1
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Kato M. Interventions in Acute or Subacute Phase for Type B Aortic Dissection. Ann Vasc Dis 2024; 17:120-127. [PMID: 38919329 PMCID: PMC11196166 DOI: 10.3400/avd.ra.24-00012] [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: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 06/27/2024] Open
Abstract
The treatment strategy for acute and subacute Stanford type B aortic dissection has changed significantly since the advent of thoracic endovascular aortic repair (TEVAR). Indication for invasive treatment: In addition to the conventional complicated cases (rupture or malperfusion case), the indication for invasive treatment now includes cases with refractory hypertension, persistent or recurrent pain, large aortic diameter, and other conditions that are considered to have a poor prognosis with conservative treatment. Treatment methods: TEVAR is the first choice for acute, subacute, and early chronic-stage treatment, and when this is not possible, other techniques (fenestration and graft replacement) are chosen. Treatment timing: The timing of invasive treatment should be emergent in life-threatening conditions (for rupture or malperfusion case) and immediate in symptomatic cases, while in other cases, preemptive TEVAR is considered appropriate on a scheduled timing within 6 months of onset. (This is a translation of Jpn J Vasc Surg 2023; 32: 157-163.).
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Affiliation(s)
- Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Osaka, Japan
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2
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Dyas AR, Thomas MB, Bronsert MR, Madsen HJ, Colborn KL, Henderson WG, David EA, Velopulos CG, Meguid RA. Emergency thoracic surgery patients have worse risk-adjusted outcomes than non-emergency patients. Surgery 2023; 174:956-963. [PMID: 37507304 DOI: 10.1016/j.surg.2023.06.034] [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: 12/16/2022] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Outcomes for patients undergoing emergency thoracic operations have not been well described. This study was designed to compare postoperative outcomes among patients undergoing emergency versus nonemergency thoracic operations. METHODS We retrospectively analyzed the American College of Surgeons National Surgical Quality Improvement Program database (2005-2018). We identified patients who underwent emergency thoracic operations using current procedural technology codes. Patients were then sorted into 1 of 4 cohorts: lung and chest wall, hiatal hernia, esophagus, and pericardium. Emergency versus nonemergency outcomes were compared. Univariate logistic regression was performed with "emergency status" as the independent variable and 30-day postoperative outcomes as the dependent variables. Multiple logistic regression models were performed to control for preoperative factors. RESULTS Of 90,398 thoracic operations analyzed, 4,044 (4.5%) were emergency. Common emergency operations were pericardial window (n = 580, 10.2%), laparoscopic hiatal hernia repair (n = 366, 8.9%), thoracoscopic partial lung decortication (n = 334, 8.1%), thoracoscopic wedge resection (n = 301, 7.3%), thoracoscopic total lung decortication (n = 256, 6.2%), and open repair of hiatal hernia without mesh (n = 254, 6.2%). In all 4 cohorts, 30-day postoperative complications occurred more frequently after emergency surgery. After controlling for patient characteristics, 8 complications were more frequent after emergency lung and chest wall surgery, 5 complications were more frequent after emergency hiatal hernia surgery, and 3 complications were more frequent after emergency pericardium surgery. Risk-adjusted complications were not different after emergency esophageal surgery. CONCLUSION Patients undergoing emergency thoracic operations have worse risk-adjusted outcomes than those undergoing nonemergency thoracic operations. Subset analysis is needed to determine what factors contribute to increased adverse outcomes in specific patient populations.
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Affiliation(s)
- Adam R Dyas
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Department of Surgery, University of Colorado Hospital, Aurora, CO.
| | - Madeline B Thomas
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Department of Surgery, University of Colorado Hospital, Aurora, CO
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Department of Surgery, University of Colorado Hospital, Aurora, CO
| | - Helen J Madsen
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Department of Surgery, University of Colorado Hospital, Aurora, CO
| | - Kathryn L Colborn
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO; Department of Medicine, University of Colorado Hospital, Aurora, CO
| | - William G Henderson
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Elizabeth A David
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Department of Surgery, University of Colorado Hospital, Aurora, CO
| | - Catherine G Velopulos
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Department of Surgery, University of Colorado Hospital, Aurora, CO
| | - Robert A Meguid
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
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3
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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4
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Furuta A, Morimoto H, Mukai S, Futagami D, Kitaura J. Successful one-stage operation for type B acute intramural hematoma with descending aortic rupture. Clin Case Rep 2022; 10:e05267. [PMID: 35028151 PMCID: PMC8743423 DOI: 10.1002/ccr3.5267] [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: 11/15/2021] [Revised: 12/13/2021] [Accepted: 12/22/2021] [Indexed: 11/11/2022] Open
Abstract
A 76-year-old man who complained of back pain was referred to our hospital. Computed tomography revealed an intramural hematoma with a descending aortic rupture. Total arch replacement with the frozen elephant trunk technique and thoracic endovascular aortic repair was performed emergently in one stage. The patient was discharged without symptoms.
