Early recognition of acute thoracic aortic dissection and aneurysm

Association between single nucleotide polymorphisms of tropoelastin gene and aortic dissection

OBJECTIVES

To evaluate the relation between single nucleotide polymorphisms (SNPs) of tropoelastin gene and aortic dissection (AD) via identifying SNPs in the tropoelastin gene, and to detect the level of tropoelastin mRNA, elastin and elastic fibers.

METHODS

The specimens of the AD group (n=96) and the control group (n=95), including their blood and aortic wall tissues, were collected. DNA was extracted from the blood samples in the 2 groups, and the SNPs in the tropoelastin gene were examined by the MassARRAY genotyping technique, and their haplotypes were constructed by PHASE software. The expression of tropoelastin mRNA and elastin in the aortic tunica media was respectively detected by real-time PCR or Western blotting. Elastin Van Gieson (EVG) staining was used to observe the shape of aortic tunica media and clarify the distribution of elastic fibers. The frequency of genotypes and haplotypes of SNP loci in the tropoelastin gene was analyzed and compared between the 2 groups, and the expression of tropoelastin mRNA, elastin and elastic fibers were also compared.

RESULTS

Seven SNP loci of the tropoelastin gene were detected in these samples. Among them, 5 SNP loci were polymorphic. The frequency of 3 SNP loci[rs2071307 (G/A), rs34945509 (C/T) and rs17855988 (G/C)] was significantly different between the AD group and the control group (all P<0.05). There were significantly different in the haplotypes frequency of rs2071307 (G/A), rs34945509 (C/T) and rs17855988 (G/C) between the 2 groups (all P<0.01). Real-time PCR and Western blotting showed that the relative expression of tropoelastin mRNA and elastin in the aortic tunica media in the AD group was significantly lower than that in the control group (P<0.05). EVG staining showed that the aortic tunica media was torn, the morphology and structure of elastic fibers were broken, cracked, and disordered in the AD group, while the aortic tunica media was in complete structure and well arrangement.The elastic fibers were presented closely and orderly in the control group.

CONCLUSIONS

The polymorphisms of rs2071307 (G/A), rs34945509 (C/T), and rs17855988(G/C) in the tropoelastin gene may eventually affect the synthesis of elastic fibers and they may play an important role in the occurrence of AD.

Effect of Resident Involvement on Morbidity and Mortality Following Thoracic Endovascular Aortic Repair

OBJECTIVE

To evaluate the effect of resident involvement in thoracic endovascular aortic repair (TEVAR).

SUMMARY OF BACKGROUND DATA

Although the influence of resident intraoperative involvement in several types of surgical procedures has been reported, the effect of resident participation in TEVAR is unknown. We evaluated patient outcomes in resident-involved TEVAR procedures.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was analyzed for TEVAR performed from 2010 to 2012. Current procedural terminology codes were used to identify adult patients (≥18 y) who underwent TEVAR. Patients were grouped into those with and without resident involvement. Descriptive and binomial logistic statistics were used to determine the effect of resident involvement on post-TEVAR outcomes. p values < 0.05 were considered statistically significant.

RESULTS

A total of 676 patients met inclusion criteria for this study. Of these, 517 (76.5%) had residents involved. Overall mortality was 9.8%, with no significant difference between the 2 groups (p = 0.88). Resident involvement was not a significant predictor of any post-TEVAR complication. Postoperative pneumonia (3.5% vs 6.9%, p = 0.06), prolonged mechanical ventilation (11.8% vs 11.9%, p = 0.96), stroke (2.7% vs 5.7%, p = 0.07), urinary tract infection (3.3% vs 4.4%, p = 0.50), progressive renal insufficiency (1.2% vs 2.5%, p = 0.22), acute renal failure (4.1% vs 5.0%, p = 0.60), cardiac arrest (2.9% vs 5.0%, p = 0.20), myocardial infarction (1.7% vs 1.9%, p = 0.91), deep venous thrombosis (1.7% vs 1.3%, p = 0.67), red blood cells transfusions (29.2% vs 36.5%, p = 0.08), sepsis (2.9% vs 4.4%, p = 0.35), septic shock (1.9% vs 3.8%, p = 0.18), and unplanned reintubation (8.7% vs 9.4%, p = 0.78) were not significantly affected. Additionally, resident involvement did not significantly affect operative time (176.1 ± 122.8 min vs 180.3 ± 119.1 min, p = 0.71) and anesthesia time (282.1 ± 146.6 min vs 278.3 ± 140.5 min, p = 0.78).

CONCLUSIONS

The participation of residents in TEVAR did not significantly affect all 30-day patient outcomes. Resident involvement in TEVAR is safe and should be encouraged.

MINI ABSTRACT

This study evaluated the effect of resident participation on postoperative outcomes of thoracic endovascular aortic repair (TEVAR) using the American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database. Results showed that resident involvement in TEVAR does not negatively affect patient outcomes.

