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Trimarchi S, Mandigers TJ, Bissacco D, Nienaber C, Isselbacher EM, Evangelista A, Suzuki T, Bossone E, Pape LA, Januzzi JL, Harris KM, O'Gara PT, Gilon D, Hutchison S, Patel HJ, Woznicki EM, Montgomery D, Kline-Rogers E, Eagle KA. Twenty-five years of observations from the International Registry of Acute Aortic Dissection (IRAD) and its impact on the cardiovascular scientific community. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00608-6. [PMID: 37453718 DOI: 10.1016/j.jtcvs.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The International Registry of Acute Aortic Dissection (IRAD) celebrated its 25th anniversary in January 2021. This study evaluated IRAD's role in promoting the understanding and management of acute aortic dissection (AD) over these years. METHODS IRAD studies were identified, analyzed, and ranked according to their citations per year (c/y) to determine the most-cited IRAD studies and topics. A systematic search of the literature identified cardiovascular guidelines on the diagnosis and management of acute AD. Consequently, IRAD's presence and impact were quantified using these documents. RESULTS Ninety-seven IRAD studies were identified, of which 82 obtained more than 10 cumulative citations. The median c/y index was 7.33 (25th-75th percentile, 4.01-16.65). Forty-two studies had a greater than median c/y index and were considered most impactful. Of these studies, most investigated both type A and type B AD (n = 17, 40.5%) and short-term outcomes (n = 26, 61.9%). Nineteen guideline documents were identified from 26 cardiovascular societies located in Northern America, Europe, and Japan. Sixty-nine IRAD studies were cited by these guidelines, including 38 of the 42 most-impactful IRAD studies. Among them, partial thrombosis of the false lumen as a predictor of postdischarge mortality and aortic diameters as a predictor of type A occurrence were determined as most-impactful specific IRAD topics by their c/y index. CONCLUSIONS IRAD has had and continues to have an important role in providing observations, credible knowledge, and research questions to improve the outcomes of patients with acute AD.
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Affiliation(s)
- Santi Trimarchi
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Tim J Mandigers
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daniele Bissacco
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Christoph Nienaber
- Department of Cardiology, Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Trust, Imperial College, London, United Kingdom
| | - Eric M Isselbacher
- Cardiology Department, Thoracic Aortic Center, Massachusetts General Hospital, Boston, Mass
| | - Arturo Evangelista
- Cardiology Department, Hospital General Universitari Vall d'Hebron, Barcelona, Spain
| | - Toru Suzuki
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | | | - Linda A Pape
- Department of Medicine, University of Massachusetts Hospital, Worcester, Mass
| | - James L Januzzi
- Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Mass; Cardiology Division, Massachusetts General Hospital, Boston, Mass
| | - Kevin M Harris
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Patrick T O'Gara
- Department of Cardiology, Brigham & Women's Hospital, Boston, Mass
| | - Dan Gilon
- Department of Non-invasive Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Stuart Hutchison
- Department of Cardiac Sciences, University of Calgary Medical Centre, Calgary, Canada
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | | | | | | | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor, Mich
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2
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Dong Z, Yang H, Li G, Xu X, Liu H, Gu J, Li M, Gu W, Shao Y, Ni B. Preoperative Predictors of Late Aortic Expansion in Acute Type B Aortic Dissection Treated with TEVAR. J Clin Med 2023; 12:jcm12082826. [PMID: 37109163 PMCID: PMC10141654 DOI: 10.3390/jcm12082826] [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: 02/19/2023] [Revised: 03/10/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND A patent false lumen (FL) in patients with thoracic endovascular aortic repair (TEVAR)-treated type B aortic dissection (TBAD) can cause a significant risk for late aortic expansion (LAE). We hypothesize that preoperative features can predict the occurrence of LAE. METHODS Sufficient preoperative and postoperative follow-up clinical and imaging feature data for patients treated with TEVAR in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2020 were collected. A univariate analysis and multivariable logistic regression analysis were used to find potential risk factors of LAE. RESULTS Ninety-six patients were finally included in this study. The mean age was 54.5 ± 11.7 years and 85 (88.5%) were male. LAE occurred in 15 (15.6%) of 96 patients after TEVAR. Two preoperative factors showed strong associations with LAE according to the multivariable logistic regression analysis: preoperative partial thrombosis of the FL (OR = 10.989 [2.295-48.403]; p = 0.002) and the maximum descending aortic diameter (OR = 1.385 [1.100-1.743] per mm increase; p = 0.006). CONCLUSIONS Preoperative partial thrombosis of the FL and an increase in the maximum aortic diameter are strongly associated with late aortic expansion. Additional interventions of the FL may help to improve the prognosis of patients with the high risk of late aortic expansion.