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Affiliation(s)
- Akihisa Furuta
- Department of Cardiovascular SurgeryFukuyama Cardiovascular HospitalHiroshimaJapan
| | - Hironobu Morimoto
- Department of Cardiovascular SurgeryFukuyama Cardiovascular HospitalHiroshimaJapan
| | - Shogo Mukai
- Department of Cardiovascular SurgeryFukuyama Cardiovascular HospitalHiroshimaJapan
| | - Daisuke Futagami
- Department of Cardiovascular SurgeryFukuyama Cardiovascular HospitalHiroshimaJapan
| | - Junya Kitaura
- Department of Cardiovascular SurgeryFukuyama Cardiovascular HospitalHiroshimaJapan
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5
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López Espada C, Linares Palomino JP, Domínguez González JM, Iborra Ortega E, Lozano Vilardell P, Solanich Valldaura T, Volo Pérez G, Blanco Cañibano E, Álvarez Salgado A, Fernández Fernández JC, Hernando Rydings M, Miralles Hernández M. A multicenter study of emergency endovascular repair of the thoracic aorta: Indications and outcomes. Med Intensiva 2021; 45:280-288. [PMID: 34059218 DOI: 10.1016/j.medine.2021.04.008] [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: 09/11/2019] [Accepted: 10/28/2019] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Endovascular techniques have become an essential tool for the treatment of descending thoracic aortic disease (thoracic endovascular aneurysm repair [TEVAR]). The aim is to analyze the indications and outcomes of emergency TEVAR at national level in relation to elective surgery. STUDY DESIGN AND SCOPE A retrospective multicenter registry of patients with descending thoracic aortic disease treated on an emergency basis using endovascular techniques between 2012-2016, in 11 clinical units. PATIENTS, INCLUSION CRITERIA 1) Ruptured descending thoracic aortic aneurysms (RTAA); 2) Blunt traumatic thoracic aortic injury (TAI); and 3) Complicated acute type B aortic dissections (TBADc). PRIMARY VARIABLES Patient mortality, survival and reoperation rate. SECONDARY VARIABLES Demographic data, cardiovascular risk factors, specific data by indication, technical resources and postoperative complications. RESULTS A total of 135 urgent TEVARs were included (111 men, mean age 60.4 ± 16.3 years): 43 ruptured thoracic aortic aneurysms (31.9%), 54 type B dissections (40%) and 32 traumatic aortic injuries (23.7%), and other etiologies 4.4%. The overall mortality rate at 30 days was 18.5%, and proved higher in the RTAA group (27.9%). The mean actuarial survival rate was 67 ± 6% at 5 years. The postoperative stroke rate was 5.2%, and the paraplegia rate was 5.9%. Aortic reoperations proved necessary in 12 patients (9%). CONCLUSIONS Emergency descending thoracic aortic diseases can be treated by endovascular techniques with optimal results and low morbidity and mortality - though the figures are slightly higher than in elective cases. This registry provides, for the first time, real information on the daily clinical practice of emergency TEVAR in Spain.
