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Nakazato T, Ozaki T, Kitahara M. Type a aortic dissection after aortic wrapping performed 26 years ago: a case report. J Cardiothorac Surg 2024; 19:563. [PMID: 39354495 PMCID: PMC11443728 DOI: 10.1186/s13019-024-03076-0] [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: 06/23/2024] [Accepted: 09/15/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Aortic wrapping (AW) has been performed as a less invasive alternative to aortoplasty. However, AW can also cause long-term aortic complications. In this report, we present a rare case of a dissecting aortic aneurysm between the proximal side of the wrap and the sinotubular junction after AW. CASE PRESENTATION A female patient had undergone urgent aortic valve replacement with a 19-mm mechanical valve to treat infective endocarditis and AW to treat an enlarged ascending aorta 26 years prior. At the age of 71 years, the patient was diagnosed with a dissecting aortic aneurysm between the proximal side of the wrap and the sinotubular junction. We performed graft replacement of the ascending aorta, including complete resection of the wrap. The patient was discharged on postoperative day 10, and there have been no cardiovascular events during her ongoing follow up. CONCLUSIONS AW in younger patients can lead to late aortic complications. Careful consideration should be paid when performing AW in young patients, and patients who have previously undergone AW require strict life-long follow-up.
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Affiliation(s)
- Taro Nakazato
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69, Amagasaki, 660-8511, Amagasaki, Japan.
| | - Tatsuya Ozaki
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69, Amagasaki, 660-8511, Amagasaki, Japan
| | - Mutsunori Kitahara
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69, Amagasaki, 660-8511, Amagasaki, Japan
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Vo TX, Rahmouni K, Visintini S, Guo MH, Ouzounian M, Chu MWA, Boodhwani M, Appoo JJ, Tucker K, Al-Atassi T. Computed Tomography Imaging Measurements as a Surrogate for Clinical Outcomes After Surgical Management of Acute Type A Aortic Dissection: A Systematic Review. J Am Heart Assoc 2024; 13:e034496. [PMID: 39248260 DOI: 10.1161/jaha.124.034496] [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: 01/17/2024] [Accepted: 06/24/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Postoperative computed tomography imaging surveillance is an essential component of care after acute type A aortic dissection (ATAAD) repair. Prognostic imaging factors after ATAAD repair have not been systematically reviewed. METHODS AND RESULTS We performed a systematic review to summarize postoperative computed tomography measurements including aortic diameter, cross-sectional area, volume, growth rate, and false lumen thrombosis in addition mid- to long-term clinical outcomes after ATAAD repair. Searches were conducted in Medline, Embase, and CENTRAL in October 2022. Studies were included if they reported clinical outcomes such as mortality or aortic reintervention after 1 year and included aforementioned computed tomography findings. Studies of chronic aortic dissection and studies of exclusive patient populations such as those with connective tissue diseases were excluded. Risk of bias was assessed with the Newcastle-Ottawa Scale. Searches retrieved 6999 articles. Sixty-eight studies met inclusion criteria (7885 patients). Extended repairs were associated with improved false lumen thrombosis, decreased aortic growth rate, and decreased rates of reintervention but not improved survival. Growth rates of the aorta post-ATAAD repair were highest in the descending thoracic aorta. The most frequent prognostic imaging factors reported were a patent/partially thrombosed false lumen and postoperative aortic diameter >40 to 45 mm. CONCLUSIONS Established measurements of positive aortic remodeling, including complete false lumen thrombosis and stabilization of postoperative aortic diameter and growth are the most studied prognostic indicators for improved clinical outcomes after ATAAD repair. Growth rate of the aorta remains significant after ATAAD repair. Future studies should prospectively evaluate and compare prognostic factors for improved surveillance and management.