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Affiliation(s)
- Zhiqiang Dong
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - He Yang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Gang Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Xinyang Xu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Hong Liu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Jiaxi Gu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Minghui Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Weidong Gu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Yongfeng Shao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Buqing Ni
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
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3
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Lazar HL. Commentary: Mechanical Vs Bioprosthetic Aortic Valve Replacement In Patients Undergoing Surgery For A Type A Aortic Dissection-Which Is Best? Semin Thorac Cardiovasc Surg 2021; 34:488-489. [PMID: 34004301 DOI: 10.1053/j.semtcvs.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/28/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, the Boston University School of Medicine, Boston, MA.
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4
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Loor G, Gleason TG, Myrmel T, Korach A, Trimarchi S, Desai ND, Bavaria JE, de Vincentiis C, Ouzounian M, Sechtem U, Montgomery DG, Chen EP, Maniar H, Sundt TM, Patel H. Effect of Aortic Valve Type on Patients Who Undergo Type A Aortic Dissection Repair. Semin Thorac Cardiovasc Surg 2021; 34:479-487. [PMID: 33984483 DOI: 10.1053/j.semtcvs.2021.04.003] [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] [Received: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 11/11/2022]
Abstract
Aortic valve replacement (AVR) is common in the setting of type A aortic dissection (TAAD) repair. Here, we evaluated the association between prosthesis choice and patient outcomes in an international patient cohort. We reviewed data from the International Registry of Acute Aortic Dissection (IRAD) interventional cohort to examine the relationship between valve choice and short- and mid-term patient outcomes. Between January 1996 and March 2016, 1290 surgically treated patients with TAAD were entered into the IRAD interventional cohort. Of those, 364 patients undergoing TAAD repair underwent aortic valve replacement (AVR; mean age, 57 years). The mechanical valve cohort consisted of 189 patients, of which 151 (79.9%) had a root replacement. The nonmechanical valve cohort consisted of 5 patients who received homografts and 160 patients who received a biologic AVR, with a total of 118 (71.5%) patients who underwent root replacements. The mean follow-up time was 2.92 ± 1.75 years overall (2.46 ± 1.69 years for the mechanical valve cohort and 3.48 ± 1.8 years for the nonmechanical valve cohort). After propensity matching, Kaplan-Meier estimates of 4-year survival rates after surgery were 64.8% in the mechanical valve group compared with 74.7% in the nonmechanical valve group (p = 0.921). A stratified Cox model for 4-year mortality showed no difference in hazard between valve types after adjusting for the propensity score (p = 0.854). A biologic valve is a reasonable option in patients with TAAD who require AVR. Although this option avoids the potential risks of anticoagulation, long-term follow up is necessary to assess the effect of reoperations or transcatheter interventions for structural valve degeneration.
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Affiliation(s)
- Gabriel Loor
- Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minn; Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas; Division of Cardiothoracic Transplantation and Circulatory Support, Texas Heart Institute, Houston, Texas.
