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Morjan M, Mestres CA, Savic V, Gerçek M, Van Hemelrijck M, Sromicki J, Dzemali O, Reser D. Indications and outcomes of second aortic procedures after acute type A dissection repair. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae076. [PMID: 38688455 DOI: 10.1093/icvts/ivae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/23/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES Aortic arch or aortic root replacement is not performed in all cases of acute type A aortic dissection (ATAD), and a second aortic procedure will become necessary over time for some patients. Indications and outcomes, of second aortic procedures have not been studied extensively. METHODS Characteristics and in-hospital outcomes of all patients undergoing surgical repair for type A acute aortic dissection were analysed and patients needing second aortic procedure during follow-up were identified. The latter group was divided in 2 subgroups: on-pump includes patients operated on using cardiopulmonary bypass and off-pump without cardiopulmonary bypass. RESULTS A total of 638 patients underwent surgery for ATAD; 8% required a second aortic procedure. The most frequent indication for the second aortic procedure was dehiscence of suture lines (44%), followed by arch dilatation (24%). In-hospital mortality was 12%. Isolated ascending aorta replacement at the first surgery was associated with higher incidence of second aortic procedure (P = 0.006). Most patients in the on-pump group underwent a proximal reoperation (75%), with a mortality rate of 14.2%. In-hospital mortality of patients in the off-pump group was 7.7%. Long-term survival analysis showed no difference between groups (P = 0,526), Off-pump patients have greater likelihood of a second intervention during follow-up (P = 0.004). CONCLUSIONS Extended aortic root surgery and customized aortic arch repair in ATAD could be reasonable to reduce the incidence and mortality of high-risk second aortic procedures.
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Affiliation(s)
- Mohammed Morjan
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
- Department of Cardiovascular Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany
| | - Carlos-A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Vedran Savic
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Mustafa Gerçek
- Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Heart Center Duisburg, Duisburg, Germany
| | | | - Juri Sromicki
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Diana Reser
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
- Herzklinik Hirslanden, Zürich, Switzerland
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2
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Filiberto AC, Ramadan OI, Wang GJ, Cooper MA. Sex disparities in patients with acute aortic dissection: A scoping review. Semin Vasc Surg 2023; 36:492-500. [PMID: 38030323 DOI: 10.1053/j.semvascsurg.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 12/01/2023]
Abstract
Disparities in outcomes for patients with cardiovascular disease and those undergoing cardiac or vascular operations are well-established. These disparities often span several dimensions and persist despite advancements in medical and surgical care; sex is among the most pervasive. Specifically, females sex has been implicated as a predictor of poor outcomes in both patients with acute type A aortic dissections (ATAADs) and type B aortic dissections (TBADs). For instance, one study, using the International Registry of Acute Aortic Dissection database, found that females with acute aortic dissection-including ATAAD and TBAD that were either medically or surgically managed-had 40% higher odds of in-hospital mortality than men. Notably, both types of acute aortic dissections affect men more commonly than females and can be life-threatening without prompt, appropriate treatment. The underlying mechanisms for these disparities are unclear but are thought to be multifactorial. The association of sex with patterns of disease and outcomes in patients with ATAAD or TBAD remains unclear, with conflicting reports from different studies. Thus, we sought to review the literature regarding sex disparities in patients with ATAAD and TBAD.
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Affiliation(s)
- Amanda C Filiberto
- Department of Surgery, Division of Vascular Surgery, 1329 SW 16th St., University of Florida, Gainesville, FL, 32610
| | - Omar I Ramadan
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Grace J Wang
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Michol A Cooper
- Department of Surgery, Division of Vascular Surgery, 1329 SW 16th St., University of Florida, Gainesville, FL, 32610.
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Lin JL, Li SL, Peng YC, Chen LW, Lin YJ. Analysis of serum calcium change trajectories and prognostic factors in patients with acute type A aortic dissection. BMC Surg 2023; 23:362. [PMID: 38012635 PMCID: PMC10683301 DOI: 10.1186/s12893-023-02249-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES This study aimed to analyze the correlation between serum calcium changes and short-term prognosis of patients with acute type A aortic dissection. METHODS Patients who underwent acute type A aortic dissection surgery at Fujian Heart Medical Center between June 2019 and June 2021 were retrospectively analyzed. RESULTS A total of 383 patients were enrolled. According to the changing track of serum calcium in patients after acute type A aortic dissection, three potential category tracks were determined: high-level (n = 85), medium-level (n = 259), and continuous low-level groups (n = 39). Using the medium-level group as the control, regression analysis showed that poor prognosis risk was increased in the group with continuous low serum calcium (odds ratio = 2.454, P < 0.05) and in the group with continuous low serum calcium > 48 h (odds ratio = 3.595, P < 0.05). Age (odds ratio = 1.063, P < 0.001), body mass index (odds ratio = 1.138, P < 0.05), hypertension (odds ratio = 3.697, P < 0.05), and the highest lactic acid within 72 h after surgery(odds ratio = 1.093, P < 0.05) were independent risk factors for poor prognosis after aortic dissection. CONCLUSION Continuous low serum calcium was an independent predictor of poor prognosis in patients with acute type A aortic dissection.