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Affiliation(s)
- C López Espada
- Servicio de Cirugía Vascular, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - J P Linares Palomino
- Servicio de Cirugía Vascular, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - E Iborra Ortega
- Servicio de Cirugía Vascular, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - P Lozano Vilardell
- Servicio de Cirugía Vascular, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - G Volo Pérez
- Servicio de Cirugía Vascular, Hospital Universitario Dr. Negrín, Gran Canaria, Spain
| | - E Blanco Cañibano
- Servicio de Cirugía Vascular, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - A Álvarez Salgado
- Servicio de Cirugía Vascular, Hospital Universitario de Cabueñes, Spain
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6
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Choi JH, Kim SP, Lee HC, Park TS, Park JH, Kim BW, Ahn J, Park JS, Lee HW, Oh JH, Choi JH, Cha KS, Hong TJ. Clinical outcomes of endovascular treatment for ruptured thoracic aortic disease. Korean J Intern Med 2021; 36:S72-S79. [PMID: 32264656 PMCID: PMC8009169 DOI: 10.3904/kjim.2019.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/15/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/AIMS Untreated rupture of the thoracic aorta is associated with a high mortality rate. We aimed to review the clinical results of endovascular treatment for ruptured thoracic aortic disease. METHODS We retrospectively reviewed data on 37 patients (mean age, 67.0 ± 15.18 years) treated for ruptured thoracic aortic disease from January 2005 to May 2016. The median follow-up duration was 308 days (interquartile range, 61 to 1,036.5). The primary end-point of the study was the composite of death, secondary intervention, endoleak, and major stroke/paraplegia after endovascular treatment. RESULTS The etiologies of ruptured thoracic aortic disease were aortic dissection (n = 11, 29.7%), intramural hematoma (n = 7, 18.9%), thoracic aortic aneurysm (n = 14, 37.8%), and traumatic aortic transection (n = 5, 13.5%). Three patients died within 24 hours of thoracic endovascular aortic repair, and one showed type I endoleak. The technical success rate was 89.2% (33/37). The in-hospital mortality rate was 13.5% (5/37); no deaths occurred during follow-up. The composite outcome rate during follow-up was 37.8% (14/37), comprising death (n = 5, 13.5%), secondary intervention (n = 5, 13.5%), endoleak (n = 5, 13.5%), and major stroke/paraplegia (n = 3, 8.1%). Left subclavian artery revascularization and proximal landing zone were not associated with the composite outcome. Low mean arterial pressure (MAP; ≤ 60 mmHg, [hazard ratio, 13.018; 95% confidence interval, 2.435 to 69.583, p = 0.003]) was the most significant predictor and high transfusion requirement in the first 24 hours was associated with event-free survival (log rank p = 0.018). CONCLUSION Endovascular treatment achieves high technical success rates and acceptable clinical outcome. High transfusion volume and low MAP were associated with poor clinical outcomes.
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Affiliation(s)
- Jong Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Busan Veterans Hospital, Busan, Korea
| | - Sang-Pil Kim
- Department of Thoracic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Han Cheol Lee
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
- Correspondence to Han Cheol Lee, M.D. Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel.: +82-51-240-7217 Fax: +82-51-240-7795 E-mail:
| | - Tae Sik Park
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jong Ha Park
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bo Won Kim
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jinhee Ahn
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jin Sup Park
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hye Won Lee
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jun-Hyok Oh
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Taek Jong Hong
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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7
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Otsuka T, Sueyoshi E, Tasaki Y, Uetani M. Computed tomography findings and in-hospital mortality in patients with rupture of type B aortic dissection. Acta Radiol 2020; 61:136-144. [PMID: 31154812 DOI: 10.1177/0284185119852730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The relationships between the computed tomography (CT) findings and outcomes of patients with ruptured type B aortic dissection have not been clarified. Purpose To evaluate the initial CT findings of patients with ruptured type B aortic dissection and investigate the relationships between the initial CT findings and in-hospital mortality. Material and Methods This study was approved by the institutional review board. Thirty-three patients were diagnosed with ruptured Stanford type B aortic dissection at our hospital between 2007 and 2016 (21 men, 12 women; mean age = 76.1±10.7 years). We retrospectively evaluated the initial CT findings of ruptured type B aortic dissection and the relationships between clinical factors and in-hospital mortality using logistic regression analysis. Results Type B aortic dissections ruptured in the acute and chronic phases in 23 and 10 patients, respectively. The initial CT images showed various findings, including an open false lumen (58%), arch involvement (88%), hematomas in the pleural space (55%), hematomas in the pericardial space (18%), and the extravasation of vascular contrast material (12%). The mean maximum diameter of the affected aorta was 49.5 ± 16.1 mm. Among the 33 patients, 14 died at hospital. Female gender (hazard ratio = 10.284; 95% confidence interval [CI] = 1.61–65.54; P = 0.0136) and the presence of a hematoma in the pleural space (hazard ratio = 6.803; 95% CI = 1.07–43.24; P = 0.0421) were found to be predictors of in-hospital mortality. Conclusion Female gender and the presence of a hematoma in the pleural space are significant predictors of in-hospital mortality in patients with ruptured type B aortic dissection.