| | - Thomas G Gleason
- Division of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Penn
| | - Truls Myrmel
- Department of Thoracic and Cardiovascular Surgery, Tromso University Hospital, Tromso, Norway
| | - Amit Korach
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Santi Trimarchi
- Department of Vascular Surgery, IRCCS Policlinico San Donato, San Donato, Italy
| | - Nimesh D Desai
- Department of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Penn
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Penn
| | - Carlo de Vincentiis
- Department of Vascular Surgery, IRCCS Policlinico San Donato, San Donato, Italy
| | - Maral Ouzounian
- Division of Cardiac Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Udo Sechtem
- Division of Cardiology, Robert-Bosch Krankenhaus, Stuttgart, Germany
| | | | - Edward P Chen
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Hersh Maniar
- Division of Cardiothoracic Surgery, Department of Cardiovascular Surgery, Washington University, St. Louis, Missouri
| | - Thoralf M Sundt
- Thoracic Aortic Center, Massachusetts General Hospital, Boston, Mass
| | - Himanshu Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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5
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Moeller E, Nores M, Stamou SC. Repair of Acute Type-A Aortic Dissection in the Present Era: Outcomes and Controversies. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2020; 7:155-162. [PMID: 32272487 PMCID: PMC7145439 DOI: 10.1055/s-0039-3401810] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Acute Type-A aortic dissection (AAAD) remains a surgical emergency with a relatively high operative mortality despite advances in medical and surgical management over the past three decades. In spite of the severity of disease, there is a paucity of studies reviewing key controversies surrounding AAAD repair and management. A systematic literature search was performed using Cochrane review and PubMed bibliography review. Abstracts were first reviewed for general pertinence and then articles were reviewed in full. Literature review indicates that use of moderate hypothermia and antegrade cerebral perfusion is a safe alternative to deep hypothermia. In hemodynamically stable patients, axillary cannulation may be substituted for femoral cannulation. With regard to the technical aspects of repair, preserving the aortic root whenever possible and performing the distal anastomosis with the open distal technique rather than with the clamp on is the preferred approach. In patients with a patent false lumen, close monitoring is indicated. As demonstrated by the literature, significant improvement of early and late mortality over the past years has occurred in patients presenting with AAAD. Repair of acute Type-A aortic dissection remains a challenge with high operative mortality; however, improvement of surgical techniques and management have resulted in improvement of early and late clinical outcomes.
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Affiliation(s)
- Ellie Moeller
- Department of Cardiothoracic Surgery, JFK Medical Center, Atlantis, FL
| | - Marcos Nores
- Department of Cardiothoracic Surgery, JFK Medical Center, Atlantis, FL
| | - Sotiris C Stamou
- Department of Cardiothoracic Surgery, JFK Medical Center, Atlantis, FL
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6
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Delsart P, Soquet J, Ramdane N, Ramond C, Mugnier A, Rousse N, Ledieu G, Bical A, Loobuyck V, Jegou B, Modine T, Hysi I, Fabre O, Juthier F, Vincentelli A, Mounier-Vehier C. Aortic morphology post type A acute aortic syndrome: Prognosis significance and association with 24-hour blood pressure-monitoring parameters. J Card Surg 2020; 35:981-987. [PMID: 32176383 DOI: 10.1111/jocs.14512] [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: 11/30/2022]
Abstract
BACKGROUND After an emergent surgery for type A acute aortic syndrome, medical management is based on optimal blood pressure (BP) control. We assessed the prognostic significance of BP monitoring and its relationship with aortic morphology following type A acute aortic syndrome. METHODS The data of 120 patients who underwent BP monitoring after a type A acute aortic syndrome from January 2005 to June 2016 were retrospectively collected. The first CT angiogram performed after surgery was used for the morphological analysis. RESULTS The population included 79 males, with an overall mean age of 60 ± 12 years. Seven patients (5.8%) died during a median follow-up of 5.5 years. The median delay between BP monitoring and discharge was 3 (1-5) months. The mean 24-hour BP of the cohort was 127/73 mm Hg ± 10/17. During follow-up, different parameters of BP monitoring were not associated with the risk of aortic events. However, the diameter of the false lumen of the descending thoracic aorta was the best predictor associated with the risk of new aortic events during follow-up, particularly for the threshold of 28 mm or more (P < .001; Hazard ratio 4.7[2.7-8.2]). The diameter of the false lumen was associated with night-time systolic BP (P = .025; r = .2), 24-hour pulse pressure (P = .002; r = .28), and night-time pulse pressure (P = .008; r = .24). CONCLUSION The risk of new aortic events following type A acute aortic syndrome is associated with the size of the residual false lumen, but not directly with BP parameters. Night-time BP parameters are associated with the size of the residual false lumen.
