - Carlos-A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Vedran Savic
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Mustafa Gerçek
- Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Heart Center Duisburg, Duisburg, Germany
| | | | - Juri Sromicki
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Diana Reser
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
- Herzklinik Hirslanden, Zürich, Switzerland
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Huang J, Tian H, Chen Z, Teng B, Zhao Y, Li F. Outcomes of thoracic endovascular aortic repair with physician-manufactured partial micropore stent grafts for aortic arch pathologies. J Vasc Surg 2024; 79:1005-1012. [PMID: 38157994 DOI: 10.1016/j.jvs.2023.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/05/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) has been used extensively in the management of thoracic aortic diseases. Numerous efforts have been made to enhance clinical outcomes through the use of stent grafts. This study aimed to investigate the effectiveness and safety of physician-manufactured partial micropore stent grafts (PSMGs) in TEVAR. METHODS Between December 2017 and June 2022, data were collected from 56 patients who underwent TEVAR using physician-manufactured PSMGs. The evaluation encompassed technical success, perioperative and follow-up morbidity and mortality, stroke incidence, and branch artery patency. RESULTS In this investigation, 56 patients received treatment with physician-manufactured PSMGs. Of these patients, 46 were male, with a mean age of 62.1 ± 11.2 years. Aortic pathologies comprised aortic dissection (n = 31 [55.4%]), aortic aneurysms (n = 10 [17.9%]), penetrating aortic ulcer (n = 8 [14.3%]), and intramural hematoma (n = 7 [12.5%]). During a median follow-up of 18 months (interquartile range, 13-25 months), the stroke rate, supra-aortic branch patency rate, and endoleak rate were 0%, 100%, and 7.1%, respectively. There were no occurrences of all-cause mortality, stroke, or the necessity for open conversion. CONCLUSIONS TEVAR with physician-manufactured PSMGs is a viable alternative for addressing aortic arch pathologies in proficient medical centers. The approach demonstrates favorable branch patency, a low complication rate, and minimal postoperative mortality.
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Affiliation(s)
- Junpu Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Tian
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Biyun Teng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fenghe Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Kwon H, Jeong YJ, Lee G, Hwang M, Kim JY, Lee NK, Lee JW. Pulmonary Artery Periadventitial Hematoma in a Patient with Aortic Intramural Hematoma: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:649-653. [PMID: 38873368 PMCID: PMC11166591 DOI: 10.3348/jksr.2023.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 02/14/2024] [Accepted: 03/05/2024] [Indexed: 06/15/2024]
Abstract
A pulmonary artery periadventitial hematoma is a rare complication of a Stanford type A intramural hematoma. As the proximal ascending aorta and pulmonary artery share a common adventitial layer, extravasated blood from the intramural hematoma in the ascending thoracic aorta may extend to beneath the adventitia of the pulmonary artery. The authors describe a case involving a 66-year-old male with acute chest pain who presented with a pulmonary artery periadventitial hematoma associated with a Stanford type A intramural hematoma.