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Affiliation(s)
- Tetsuhiro Otsuka
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Eijun Sueyoshi
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yutaro Tasaki
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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8
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López Espada C, Linares Palomino JP, Domínguez González JM, Iborra Ortega E, Lozano Vilardell P, Solanich Valldaura T, Volo Pérez G, Blanco Cañibano E, Álvarez Salgado A, Fernández Fernández JC, Hernando Rydings M, Miralles Hernández M. A multicenter study of emergency endovascular repair of the thoracic aorta: indications and outcomes. Med Intensiva 2019; 45:280-288. [PMID: 31836259 DOI: 10.1016/j.medin.2019.10.008] [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: 09/11/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Endovascular techniques have become an essential tool for the treatment of descending thoracic aortic disease (thoracic endovascular aneurysm repair [TEVAR]). The aim is to analyze the indications and outcomes of emergency TEVAR at national level in relation to elective surgery. STUDY DESIGN AND SCOPE A retrospective multicenter registry of patients with descending thoracic aortic disease treated on an emergency basis using endovascular techniques between 2012-2016, in 11 clinical units. PATIENTS, INCLUSION CRITERIA 1) Ruptured descending thoracic aortic aneurysms; 2) Blunt traumatic thoracic aortic injury; and 3) Complicated acute type B aortic dissections (TBADc). PRIMARY VARIABLES Patient mortality, survival and reoperation rate. SECONDARY VARIABLES Demographic data, cardiovascular risk factors, specific data by indication, technical resources and postoperative complications. RESULTS A total of 135 urgent TEVARs were included (111 men, mean age 60.4 ± 16.3 years): 43 ruptured thoracic aortic aneurysms (31.9%), 54 type B dissections (40%) and 32 traumatic aortic injuries (23.7%), and other etiologies 4.4%. The overall mortality rate at 30 days was 18.5%, and proved higher in the ruptured descending thoracic aortic aneurysms group (27.9%). The mean actuarial survival rate was 67± 6% at 5 years. The postoperative stroke rate was 5.2%, and the paraplegia rate was 5.9%. Aortic reoperations proved necessary in 12 patients (9%). CONCLUSIONS Emergency descending thoracic aortic diseases can be treated by endovascular techniques with optimal results and low morbidity and mortality - though the figures are slightly higher than in elective cases. This registry provides, for the first time, real information on the daily clinical practice of emergency TEVAR in Spain.
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Affiliation(s)
- C López Espada
- Servicio de Cirugía Vascular, Hospital Universitario Virgen de las Nieves, Granada, España.
| | - J P Linares Palomino
- Servicio de Cirugía Vascular, Hospital Universitario Virgen de las Nieves, Granada, España
| | | | - E Iborra Ortega
- Servicio de Cirugía Vascular, Hospital Universitari de Bellvitge, Barcelona, España
| | - P Lozano Vilardell
- Servicio de Cirugía Vascular, Hospital Universitari Son Espases, Palma de Mallorca, España
| | | | - G Volo Pérez
- Servicio de Cirugía Vascular, Hospital Universitario Dr. Negrín, Gran Canaria, España
| | - E Blanco Cañibano
- Servicio de Cirugía Vascular, Hospital Universitario de Guadalajara, Guadalajara, España
| | - A Álvarez Salgado
- Servicio de Cirugía Vascular, Hospital Universitario de Cabueñes, España
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9
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Chino S, Kato N, Nakajima K, Hashimoto T, Higashigawa T, Ouchi T, Kato H, Yamamoto N, Ito H, Maze Y, Tokui T, Sakuma H. Thoracic endovascular aortic repair for the treatment of ruptured acute type B aortic dissection. Jpn J Radiol 2019; 37:321-327. [DOI: 10.1007/s11604-019-00813-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/18/2019] [Indexed: 11/27/2022]
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10
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Lim CY. Endovascular Repair in Acute Complicated Type B Aortic Dissection: 3-Year Results from the Valiant US Investigational Device Exemption Study. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:137-143. [PMID: 28593148 PMCID: PMC5460959 DOI: 10.5090/kjtcs.2017.50.3.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/05/2017] [Accepted: 05/11/2017] [Indexed: 01/09/2023]
Abstract
Acute complicated type B aortic dissection (TBAD) is a potentially catastrophic, life-threatening condition. If left untreated, there is a high risk of aortic rupture, irreversible organ or limb damage, or death. Several risk factors have been associated with acute complicated TBAD, including age and refractory hypertension. In the acute phase, even uncomplicated patients are more prone to develop complications if hypertension and pain are left medically untreated. Innovations in stent graft technologies have incrementally improved outcomes since their first use for this condition in 1999, though improvement is needed in mitigating periprocedural complications, adverse events, and mortality. In the past decade, endovascular repair has become the preferred treatment because of its superior outcomes to open repair and medical therapy. The Valiant Captivia Thoracic Stent Graft System is a third-generation endovascular stent graft with advancements in minimally invasive delivery, conformability to the anatomy, and the minimization of adverse sequelae. Herein, this stent graft is briefly reviewed and its 3-year outcomes are presented. Freedom from all-cause and dissection-related mortality was 79.1% and 90.0%, respectively. The Valiant Captivia Stent Graft represents a safe, effective intervention for acute complicated TBAD. Continued surveillance is needed to verify its longer-term durability.