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Affiliation(s)
| | - Jérôme Soquet
- CHU Lille, Institut Cœur Poumon, Lille, France.,University of Lille, CHU Lille, Inserm U1011, Lille, France
| | - Nassima Ramdane
- METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, University of Lille, CHU Lille, ULR 2694, Lille, France
| | | | | | - Natacha Rousse
- CHU Lille, Institut Cœur Poumon, Lille, France.,University of Lille, CHU Lille, Inserm U1011, Lille, France
| | | | - Antoine Bical
- CHU Lille, Institut Cœur Poumon, Lille, France.,University of Lille, CHU Lille, Lille, France
| | - Valentin Loobuyck
- CHU Lille, Institut Cœur Poumon, Lille, France.,University of Lille, CHU Lille, Inserm U1011, Lille, France
| | - Bruno Jegou
- CHU Lille, Institut Cœur Poumon, Lille, France
| | | | - Ilir Hysi
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard, Ramsay Générale de Santé, Lens, France
| | - Olivier Fabre
- Department of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard, Ramsay Générale de Santé, Lens, France
| | - Francis Juthier
- CHU Lille, Institut Cœur Poumon, Lille, France.,University of Lille, CHU Lille, Inserm U1011, Lille, France
| | - Andre Vincentelli
- CHU Lille, Institut Cœur Poumon, Lille, France.,University of Lille, CHU Lille, Inserm U1011, Lille, France
| | - Claire Mounier-Vehier
- CHU Lille, Institut Cœur Poumon, Lille, France.,University of Lille, CHU Lille, Lille, France
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7
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Evangelista A, Isselbacher EM, Bossone E, Gleason TG, Eusanio MD, Sechtem U, Ehrlich MP, Trimarchi S, Braverman AC, Myrmel T, Harris KM, Hutchinson S, O'Gara P, Suzuki T, Nienaber CA, Eagle KA. Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research. Circulation 2019; 137:1846-1860. [PMID: 29685932 DOI: 10.1161/circulationaha.117.031264] [Citation(s) in RCA: 686] [Impact Index Per Article: 137.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acute aortic dissection (AAD) is a life-threatening condition associated with high morbidity and mortality rates, and it remains a challenge to diagnose and treat. The International Registry of Acute Aortic Dissection was established in 1996 with the mission to raise awareness of this condition and provide insights to guide diagnosis and treatment. Since then, >7300 cases have been included from >51 sites in 12 countries. Although presenting symptoms and physical findings have not changed significantly over this period, the use of computed tomography in the diagnosis has increased, and more patients are managed with interventional procedures: surgery in type A AAD and endovascular therapy in type B AAD; with these changes in care, there has been a significant decrease in overall in-hospital mortality in type A AAD but not in type B AAD. Herein, we summarized the key lessons learned from this international registry of patients with AAD over the past 20 years.
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Affiliation(s)
- Arturo Evangelista
- Hospital General Universitari Vall d'Hebron, CIBER-CV, Barcelona, Spain (A.E.)
| | | | | | | | | | - Udo Sechtem
- Robert-Bosch Krankenhaus, Stuttgart, Germany (U.S.)
| | | | | | - Alan C Braverman
- Washington University School of Medicine, St. Louis, MO (A.C.B.)
| | | | | | | | | | - Toru Suzuki
- University of Leicester, United Kingdom (T.S.)
| | - Christoph A Nienaber
- The Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom (C.A.N.)