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Affiliation(s)
- Thin X Vo
- Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Kenza Rahmouni
- Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Sarah Visintini
- Berkman Library University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Ming H Guo
- Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery University of Toronto Toronto Ontario Canada
| | - Michael W A Chu
- Division of Cardiac Surgery Western University London Ontario Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Jehangir J Appoo
- Division of Cardiac Surgery University of Calgary Calgary Alberta Canada
| | - Katherine Tucker
- Division of Medical Sciences, Nuffield Department of Primary Care Health Sciences Oxford University Oxford UK
| | - Talal Al-Atassi
- Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada
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Roberts CS, McCullough KA, Sbrocchi AJ, Hamman BL. When to Decline or Delay Central Repair in Aortic Dissection. Am J Cardiol 2024; 230:3-5. [PMID: 39154870 DOI: 10.1016/j.amjcard.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/05/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical Center, Dallas, Texas.
| | - Kyle A McCullough
- Department of Cardiovascular Research, Baylor Scott & White Research Institute, Plano, Texas
| | | | - Baron L Hamman
- Department of Cardiac Surgery, Baylor University Medical Center, Dallas, Texas
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Yu X, Chen Y, Peng Y, Chen L, Lin Y. The Pan-Immune Inflammation Value at Admission Predicts Postoperative in-hospital Mortality in Patients with Acute Type A Aortic Dissection. J Inflamm Res 2024; 17:5223-5234. [PMID: 39131211 PMCID: PMC11313576 DOI: 10.2147/jir.s468017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/25/2024] [Indexed: 08/13/2024] Open
Abstract
Purpose The inflammatory response of the body is intimately linked to the quick onset and high in-hospital mortality of Acute Type A Aortic Dissection (ATAAD). The purpose of the study was to examine the connection between in-hospital mortality in patients with ATAAD upon admission and the Pan-Immune-Inflammation Value (PIV). Patients and Methods 308 patients who were diagnosed with ATAAD between September 2018 and October 2021 at Fujian Provincial Center for Cardiovascular Medicine had their clinical data retrospectively examined. PIV was assessed at the time of study population admission, with in-hospital mortality serving as the main outcome measure. Patients were divided into two groups, the high PIV group (PIV > 1807.704) and the low PIV group (PIV < 1807.704), based on the PIV ROC curve and the best threshold of the Youden index. The clinical results of the two groups were then compared. Results Among ATAAD patients, postoperative in-hospital mortality was higher in the high PIV group (54.7% vs 10.6%, P < 0.001), and the high PIV group had significantly higher rates of postoperative acute kidney injury, acute liver insufficiency, and gastrointestinal hemorrhage (P < 0.05). Additionally, the high PIV group's ICU stays lasted longer than the low PIV group's (P < 0.05). The results of multifactorial logistic regression analysis, which controlled for other variables, indicated that the mechanical ventilation time (OR = 1.860, 95% CI: 1.437, 2.408; P < 0.001), the high PIV group (> 1807.704) (OR = 1.939, 95% CI: 1.257, 2.990; P = 0.003), the cardiopulmonary bypass time (OR = 1.011, 95% CI: 1.004, 1.018; P = 0.002), and the white blood cell count (OR = 1.188, 95% CI: 1.054, 1.340; P = 0.005) were independent risk factors for postoperative in-hospital mortality in ATAAD patients. Conclusion Postoperative death in ATAAD patients was independently predicted by high PIV levels at admission. Patients should be informed about their preoperative inflammatory status and actively participate in prompt clinical decision-making and treatment.