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Tomura N, Nakagami T, Kikai M, Hamaoka T, Fukai K, Yamaguchi S, Matsubayashi K, Matoba S. Acute Heart Failure Due to a Fistula Between the Anastomotic Pseudoaneurysm and the Right Atrium Following a Previous Aortic Dissection Repair. CJC Open 2024; 6:755-758. [PMID: 38846441 PMCID: PMC11150946 DOI: 10.1016/j.cjco.2024.01.005] [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: 08/14/2023] [Accepted: 01/19/2024] [Indexed: 06/09/2024] Open
Affiliation(s)
- Nobunari Tomura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuo Nakagami
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Masakazu Kikai
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Tetsuro Hamaoka
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Kuniyoshi Fukai
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Shinichiro Yamaguchi
- Department of Cardiovascular Medicine, Rakuwakai Marutamachi Hospital, Kyoto, Japan
| | - Keiji Matsubayashi
- Department of Cardiovascular Surgery, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Pedersen MW, Duch K, Lindgren FL, Lundgren NLO, Tayal B, Hagendorff A, Jensen GB, Biering-Sørensen T, Schnohr P, Møgelvang R, Høst N, Kragholm K, Andersen NH, Søgaard P. Aortic Root Dimension Using Transthoracic Echocardiography: Results from the Copenhagen City Heart Study. Am J Cardiol 2024; 218:86-93. [PMID: 38452843 DOI: 10.1016/j.amjcard.2024.02.031] [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: 11/16/2023] [Revised: 01/29/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
Findings regarding the relation between aortic size and risk factors are heterogeneous. This study aimed to generate new insights from a population-based adult cohort on aortic root dimensions and their association with age, anthropometric measures, and cardiac risk factors and evaluate the incidence of acute aortic events. Participants from the fifth examination round of the Copenhagen City Heart study (aged 20 to 98 years) with applicable echocardiograms and no history of aortic disease or valve surgery were included. Aorta diameter was assessed at the annulus, sinus of Valsalva, sinotubular junction, and the tubular part of the ascending aorta. The study population comprised 1,796 men and 2,316 women; mean age: 56.4 ± 17.0 and 56.9 ± 18.1 years, respectively. Men had larger aortic root diameters than women regardless of height indexing (p <0.01). Age, height, weight, systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, hypertension, diabetes, ischemic heart disease, and smoking were positively correlated with aortic sinus diameter in the crude and gender-adjusted analyses. However, after full adjustment, only height, weight, and diastolic blood pressure remained significantly positively correlated with aortic sinus diameter (p <0.001). For systolic blood pressure and pulse pressure, the correlation was inverse (p <0.001). During follow-up (median 5.4 [quartile 1 to quartile 3 4.5 to 6.3] years), the incidence rate of first-time acute aortic events was 13.6 (confidence interval 4.4 to 42.2) per 100,000 person-years. In conclusion, beyond anthropometric measures, age, and gender, diastolic blood pressure was the only cardiac risk factor that was independently correlated with aortic root dimensions. The number of aortic events during follow-up was low.
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Affiliation(s)
- Maria W Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
| | - Kirsten Duch
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Filip L Lindgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Nils L O Lundgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bhupendar Tayal
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | | | - Gorm B Jensen
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Cardiovascular Non-invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark; Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nis Høst
- Department of Cardiology, Nordsjællands Hospital, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Chow SCY, Lim K, Lum TW, Ho JYK, Wan S, Fujikawa T, Wong RHL. Individualized treatment of type A intramural hematoma-upfront surgery is not always necessary. J Thorac Dis 2024; 16:2225-2235. [PMID: 38738232 PMCID: PMC11087625 DOI: 10.21037/jtd-23-1837] [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: 12/03/2023] [Accepted: 02/08/2024] [Indexed: 05/14/2024]
Abstract
Background Management of acute type A intramural hematoma (IMH) is a controversial topic, and variable treatment strategies have been reported. Upfront aortic replacement may not be necessary in all cases. The goal of our study was to evaluate clinical outcomes of patients with acute type A IMH or thrombosed false lumen (FL) treated with upfront surgery or watchful waiting. Methods Patients admitted to our hospital with type A IMH or aortic dissection with thrombosed ascending FL from December 2012 to February 2023 were retrospectively reviewed. Results Among the 93 patients with type A IMH, 36 (38.7%) patients underwent upfront aortic surgery (Group S), and 57 (61.3%) patients were offered watchful waiting with medical surveillance (Group W). Of the 57 patients in Group W, 32 were treated conservatively with medical therapy alone (Group C). Patients in Group S had larger ascending aortic diameter (47.8±5.3 vs. 44.4±4.2 mm: P=0.001), higher frequency of pericardial effusion (38.9% vs. 10.5%; P=0.001) and cardiac tamponade (16.7% vs. 1.8%; P=0.008). The overall mortality rate was 4.3% in the whole cohort over a median follow up of 40.5 months. Overall survival for Group S was 100% at 30 days and 1 year, and 96.2% at 5 years. Overall survival for Group W was 98.2% at 30 days, 96.3% at 1 year and 95.2% at 5 years. The difference in overall survival was not statistically significant (P=0.64). Overall survival for Group C was 100% at 30 days and 1 year, and 90.9% at 5 years. Conclusions Survival outcomes in selected patients with type A IMH were satisfactory. An individualized approach to patients with uncomplicated type A IMH was feasible. Upfront surgery was not necessary in all cases.