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8
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Liu H, Shi L, Zeng T, Ji Q, Shi Y, Huang Y, Zhang L, Xiao T, Ye J, Lin Y, Liu L. Type 2 diabetes mellitus reduces clinical complications and mortality in Stanford type B aortic dissection after thoracic endovascular aortic repair: A 3-year follow-up study. Life Sci 2019; 230:104-110. [PMID: 31128138 DOI: 10.1016/j.lfs.2019.05.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/12/2019] [Accepted: 05/21/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous studies have demonstrated that type 2 diabetes mellitus (T2DM) is negatively correlated with the occurrence of aortic dissection (AD). This study aimed to investigate the effects of T2DM on the prognosis of Stanford type B AD (STBAD) patients after thoracic endovascular aortic repair (TEVAR). METHODS STBAD patients (n = 141) who underwent TEVAR received an oral glucose tolerance test (OGTT) and were divided into a normal glucose (NG, n = 55) group, an abnormal glucose tolerance (AGT, n = 48) group and a T2DM (n = 38) group according to the results of the OGTT. Data on mortality, clinical complications, left ventricular (LV) remodeling and aortic remodeling were collected during the 3-year follow-up. RESULTS Lower mortality and fewer clinical complications after TEVAR were found in the T2DM group than in the NG group. Multivariate linear regression analysis showed that 2-hour postprandial glucose (Glu-2h) was negatively correlated with mortality and the occurrence of clinical complications in STBAD patients after TEVAR. In addition, better LV remodeling, larger true lumen areas and smaller false lumen areas in both the proximal aortas and abdominal aortas were observed in the T2DM group than in the NG group. Furthermore, no significant differences in mortality or clinical complications after TEVAR were found between the NG group and the AGT group or between the T2DM group and the AGT group. CONCLUSION During the 3-year follow-up period, mortality and clinical complications in STBAD patients after TEVAR were significantly reduced in the T2DM group. For STBAD patients who undergo TEVAR, properly relaxing of blood glucose control requirements may be beneficial for their prognosis.
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Affiliation(s)
- Hongtao Liu
- Department of Cardiovascular Medicine, Shenzhen Longhua District Central Hospital, Longhua Central Hospital Affiliated Guangdong Medical University, Shenzhen, Guangdong Province 518110, China
| | - Lei Shi
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Tao Zeng
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Qingwei Ji
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China; Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing 100029, China
| | - Ying Shi
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Ying Huang
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Le Zhang
- Department of Cardiovascular Medicine, Shenzhen Longhua District Central Hospital, Longhua Central Hospital Affiliated Guangdong Medical University, Shenzhen, Guangdong Province 518110, China
| | - Ting Xiao
- Department of Cardiovascular Medicine, Shenzhen Longhua District Central Hospital, Longhua Central Hospital Affiliated Guangdong Medical University, Shenzhen, Guangdong Province 518110, China
| | - Jing Ye
- Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Yingzhong Lin
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China.
| | - Ling Liu
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China.
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9
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Pan E, Gudbjartsson T, Ahlsson A, Fuglsang S, Geirsson A, Hansson EC, Hjortdal V, Jeppsson A, Järvelä K, Mennander A, Nozohoor S, Olsson C, Wickbom A, Zindovic I, Gunn J. Low rate of reoperations after acute type A aortic dissection repair from The Nordic Consortium Registry. J Thorac Cardiovasc Surg 2018; 156:939-948. [DOI: 10.1016/j.jtcvs.2018.03.144] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 02/06/2018] [Accepted: 03/02/2018] [Indexed: 11/16/2022]
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10
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Lin FY, Tseng YH, Huang JW, Hsieh CC, Chen HM, Chiu CC, Chen YF. Fate of distal aorta after acute type A aortic dissection repair: Change and persistency of postoperative false lumen status. Int J Cardiol 2018; 266:50-55. [DOI: 10.1016/j.ijcard.2018.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/08/2017] [Accepted: 01/02/2018] [Indexed: 01/16/2023]
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11
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Paolucci M, Van Damme H, Boesmans E, Desiron Q, Defraigne JO. [Type A intramural hematoma of aorta: An undervalued clinical entity]. JOURNAL DE MÉDECINE VASCULAIRE 2018; 43:206-212. [PMID: 29754731 DOI: 10.1016/j.jdmv.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 03/12/2018] [Indexed: 11/29/2022]
Abstract
Intramural hematoma of the ascending aorta occurs after rupture of the vasa vasorum. Previously considered as a first step of acute aortic dissection, it was later defined as a separate entity that may or may not lead to arterial dissection. The debate about the most appropriate treatment for a 69-year-old patient with intramural hematoma of the ascending aorta, led to this extensive review of the literature demonstrating that intramural hematoma type A is a life-threatening condition requiring urgent surgical support.