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Affiliation(s)
- Jian-Long Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, Fujian, 350001, China
| | - Sai-Lan Li
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, Fujian, 350001, China
| | - Yan-Chun Peng
- Department of Nursing, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, Fujian, 350001, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, Fujian, 350001, China.
| | - Yan-Juan Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, Fujian, 350001, China.
- Department of Nursing, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, Fujian, 350001, China.
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Banceu CM, Gurzu S, Satala CB, Ghiga D, Neamtu MH, Voth V, Liebrich M, Suciu H. Histopathological Gap in Aortic Diseases: A Prospective Analysis. Int J Mol Sci 2023; 24:15470. [PMID: 37895149 PMCID: PMC10607681 DOI: 10.3390/ijms242015470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/08/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Aortic dissection (AD) is a critical cardiovascular condition with the potential for devastating consequences. This study evaluated the histological changes in the aorta wall in patients with AD and aortic aneurysm (AA) who received surgical aortic replacement. Histopathological data showed that modifications of the media layer (p = 0.0197), myxomatous aspect (p = 0.0001), and subendothelial layer degeneration (p = 0.0107) were more frequently seen in AA versus AD samples. Patients with AA were approximately twice as likely to develop histological changes than those with AD (p = 0.0037). Patients with moderate or severe medial degeneration had a higher chance of developing AD (p = 0.0001). Because the histopathological score proved to be a predictor of both in-hospital and overall mortality, its evaluation should become the standard of care in any patients who undergo aortic replacement. Individualized postoperative management might be influenced by the histopathological aspect of the aortic layer.
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Affiliation(s)
- Cosmin Marian Banceu
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
- Department of Surgery M3, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
| | - Simona Gurzu
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
- Research Center for Oncopathology and Translational Medicine (CCOMT), George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
- Romanian Academy of Medical Sciences, 030167 Bucharest, Romania
| | - Catalin-Bogdan Satala
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Dana Ghiga
- Department of Medical Scientific Research Methodology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Mihai Halic Neamtu
- Swiss Federal Institute of Forest, Snow and Landscape Research WSL, 8903 Birmensdorf, Switzerland;
- Institute of Environmental Engineering, ETH Zurich, 8039 Zurich, Switzerland
| | - Vladimir Voth
- Sana Cardiac Surgery, Herdweg 2, 70174 Stuttgart, Germany; (V.V.); (M.L.)
| | - Markus Liebrich
- Sana Cardiac Surgery, Herdweg 2, 70174 Stuttgart, Germany; (V.V.); (M.L.)
| | - Horatiu Suciu
- Department of Surgery M3, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
- Romanian Academy of Medical Sciences, 030167 Bucharest, Romania
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Banceu C, Harpa M, Brinzaniuc K, Tilea I, Varga A, Gliga ML, Voidazan S, Neagu N, Szabo DA, Banceu D, Cristutiu D, Balmos IA, Puscas A, Oprean M, Suciu H. The Gender Gap in Aortic Dissection: A Prospective Analysis of Risk and Outcomes. J Crit Care Med (Targu Mures) 2023; 9:178-186. [PMID: 37588179 PMCID: PMC10425927 DOI: 10.2478/jccm-2023-0024] [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: 01/27/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
Aortic dissection (AD) is a severe cardiovascular condition that could have negative consequences. Our study employed a prospective design and examined preoperative, perioperative, and postoperative data to evaluate the effects of gender on various medical conditions. We looked at how gender affected the results of aortic dissection (AD). In contrast to female patients who had more systemic hypertension (p=0.031), male patients had higher rates of hemopericardium (p=0.003), pulmonary hypertension (p=0.039), and hemopericardium (p=0.003). Dobutamine administration during surgery significantly raised the mortality risk (p=0.015). There were noticeably more women patients (p=0.01) in the 71 to 80 age group. Significant differences in age (p=0.004), eGFR at admission (p=0.009), and eGFR at discharge (p=0.006) were seen, however, there was no association between gender and mortality. In conclusion, our findings highlight that gender may no longer be such an important aspect of aortic dissection disease as we previously thought, and this information could have an important contribution for surgeons as well as for anesthesiologists involved in the management of acute aortic dissection.
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Affiliation(s)
- Cosmin Banceu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- I.O.S.U.D George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Marius Harpa
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Klara Brinzaniuc
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Ioan Tilea
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Andreea Varga
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Mirela Liana Gliga
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Septimiu Voidazan
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Nicolae Neagu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Dan Alexandru Szabo
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Diana Banceu
- Dimitrie Cantemir University of Targu Mures, Romania
| | - Daiana Cristutiu
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Ionut Alexandru Balmos
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Alexandra Puscas
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Marvin Oprean
- Dimitrie Cantemir University of Targu Mures, Romania
| | - Horatiu Suciu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
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6
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Shetty V, Narayan P. Sex-based differences in acute type A aortic dissection-Biology or bias? J Card Surg 2022; 37:4348-4350. [PMID: 36183404 DOI: 10.1111/jocs.16986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Varun Shetty
- Department of Cardiac Surgery, Narayana Institute of Cardiac Sciences, Narayan Health, Bengaluru, Karnataka, India
| | - Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
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