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Affiliation(s)
- Simon Chi-Ying Chow
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Kevin Lim
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Tak-Wai Lum
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Jacky Yan-Kit Ho
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Song Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Takuya Fujikawa
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Randolph Hung-Leung Wong
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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42
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Akrawi D, Femia G, Fung M, Cho K, Toufaili A. Right Coronary Sinus of Valsalva Aneurysm Rupture Precipitated by Nonsyndromic Aortopathy. JACC Case Rep 2024; 29:102250. [PMID: 38774810 PMCID: PMC11103603 DOI: 10.1016/j.jaccas.2024.102250] [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: 10/30/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 05/24/2024]
Abstract
We present a case highlighting the diagnostic challenges of identifying a ruptured right coronary sinus of Valsalva aneurysm in a patient with nonsyndromic aortopathy. Timely assessment with transthoracic and transesophageal echocardiography is vital for prompt diagnosis and successful treatment. Genetic panel testing should be offered to probands and first-degree family members.
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Affiliation(s)
- Daniel Akrawi
- Department of Cardiology, Campbelltown Hospital, Sydney, New South Wales, Australia
- Western Sydney University, Sydney, New South Wales, Australia
| | - Giuseppe Femia
- Western Sydney University, Sydney, New South Wales, Australia
| | - Matle Fung
- Department of Cardiology, Campbelltown Hospital, Sydney, New South Wales, Australia
- Western Sydney University, Sydney, New South Wales, Australia
| | - Kenneth Cho
- Department of Cardiology, Campbelltown Hospital, Sydney, New South Wales, Australia
- Western Sydney University, Sydney, New South Wales, Australia
| | - Ali Toufaili
- Department of Cardiology, Campbelltown Hospital, Sydney, New South Wales, Australia
- Western Sydney University, Sydney, New South Wales, Australia
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43
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Baquero L, Loaisiga H, Alvarado E. Giant Aortic Root Thrombus in a Chronic, Asymptomatic Stanford Type A Aortic Dissection. JACC Case Rep 2024; 29:102249. [PMID: 38774794 PMCID: PMC11103594 DOI: 10.1016/j.jaccas.2024.102249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/20/2023] [Indexed: 05/24/2024]
Abstract
Type A aortic dissection rarely becomes chronic because of high early mortality. Thrombus in the false lumen and an immobile flap are indicative of this condition. A 61-year-old man with an initial diagnosis of gastroenteritis later presented with a diastolic murmur. Echocardiography revealed chronic Stanford A aortic dissection with a thrombus causing severe aortic regurgitation.
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Affiliation(s)
- Laura Baquero
- Cardiology Fellowship, University of Costa Rica, San Jose, Costa Rica
| | - Hilda Loaisiga
- Department of Cardiology, Hospital San Vicente de Paul, San Jose, Costa Rica
| | - Eduardo Alvarado
- Department of Cardiology, Hospital San Vicente de Paul, San Jose, Costa Rica
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44
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Lok YI, Villaquiran J, Kuo J. A challenging case of emergency redo surgery for acute type A aortic dissecting aneurysm of ascending and aortic arch with frozen elephant trunk following aortic root replacement. J Cardiothorac Surg 2024; 19:237. [PMID: 38627730 PMCID: PMC11020323 DOI: 10.1186/s13019-024-02653-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Redo ascending and aortic arch surgeries following previous cardiac or aortic surgery are associated with high risk of morbidity and mortality due to multiple factors included sternal re-entry injury, extensive aortic arch surgery, emergency aortic surgery, prolonged cardiopulmonary bypass duration, poor heart function, and patients with older age. Therefore, appropriate surgical strategies are important. We report a case of a 72-year-old gentleman with previous surgery of aortic root replacement who presented with acute Type A aortic dissecting aneurysm of ascending and aortic arch complicated with left hemothorax, which was successfully treated by emergency redo aortic surgery with frozen elephant trunk (FET) technique.