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Affiliation(s)
- M Paolucci
- Service de chirurgie cardiovasculaire et thoracique, CHU Sart Tilman, avenue de L'Hôpital 1, 4000 Liège, Belgique
| | - H Van Damme
- Service de chirurgie cardiovasculaire et thoracique, CHU Sart Tilman, avenue de L'Hôpital 1, 4000 Liège, Belgique.
| | - E Boesmans
- Service de chirurgie cardiovasculaire et thoracique, CHU Sart Tilman, avenue de L'Hôpital 1, 4000 Liège, Belgique
| | - Q Desiron
- Service de chirurgie cardiovasculaire et thoracique, CHU Sart Tilman, avenue de L'Hôpital 1, 4000 Liège, Belgique
| | - J O Defraigne
- Service de chirurgie cardiovasculaire et thoracique, CHU Sart Tilman, avenue de L'Hôpital 1, 4000 Liège, Belgique
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12
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Tanaka A, Ishii H, Suzuki S, Ota T, Oshima H, Usui A, Komori K, Murohara T. Influence of False Lumen Status on the Prognosis of Acute Type A Aortic Dissection without Urgent Surgical Treatment. J Atheroscler Thromb 2017; 24:169-175. [PMID: 27466158 PMCID: PMC5305677 DOI: 10.5551/jat.35675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Recently, much attention has been focused on partial thrombosis of the false lumen in patients with acute aortic dissection. However, its effect on clinical outcomes in these patients, especially in case of acute type A aortic dissection, has not been clearly elucidated. This study evaluated the influence of the false lumen status, including partial thrombosis, on short-term clinical outcomes in acute type A aortic dissection patients without urgent surgical treatment. METHODS Sixty-two patients (29 males, mean age 73±13 years) with acute type A aortic dissection who did not receive urgent surgical treatment at four hospitals were enrolled. Patients were divided into three groups based on the false lumen status on enhanced computed tomography image (complete thrombosis, n=28; partial thrombosis, n=27; patent, n=7). Patients with partial thrombosis were further divided into two groups (thrombus-dominant, n=15; flow-dominant, n=12). RESULTS The short-term mortality rate (in-hospital and 30-day) was significantly higher in patients with a patent false lumen, while no significant difference was seen between the other two groups. Patients with flow-dominant partial thrombosis had significantly higher short-term mortality rate than those with thrombus-dominant partial thrombosis (in-hospital, p=0.001 and 30-day, p<0.001). CONCLUSIONS The short-term mortality rate in acute type A aortic dissection patients without urgent surgical treatment was lower in patients with partial thrombosis of the false lumen than in those with a patent false lumen. Furthermore, patients with flow-dominant partial thrombosis had higher mortality rate than those with thrombus-dominant partial thrombosis.
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Affiliation(s)
- Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine
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Myrmel T, Larsen M, Bartnes K. The International Registry of Acute Aortic Dissections (IRAD) – experiences from the first 20 years. SCAND CARDIOVASC J 2016; 50:329-333. [DOI: 10.1080/14017431.2016.1240829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Truls Myrmel
- The Heart and Lung Clinic, University Hospital North Norway, Tromsø, Norway
- The University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Magnus Larsen
- Department of Urology and Endocrine Surgery, University Hospital North Norway, Tromsø, Norway
| | - Kristian Bartnes
- The Heart and Lung Clinic, University Hospital North Norway, Tromsø, Norway
- The University of Tromsø, The Arctic University of Norway, Tromsø, Norway
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Li D, Ye L, He Y, Cao X, Liu J, Zhong W, Cao L, Zeng R, Zeng Z, Wan Z, Cao Y. False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2016; 5:JAHA.115.003172. [PMID: 27166218 PMCID: PMC4889188 DOI: 10.1161/jaha.115.003172] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The long‐term association between the status of the false lumen and poor patient outcomes in acute aortic dissection (AAD) remains unclear. This systematic review and meta‐analysis investigated whether the status of the false lumen was a predictor of poor long‐term survival in AAD. Methods and Results Eleven cohort studies (2924 participants) exploring the association between the false lumen status and long‐term outcomes (>1 year) in AAD were included. All studies reported multivariate‐adjusted hazard ratios (HRs) with 95% CIs for long‐term outcomes, according to false lumen status. Pooled HRs for mortality and aortic events were computed and weighted using generic inverse‐variance and random‐effect modeling. Residual patent false lumen was an independent predictor of long‐term mortality in AAD type A (HR, 1.71; 95% CI, 1.16–2.52; P=0.007) and type B (HR, 2.79; 95% CI, 1.80–4.32; P<0.001). AAD patients with residual patent false lumen exhibited an increased risk of aortic events (HR, 5.43; 95% CI, 2.95–9.99; P<0.001). Partial false lumen thrombosis was independently associated with long‐term mortality in type B AAD (HR, 2.24; 95% CI, 1.37–3.65; P=0.001). This association was not observed in AAD type A patients (HR, 1.75; 95% CI, 0.88–3.45; P=0.211). Conclusions The false lumen status influences late outcomes in AAD. Residual patent false lumen is independently associated with poor long‐term survival in AAD. However, only type B AAD patients with partial false lumen thrombosis had an increased late mortality risk.