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Affiliation(s)
- Chang Young Lim
- Department of Thoracic and Cardiovascular Surgery, Andong General Hospital
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11
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Inci K, Koutouzi G, Chernoray V, Jeppsson A, Nilsson H, Falkenberg M. Air bubbles are released by thoracic endograft deployment: An in vitro experimental study. SAGE Open Med 2016; 4:2050312116682130. [PMID: 27994872 PMCID: PMC5153025 DOI: 10.1177/2050312116682130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/09/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose: Embolic stroke is a dreaded complication of thoracic endovascular aortic repair. The prevailing theory about its cause is that particulate debris from atherosclerotic lesions in the aortic wall are dislodged by endovascular instruments and embolize to the brain. An alternative source of embolism might be air trapped in the endograft delivery system. The aim of this experimental study was to determine whether air is released during deployment of a thoracic endograft. Methods: In an experimental benchtop study, eight thoracic endografts (five Medtronic Valiant Thoracic and three Gore TAG) were deployed in a water-filled transparent container drained from air. Endografts were prepared and deployed according to their instructions for use. Deployment was filmed and the volume of air released was collected and measured in a calibrated syringe. Results: Air was released from all the endografts examined. Air volumes ranged from 0.1 to 0.3 mL for Medtronic Valiant Thoracic and from <0.025 to 0.04 mL for Gore TAG. The largest bubbles had a diameter of approximately 3 mm and came from the proximal end of the Medtronic Valiant device. Conclusion: Air bubbles are released from thoracic endografts during deployment. Air embolism may be an alternative cause of stroke during thoracic endovascular aortic repair.
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Affiliation(s)
- Kamuran Inci
- Department of Surgery, Varberg Hospital, Varberg, Sweden
| | - Giasemi Koutouzi
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Valery Chernoray
- Department of Applied Mechanics, Chalmers University of Technology, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Thoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Håkan Nilsson
- Department of Applied Mechanics, Chalmers University of Technology, Gothenburg, Sweden
| | - Mårten Falkenberg
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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12
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Zhu Y, Wang B, Meng Q, Liu J, Zhai S, He J. Long-term efficacy of endovascular vs open surgical repair for complicated type-B aortic dissection: a single-center retrospective study and meta-analysis. ACTA ACUST UNITED AC 2016; 49:e5194. [PMID: 27254661 PMCID: PMC4932819 DOI: 10.1590/1414-431x20165194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/08/2016] [Indexed: 11/22/2022]
Abstract
This study aimed to evaluate the long-term survival and risk factors of traditional
open surgical repair (OSR) vs thoracic endovascular aneurysm repair
(TEVAR) for complicated type-B aortic dissection (TBAD). A total of 118 inpatients
(45 OSR vs 73 TEVAR) with TBAD were enrolled from January 2004 to
January 2015. Kaplan-Meier curves and Cox proportional hazards analysis were
performed to identify the long-term survival rate and independent predictors of
survival, respectively. Meta-analysis was used to further explore the long-term
efficacy of OSR and TEVAR in the eight included studies using Review Manager 5.2
software. An overall 10-year survival rate of 41.9% was found, and it was similar in
the two groups (56.7% OSR vs 26.1% TEVAR; log-rank P=0.953). The
risk factors of long-term survival were refractory hypertension (OR=11.1;
95%CI=1.428-86.372; P=0.021] and preoperative aortic diameter >55
mm (OR=4.5; 95%CI=1.842-11.346; P=0.001). Long-term survival rate
did not differ significantly between OSR and TEVAR (hazard ratio=0.87;
95%CI=0.52-1.47; P=0.61). Compared with OSR, TEVAR did not show
long-term advantages for patients with TBAD. Refractory hypertension and total aortic
diameter >55 mm can be used to predict the long-term survival of TBAD in the
Chinese Han population.