LncRNA and mRNA interaction study based on transcriptome profiles reveals potential core genes in the pathogenesis of human thoracic aortic dissection

The aim of the present study was to determine the potential core genes in the pathogenesis of human thoracic aortic dissection (TAD) by analyzing microarray profiles of long non‑coding (lnc)‑RNAs between TAD and normal thoracic aorta (NTA). The differentially expressed lncRNA profiles of the aorta tissues between TAD patients (TAD group, n=6) and age‑matched donors with aortic diseases (NTA group, n=6) were analyzed by lncRNAs microarray. Gene ontology (GO), pathway and network analyses were used to further investigate candidate lncRNAs and mRNAs. Differentially expressed lncRNAs and mRNAs were validated by reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR). In total, the present study identified 765 lncRNAs and 619 mRNAs with differential expression between TAD and NTA (fold change >2.0, P<0.01). GO analysis demonstrated that the differentially upregulated lncRNAs are associated with cell differentiation, homeostasis, cell growth and angiogenesis. Kyoto Encyclopedia of Gene and Genomes pathway analysis demonstrated that the differentially downregulated lncRNAs are mainly associated with arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy and dilated cardiomyopathy. To reduce the lncRNAs for further investigation and to enrich those potentially involved in TAD, a total of 16 candidate lncRNAs with a significant expression (fold change >4, P<0.01) were selected, that were associated with an annotated protein‑coding gene through the GO term and scientific literatures. Then a set of significantly expressed lncRNAs [purinergic receptor P2X7 (P2RX7), hypoxia inducing factor (HIF)‑1A‑AS2, AX746823, RP11‑69I8.3 and RP11‑536K7.5) and the corresponding mRNAs (P2RX7, cyclin dependent kinase inhibitor 2B, HIF‑1A, runt‑related transcription factor 1, connective tissue growth factor and interleukin 2 receptor a chain] were confirmed using RT‑qPCR. The present study revealed that the expression profiles of lncRNAs and mRNAs in aorta tissues from TAD were significantly altered. These results may provide important insights into the pathogenesis of TAD disease.

Negative Association of Diabetes With Thoracic Aortic Dissection and Aneurysm

We performed a meta-analysis to assess the association of diabetes mellitus (DM) with the presence of thoracic aortic dissection (TAD) and/or thoracic aortic aneurysm (TAA). MEDLINE and EMBASE were searched through December 2015 using PubMed and OVID. For each study, data regarding DM prevalence in both the TAD/TAA and control groups were used to generate unadjusted odds ratios (ORs) for DM and 95% confidence intervals (CIs). Alternatively, an unadjusted and/or adjusted OR was directly abstracted from each individual study. Eleven eligible studies enrolling a total of 47 827 participants were included. A primary pooled analysis of all the 11 studies demonstrated that TAD/TAA was associated with significantly lower DM prevalence than controls (OR, 0.43; 95% CI, 0.31-0.59; P < .00001). Separate pooled analyses of 6 TAD case studies and 4 TAA case studies demonstrated TAD (OR, 0.34; 95% CI, 0.19-0.61; P = .0003) and TAA (OR, 0.65; 95% CI, 0.45-0.94; P = .02) were associated with significantly lower DM prevalence than controls. In conclusion, DM may be negatively associated with the presence of TAD/TAA.

Outcomes before and after the Implementation of a Critical Pathway for Patients with Acute Aortic Disease

PURPOSE

Acute aortic diseases, such as aortic dissection and aortic aneurysm, can be life-threatening vascular conditions. In this study, we compared outcomes before and after the implementation of a critical pathway (CP) for patients with acute aortic disease at the emergency department (ED).

MATERIALS AND METHODS

This was a retrospective observational cohort study. The CP was composed of two phases: PRE-AORTA for early diagnosis and AORTA for prompt treatment. We compared patients who were diagnosed with acute aortic disease between pre-period (January 2010 to December 2011) and post-period (July 2012 to June 2014).

RESULTS

Ninety-four and 104 patients were diagnosed with acute aortic disease in the pre- and post-periods, respectively. After the implementation of the CP, 38.7% of acute aortic disease cases were diagnosed via PRE-AORTA. The door-to-CT time was reduced more in PRE-AORTA-activated patients [71.0 (61.0, 115.0) min vs. 113.0 (56.0, 170.5) min; p=0.026]. During the post-period, more patients received emergency intervention than during the pre-period (22.3% vs. 36.5%; p=0.029). Time until emergency intervention was reduced in patients, who visited the ED directly, from 378.0 (302.0, 489.0) min in the pre-period to 200.0 (170.0, 299.0) min in the post-period (p=0.001). The number of patients who died in the ED declined from 11 to 4 from the pre-period to the post-period. Hospital mortality decreased from 26.6% to 14.4% in the post-period (p=0.033).

CONCLUSION

After the implementation of a CP for patients with acute aortic disease, more patients received emergency intervention within a shorter time, resulting in improved hospital mortality.

A single-center experience of hemofiltration treatment for acute aortic dissection (Stanford type A) complicated with postoperative acute renal failure

OBJECTIVE

To investigate the effect of continuous venovenous hemofiltration (CVVH) for aortic dissection patients with acute renal failure after surgery in retrospective manner.

METHODS

A total of thirty-seven aortic dissection patients with postoperative acute renal failure accepted CVVH therapy. The effect of CVVH was evaluated by analyzing clinical condition changes and laboratory examination results.

RESULTS

After treatment of CVVH, renal function and clinical symptoms were significantly improved in thirty patients. Eight of the thirty patients got completely renal function recovery within two weeks after CVVH therapy; and twenty-two of the thirty patients got completely renal function recovery within four weeks after CVVH therapy. Nevertheless, seven patients got no benefit from CVVH therapy with poor prognosis.

CONCLUSION

CVVH is an effective treatment to most aortic dissection patients with postoperative acute renal failure. The effect of CVVH was correlated with original renal function, early CVVH therapy, and continuous intensive care.