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Affiliation(s)
- Dongze Li
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Ye
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yarong He
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoping Cao
- Department of Emergency Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jining Liu
- Department of Emergency Medicine, Mianyang Central Hospital, Mianyang, China
| | - Wu Zhong
- Department of Emergency Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Linghong Cao
- Department of Emergency Medicine, Zigong No. 4 People's Hospital, Zigong, China
| | - Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi Zeng
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi Wan
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Cao
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
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Diagnosis and Management of Acute Aortic Syndromes: Dissection, Intramural Hematoma, and Penetrating Aortic Ulcer. Curr Cardiol Rep 2014; 16:536. [DOI: 10.1007/s11886-014-0536-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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16
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Esposito G, Cappabianca G, Bichi S, Cricco A, Albano G, Anzuini A. Hybrid repair of type A acute aortic dissections with the Lupiae technique: ten-year results. J Thorac Cardiovasc Surg 2014; 149:S99-104. [PMID: 25256081 DOI: 10.1016/j.jtcvs.2014.07.099] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/14/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Replacing the ascending aorta and the arch in patients with type A acute aortic dissection achieves good short-term results, but several patients are left with distal intimal tears or a patent false lumen in the descending aorta. In this series, we report the 10-year experience with the Lupiae technique, a hybrid aortic repair technique for patients with type A acute aortic dissection. METHODS From 2003 to 2013, 89 patients with type A acute aortic dissections underwent replacement of the ascending aorta, the arch, and the rerouting of the neck vessels on the ascending aorta, creating a proximal Dacron landing zone for a completion with thoracic endovascular aortic repair if necessary. RESULTS In-hospital mortality was 8.9%. In 16 patients, the false lumen healed spontaneously, whereas the remaining 65 patients underwent thoracic endovascular aortic repair. One patient died after thoracic endovascular aortic repair. Eighty patients were followed up. Complete thrombosis of the false lumen was obtained in 93.8% of patients. The median follow-up was 46 ± 35 months. Overall 8-year survival was 93.7% ± 5%, 100% for patients with spontaneously healed residual false lumen after just type A acute aortic dissection repair and 92.3% ± 7.7% for patients who underwent thoracic endovascular aortic repair after type A acute aortic dissection repair. In 10 years, 1 patient underwent a reoperation on the distal aorta (1.25%). CONCLUSIONS The availability of a Dacron landing zone on the distal ascending aorta after type A acute aortic dissection repair allows the exclusion, with a thoracic endovascular aortic repair, of any residual intimal tear refilling a patent false lumen. This approach seems to be associated with a high probability of false lumen thrombosis and low rates of reoperations on the distal aorta.
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Affiliation(s)
- Giampiero Esposito
- Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | | | - Samuele Bichi
- Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonio Cricco
- Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Giovanni Albano
- Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Angelo Anzuini
- Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
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Partially patent false lumen does not exhibit the highest growth rate. Int J Cardiol 2014; 175:385-8. [DOI: 10.1016/j.ijcard.2014.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/12/2014] [Indexed: 11/17/2022]
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18
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Carmona P, Pérez-Boscá JL, Marqués JI, Mateo E, de Andrés J. Papel de la ecocardiografía transesofágica perioperatoria en la patología de la aorta. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2013.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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