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Affiliation(s)
- Yuh Ing Lok
- Department of Cardiothoracic Surgery, Derriford Hospital, Derriford Road, Plymouth, PL6 8DH, UK.
| | - Jaime Villaquiran
- Department of Cardiothoracic Surgery, Derriford Hospital, Derriford Road, Plymouth, PL6 8DH, UK
| | - James Kuo
- Department of Cardiothoracic Surgery, Derriford Hospital, Derriford Road, Plymouth, PL6 8DH, UK
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45
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Pan H, Shi Z, Wang S, Bai J, Zhang T. A predictive model of 30-day mortality in patients with acute type A aortic dissection. Eur J Radiol 2024; 175:111469. [PMID: 38636409 DOI: 10.1016/j.ejrad.2024.111469] [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: 11/18/2023] [Accepted: 04/14/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Acute type A aortic dissection (ATAAD) is a life-threatening cardiovascular disease that requires an effective predictive model to predict and assess a patient's risk of death. Our study aimed to construct a model for predicting the risk of 30-day death in patients with ATAAD and the prediction accuracy of the German Registry of Acute Aortic Dissection Type A (GERAADA) Score and the European System for Cardiac Operative Risk Evaluation (EuroSCORE II) was verified. MATERIALS AND METHODS Between June 2019 and June 2023, 109 patients with ATAAD underwent surgical treatment at our hospital (35 in the death group and 74 in the survival group). The differences in image parameters between the two groups were compared. Search for independent predictors and develop models that predict 30-day mortality in patients with ATAAD. GERAADA Score and EuroSCORE II were retrospectively calculated and indicated mortality was assessed using the receiver operating characteristic (ROC) curve. RESULTS Logistic regression analysis showed that ascending aortic length and pericardial effusion were independent predictors of death within 30 days in patients with ATAAD. We constructed four models, GERAADA Score (Model 1), EuroSCORE II (Model 2), Model 1, ascending aorta length, and pericardial effusion (Model 3), and Model 2, ascending aorta length, and pericardial effusion (Model 4). The area under the curve (AUC = 0.832) of Model 3 was significantly different from those of Models 1 (AUC = 0.683) and 2 (AUC = 0.599), respectively (p < 0.05, DeLong test). CONCLUSIONS Adding ascending aorta length and pericardial effusion to the GERAADA Score can improve the predictive power of 30-day mortality in patients with ATAAD.
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Affiliation(s)
- Hong Pan
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhenzhou Shi
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Shuting Wang
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jinquan Bai
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tong Zhang
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
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Aronow HD, Bonaca MP, Kolluri R, Beckman JA. Recapturing the Team Approach to Vascular Care. Ann Vasc Surg 2024; 101:84-89. [PMID: 38128694 DOI: 10.1016/j.avsg.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The care of the vascular patient remains decentralized rather than coordinated. METHODS We reviewed the current state of practice and published competency and care documents created by vascular professional societies. RESULTS Vascular professional societies routinely and repeatedly endorse both a team approach and the competency of specialists from disparate training backgrounds. The care of the vascular patient does not always reflect these public endorsements. CONCLUSIONS Centering the vascular patient as the mode of organization of care should improve care processes, expertise brought to bear, and outcomes.