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Affiliation(s)
- Y Zhu
- Department of Cardiothoracic Surgery, Kaifeng Central Hospital, Kaifeng, China
| | - B Wang
- Department of Cardiothoracic Surgery, Kaifeng Central Hospital, Kaifeng, China
| | - Q Meng
- Department of Cardiothoracic Surgery, Kaifeng Central Hospital, Kaifeng, China
| | - J Liu
- Department of Cardiothoracic Surgery, Kaifeng Central Hospital, Kaifeng, China
| | - S Zhai
- Department of Cardiothoracic Surgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - J He
- Department of Cardiothoracic Surgery, Kaifeng Central Hospital, Kaifeng, China
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13
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Faure EM, Canaud L, Marty-Ané C, Becquemin JP, Alric P. Endovascular management of rupture in acute type B aortic dissections. Eur J Vasc Endovasc Surg 2015; 49:655-660. [PMID: 25805327 DOI: 10.1016/j.ejvs.2015.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/27/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Reports of thoracic endovascular aortic repair (TEVAR) for complicated acute type B aortic dissection (ABAD) bring together a large range of clinical presentations. With a 30 day mortality of 50% when managed with open surgery, rupture is the most devastating complication of ABAD. This study investigated the outcome of TEVAR for ABAD complicated by rupture (r-ABAD) to assess the results of this particularly critical subgroup. METHODS A review of consecutive TEVAR for r-ABAD in two tertiary referral centers was performed using a prospectively maintained database. RESULTS Between 2000 and 2013, 24 patients (mean age 71 years; 14 males) underwent TEVAR for r-ABAD. Sixteen (67%) were in shock (Systolic blood pressure <80 mmHg) before surgery. Seven patients had coverage of the left subclavian artery, of whom four had partial arch debranching procedures via cervical access concomitant with TEVAR. Median length of aortic coverage was 150 mm, median proximal oversizing was 13.3% (range 6.2-33.3%). Technical success was achieved in 100%. There were four in hospital deaths (16%). Two patients (8%) had paraplegia, but neither stroke nor renal insufficiency requiring dialysis occurred. During a mean follow up of 28 months, there was one aortic dissection related death and eight patients (40% of the surviving patients) required re-intervention. All re-interventions were managed endovascularly. At last follow up CT scan, eight patients (40%) had complete remodeling of the aortic wall. CONCLUSION With 16% in hospital mortality and 8% early major complications, this study confirms the feasibility of TEVAR for r-ABAD with a lower peri-operative morbidity and mortality rate compared with open surgery. Given the high rate of re-intervention, close follow up is required in surviving patients.
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Affiliation(s)
- E M Faure
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, France.
| | - L Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - C Marty-Ané
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - J-P Becquemin
- Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, France
| | - P Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France
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14
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Minami T, Imoto K, Uchida K, Karube N, Yasuda S, Choh T, Suzuki S, Masuda M. Thoracic Endovascular Aortic Repair for Ruptured Descending Thoracic Aortic Aneurysm. J Card Surg 2014; 30:163-9. [DOI: 10.1111/jocs.12499] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tomoyuki Minami
- Cardiovascular Center; Yokohama City University Medical Center; Yokohama Kanagawa Japan
- Cardiovascular Surgery; Yokohama Municipal Citizen's Hospital; Yokohama Kanagawa Japan
| | - Kiyotaka Imoto
- Cardiovascular Center; Yokohama City University Medical Center; Yokohama Kanagawa Japan
| | - Keiji Uchida
- Cardiovascular Center; Yokohama City University Medical Center; Yokohama Kanagawa Japan
| | - Norihisa Karube
- Cardiovascular Center; Yokohama City University Medical Center; Yokohama Kanagawa Japan
| | - Shota Yasuda
- Cardiovascular Center; Yokohama City University Medical Center; Yokohama Kanagawa Japan
| | - Tomoki Choh
- Cardiovascular Center; Yokohama City University Medical Center; Yokohama Kanagawa Japan
| | - Shinichi Suzuki
- Department of Surgery; Yokohama City University Hospital; Yokohama Kanagawa Japan
| | - Munetaka Masuda
- Department of Surgery; Yokohama City University Hospital; Yokohama Kanagawa Japan
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15