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Affiliation(s)
- Xijing Yu
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China
| | - Yaqin Chen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China
| | - Yanchun Peng
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Liangwan Chen
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China
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Doenst T, Schneider U, Caldonazo T, Toshmatov S, Diab M, Siemeni T, Färber G, Kirov H. Cardiac Surgery 2022 Reviewed. Thorac Cardiovasc Surg 2023; 71:356-365. [PMID: 37196662 DOI: 10.1055/s-0043-57228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
PubMed displayed almost 37,000 hits for the search term "cardiac surgery AND 2022." As before, we used the PRISMA approach and selected relevant publications for a results-oriented summary. We focused on coronary and conventional valve surgery, their overlap with interventional alternatives, and briefly assessed surgery for aorta or terminal heart failure. In the field of coronary artery disease (CAD), key manuscripts addressed prognostic implications of invasive treatment options, classically compared modern interventions (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass grafting [CABG]), and addressed technical aspects of CABG. The general direction in 2022 confirms the superiority of CABG over PCI in patients with anatomically complex chronic CAD and supports an infarct-preventative effect as underlying mechanism. In addition, the relevance of proper surgical technique to achieve durable graft patency and the need for optimal medical treatment in CABG patients was impressively illustrated. In structural heart disease, the comparisons of interventional and surgical techniques have been characterized by prognostic and mechanistic investigations underscoring the need for durable treatment effects and reductions of valve-related complications. Early surgery for most valve pathologies appears to provide significant survival advantages, and two publications on the Ross operation prototypically illustrate an inverse association between long-term survival and valve-related complications. For surgical treatment of heart failure, the first xenotransplantation was certainly dominant, and in the aortic surgery field, innovations in arch surgery prevailed. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Sultonbek Toshmatov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
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Carrel T, Sromicki J, Schmiady M, Aser R, Ouda A, Vogt PR. Aortic wrapping is life-saving in high-risk acute aortic dissection and intramural haematoma. Interact Cardiovasc Thorac Surg 2022; 35:6751791. [PMID: 36205640 PMCID: PMC9580516 DOI: 10.1093/icvts/ivac254] [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: 07/29/2022] [Revised: 09/14/2022] [Accepted: 10/05/2022] [Indexed: 12/02/2022] Open
Abstract
Aortic wrapping is a controversial repair in patients presenting with acute type A aortic dissection or intramural haematoma, but this method may be a potential alternative to medical treatment or conventional repair in patients aged >80 years and in those presenting with prohibitive co-morbidities such as stroke, circulatory collapse, full oral anticoagulation with the last generation drugs. We report on 5 high-risk and/or patients over 80 years who received external aortic wrapping with or without cardiopulmonary bypass during the last 18 months. All survived the procedure and could be extubated early postoperatively. No patient remained on the intensive care longer than 2 days and all were discharged without additional complications. Postoperative radiological control was acceptable and no patient had any new aortic event up to 18 months postoperatively.
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Affiliation(s)
- Thierry Carrel
- Corresponding author. Clinic for Cardiac Surgery, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland. Tel: +41 44 244 47 29; e-mail: (T. Carrel)
| | - Juri Sromicki
- Department of Cardiac Surgery, Clinic for Cardiac Surgery, University Hospital, Zürich, Switzerland
| | - Martin Schmiady
- Department of Cardiac Surgery, Clinic for Cardiac Surgery, University Hospital, Zürich, Switzerland
| | - Raed Aser
- Department of Cardiac Surgery, Clinic for Cardiac Surgery, University Hospital, Zürich, Switzerland
| | - Ahmed Ouda
- Department of Cardiac Surgery, Clinic for Cardiac Surgery, University Hospital, Zürich, Switzerland
| | - Paul Robert Vogt
- Department of Cardiac Surgery, Clinic for Cardiac Surgery, University Hospital, Zürich, Switzerland
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Outcomes and ascending aorta diameter change after zone 0 endografting with ascending aortic wrapping. Eur J Vasc Endovasc Surg 2022; 64:276-277. [DOI: 10.1016/j.ejvs.2022.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 11/13/2022]
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Estrera AL. Commentary: E does not equal M without C 2. J Thorac Cardiovasc Surg 2021; 164:1424-1425. [PMID: 33436292 DOI: 10.1016/j.jtcvs.2020.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 10/31/2022]
Affiliation(s)
- Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Tex.
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Lau C, Girardi LN. Commentary: Aortic wrapping remains an incomplete solution for treatment of acute type A aortic dissections. J Thorac Cardiovasc Surg 2020; 164:1421-1422. [PMID: 33293064 DOI: 10.1016/j.jtcvs.2020.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
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Commentary: Urgent aortic wrapping for acute type A aortic dissection: New hat for an old trick? J Thorac Cardiovasc Surg 2020; 164:1422-1423. [PMID: 33323193 DOI: 10.1016/j.jtcvs.2020.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 11/23/2022]
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