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Affiliation(s)
- Herbert D Aronow
- Henry Ford Health, Detroit, MI; Michigan State University College of Human Medicine, East Lansing, MI
| | - Marc P Bonaca
- CPC Clinical Research, Aurora, CO; University of Colorado, Aurora, CO; University of Colorado School of Medicine, Aurora, CO
| | - Raghu Kolluri
- OhioHealth Heart and Vascular, Riverside Methodist Hospital, Columbus, OH
| | - Joshua A Beckman
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
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47
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Baghbani-Oskouei A, Savadi S, Mesnard T, Sulzer T, Mirza AK, Baig S, Timaran CH, Oderich GS. Transcatheter electrosurgical septotomy technique for chronic postdissection aortic aneurysms. J Vasc Surg Cases Innov Tech 2024; 10:101402. [PMID: 38304296 PMCID: PMC10830870 DOI: 10.1016/j.jvscit.2023.101402] [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] [Indexed: 02/03/2024] Open
Abstract
Aortic dissection often results in chronic aneurysmal degeneration due to progressive false lumen expansion. Thoracic endovascular aortic repair and other techniques of vessel incorporation such as fenestrated-branched or parallel grafts have been increasingly used to treat chronic postdissection aneurysms. True lumen compression or a vessel origin from the false lumen can present considerable technical challenges. In these cases, the limited true lumen space can result in inadequate stent graft expansion or restrict the ability to reposition the device or manipulate catheters. Reentrance techniques can be used selectively to assist with target vessel catheterization. Transcatheter electrosurgical septotomy is a novel technique that has evolved from the cardiology experience with transseptal or transcatheter aortic valve procedures. This technique has been applied in select patients with chronic dissection to create a proximal or distal landing zone, disrupt the septum in patients with an excessively compressed true lumen, or connect the true and false lumen in patients with vessels that have separate origins. In the present report, we summarize the indications and technical pitfalls of transcatheter electrosurgical septotomy in patients treated by endovascular repair for chronic postdissection aortic aneurysms.
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Affiliation(s)
- Aidin Baghbani-Oskouei
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Safa Savadi
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Thomas Mesnard
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Titia Sulzer
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Aleem K. Mirza
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Shadman Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H. Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Gustavo S. Oderich
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
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Lopes A, Gouveia E Melo R, Amorim P, Fernandes E Fernandes R, Mendes Pedro L. Current perspectives in acute type B aortic dissections: a literature review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:132-138. [PMID: 37255494 DOI: 10.23736/s0021-9509.23.12636-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this new millennial, endovascular strategies have revolutionized the treatment of acute type B aortic dissection (aTBAD). With reduced in-hospital mortality and good long-term outcomes TEVAR has become the gold standard for the treatment of complicated dissection and is gaining increasing support for its preventive applicability in some uncomplicated dissections. With this new paradigm came a shift of the treatment goal where just covering the entry tear is not enough and instead achieving long-term positive thoracoabdominal remodeling is needed. More extensive approaches with composite device designs (covered stent graft and bare metal stent) emerged to answer this aortic conundrum. At 5-year of follow-up, "Provisional ExTension To Induce COmplete Attachment technique" (PETTICOAT) and its evolution "Stent assisted balloon induced intimal disruption and relamination in aortic dissection repair" (STABILISE) seem to be safe techniques that can allow, when anatomically feasible, excellent aortic remodeling and, in some cases, even the healing of the dissection. Nevertheless, STABILISE results, although promising, are mostly based on small series and therefore need to be validated by analyzing medium-long-term results from the international registry. Given the plethora of new data and the disparity of expert opinions on the best treatment to adopt, in this review we aim to summarize the current knowledge on the results of these different strategies for acute TBAD.
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Affiliation(s)
- Alice Lopes
- Division of Heart and Vessels, Department of Vascular Surgery, Saint Mary's Hospital, Lisbon, Portugal -
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal -
- Cardiovascular Center of the University of Lisbon (CCUL), Lisbon, Portugal -
| | - Ryan Gouveia E Melo
- Division of Heart and Vessels, Department of Vascular Surgery, Saint Mary's Hospital, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Lisbon, Portugal
| | - Pedro Amorim
- Division of Heart and Vessels, Department of Vascular Surgery, Saint Mary's Hospital, Lisbon, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Lisbon, Portugal
| | - Ruy Fernandes E Fernandes
- Division of Heart and Vessels, Department of Vascular Surgery, Saint Mary's Hospital, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Lisbon, Portugal
| | - Luís Mendes Pedro