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Moulakakis KG, Mylonas SN, Dalainas I, Kakisis J, Kotsis T, Liapis CD. Management of complicated and uncomplicated acute type B dissection. A systematic review and meta-analysis. Ann Cardiothorac Surg 2014; 3:234-46. [PMID: 24967162 DOI: 10.3978/j.issn.2225-319x.2014.05.08] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/21/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND The management of acute type B dissection represents a clinical challenge. We undertook a systematic review of the available literature regarding medical, surgical and endovascular treatments of acute type B aortic dissection and combined the eligible studies into a meta-analysis. METHODS An extensive electronic health database search was performed on all articles published from January 2006 up to November 2013 describing the management of acute type B aortic dissection. Studies including less than 15 patients were excluded. RESULTS ACUTE COMPLICATED TYPE B DISSECTION: overall, 2,531 patients were treated with endovascular repair (TEVAR) and the pooled rate for 30-day/in-hospital mortality was 7.3%. The pooled estimates for cerebrovascular events, spinal cord ischemia (SCI) and total neurologic events were 3.9%, 3.1% and 7.3%, respectively. A total of 1,276 patients underwent open surgical repair and the pooled rate for 30-day/in-hospital mortality was 19.0%. The pooled rate for cerebrovascular events was 6.8%, for SCI 3.3% and for total neurologic complications 9.8%. Acute uncomplicated type B dissection: outcome of 2,347 patients who underwent conservative medical management were analyzed. The pooled 30-day/in-hospital mortality rate was 2.4%. The pooled rate for cerebrovascular events was 1%, for SCI 0.8% and for overall neurologic complications 2%. CONCLUSIONS Endovascular repair provides a superior 30-day/in-hospital survival for acute complicated type B aortic dissection compared to surgical aortic reconstruction. However, open repair still has a significant role as endovascular repair is not applicable in all patients and there remains concerns regarding the durability of this technique. TEVAR seems to have a more favorable outcome regarding aortic remodeling and the aortic-specific survival rate when compared with medical therapy alone. Randomized controlled trials focusing on the prognostic factors of early and late complications in uncomplicated type B dissections are needed.
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Affiliation(s)
- Konstantinos G Moulakakis
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Spyridon N Mylonas
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Ilias Dalainas
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - John Kakisis
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Thomas Kotsis
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Christos D Liapis
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
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16
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Botsios S, Frömke J, Walterbusch G, Schuermann K, Reinstadler J, Dohmen G. Endovascular Treatment for Nontraumatic Rupture of the Descending Thoracic Aorta: Long-Term Results. J Card Surg 2014; 29:353-8. [DOI: 10.1111/jocs.12329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Spiridon Botsios
- Department of Thoracic- and Cardiovascular Surgery; St.-Johannes Hospital Dortmund; Dortmund Germany
- Faculty of Health; University Witten/Herdecke; Witten Germany
| | - Johannes Frömke
- Department of Thoracic- and Cardiovascular Surgery; St.-Johannes Hospital Dortmund; Dortmund Germany
| | - Gerhard Walterbusch
- Department of Thoracic- and Cardiovascular Surgery; St.-Johannes Hospital Dortmund; Dortmund Germany
| | - Karl Schuermann
- Department of Radiology; St.-Johannes Hospital Dortmund; Dortmund Germany
| | - Jan Reinstadler
- Department of Thoracic- and Cardiovascular Surgery; St.-Johannes Hospital Dortmund; Dortmund Germany
| | - Guido Dohmen
- Department of Thoracic- and Cardiovascular Surgery; St.-Johannes Hospital Dortmund; Dortmund Germany
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17
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Rylski B, Blanke P, Beyersdorf F, Desai ND, Milewski RK, Siepe M, Kari FA, Czerny M, Carrel T, Schlensak C, Krüger T, Mack MJ, Brinkman WT, Mohr FW, Etz CD, Luehr M, Bavaria JE. How Does the Ascending Aorta Geometry Change When It Dissects? J Am Coll Cardiol 2014; 63:1311-1319. [DOI: 10.1016/j.jacc.2013.12.028] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/24/2013] [Accepted: 12/23/2013] [Indexed: 11/26/2022]
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