- Division of Heart and Vessels, Department of Vascular Surgery, Saint Mary's Hospital, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Lisbon, Portugal
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Park SJ, Kim HR, Kim HJ, Kim JB. Tailored surgical strategies for mini-access open total arch repair. JTCVS Tech 2024; 24:1-13. [PMID: 38835578 PMCID: PMC11145074 DOI: 10.1016/j.xjtc.2023.12.005] [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: 10/06/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 06/06/2024] Open
Abstract
Objective Open arch repair is perceived as a challenging, high-risk procedure, with a barrier against the use of a minimally invasive approach. We aimed to present a mini-access total arch replacement performed by stratified approaches and to evaluate perioperative outcomes to contribute to the body of evidence. Methods We evaluated 40 consecutive patients (aged 69.5 years; interquartile range, 65.6-76.3 years) undergoing elective total arch replacement using 5- to 8-cm upper mini-sternotomy between 2018 and 2022. Surgical strategies, including arterial inflow site and methods of branching vessel reconstruction, were systematically selected at the individual level. To evaluate comparative outcomes, contemporary cases undergoing total arch replacement via sternotomy with similar eligibility criteria served as a control group, and the inverse-treatment-weighting method was used to adjust for baseline characteristics. Results Arch-first anastomosis using trifurcate graft, distal-first anastomosis using 4-branch graft, and island anastomosis were used in 18 (45%), 12 (30.0%), and 10 (25%) patients, respectively. Lower body and cardiac ischemic times were 23.4 minutes (interquartile range, 18.0-29.0 minutes) and 66.7 minutes (interquartile range, 50.1-78.2 minutes). There was no early (30-day or in-hospital) mortality, and 2 patients experienced disabling stroke (5.0%). The contemporary control group comprised 55 patients. After an adjustment, a mini-access group showed lower risks of stroke (odds ratio, 0.88; 95% CI, 0.78-1.00; P = .049) and a composite of major complications (odds ratio, 0.79; 95% CI, 0.68-0.92; P = .003), compared with a sternotomy approach. Conclusions Based on present results, mini-access total arch replacement may be performed with reasonable safety and efficiency.
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Affiliation(s)
- Soo Jin Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Korea
| | - Hong Rae Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Korea
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50
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Lau ES, Aggarwal NR, Briller JE, Crousillat DR, Economy KE, Harrington CM, Lindley KJ, Malhamé I, Mattina DJ, Meng ML, Mohammed SF, Quesada O, Scott NS. Recommendations for the Management of High-Risk Cardiac Delivery: ACC Cardiovascular Disease in Women Committee Panel. JACC. ADVANCES 2024; 3:100901. [PMID: 38939671 PMCID: PMC11198580 DOI: 10.1016/j.jacadv.2024.100901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/28/2023] [Accepted: 01/30/2024] [Indexed: 06/29/2024]
Abstract
Maternal mortality is a major public health crisis in the United States. Cardiovascular disease (CVD) is a leading cause of maternal mortality and morbidity. Labor and delivery is a vulnerable time for pregnant individuals with CVD but there is significant heterogeneity in the management of labor and delivery in high-risk patients due in part to paucity of high-quality randomized data. The authors have convened a multidisciplinary panel of cardio-obstetrics experts including cardiologists, obstetricians and maternal fetal medicine physicians, critical care physicians, and anesthesiologists to provide a practical approach to the management of labor and delivery in high-risk individuals with CVD. This expert panel will review key elements of management from mode, timing, and location of delivery to use of invasive monitoring, cardiac devices, and mechanical circulatory support.
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Affiliation(s)
- Emily S. Lau
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Niti R. Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Joan E. Briller
- Division of Cardiology, Department of Medicine, Obstetrics, and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Daniela R. Crousillat
- Division of Cardiovascular Sciences, Department of Medicine, Obstetrics, and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Katherine E. Economy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Colleen M. Harrington
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn J. Lindley
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Deirdre J. Mattina
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marie-Louise Meng
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Selma F. Mohammed
- Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Odayme Quesada
- Women’s Heart Center, The Carl and Edyth Lindner Center for Research & Education, The Christ Hospital Network Heart & Vascular Institute, Cincinnati, Ohio, USA
| | - Nandita S. Scott
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - ACC Cardiovascular Disease in Women Committee
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
- Division of Cardiology, Department of Medicine, Obstetrics, and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
- Division of Cardiovascular Sciences, Department of Medicine, Obstetrics, and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
- Women’s Heart Center, The Carl and Edyth Lindner Center for Research & Education, The Christ Hospital Network Heart & Vascular Institute, Cincinnati, Ohio, USA
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