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Lee J, Chadalavada SC, Ghodadra A, Ali A, Arribas EM, Chepelev L, Ionita CN, Ravi P, Ryan JR, Santiago L, Wake N, Sheikh AM, Rybicki FJ, Ballard DH. Clinical situations for which 3D Printing is considered an appropriate representation or extension of data contained in a medical imaging examination: vascular conditions. 3D Print Med 2023; 9:34. [PMID: 38032479 PMCID: PMC10688120 DOI: 10.1186/s41205-023-00196-6] [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: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Medical three-dimensional (3D) printing has demonstrated utility and value in anatomic models for vascular conditions. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (3DPSIG) provides appropriateness recommendations for vascular 3D printing indications. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with vascular indications. Each study was vetted by the authors and strength of evidence was assessed according to published appropriateness ratings. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for the following areas: aneurysm, dissection, extremity vascular disease, other arterial diseases, acute venous thromboembolic disease, venous disorders, lymphedema, congenital vascular malformations, vascular trauma, vascular tumors, visceral vasculature for surgical planning, dialysis access, vascular research/development and modeling, and other vasculopathy. Recommendations are provided in accordance with strength of evidence of publications corresponding to each vascular condition combined with expert opinion from members of the 3DPSIG. CONCLUSION This consensus appropriateness ratings document, created by the members of the 3DPSIG, provides an updated reference for clinical standards of 3D printing for the care of patients with vascular conditions.
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Affiliation(s)
- Joonhyuk Lee
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | - Anish Ghodadra
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | - Elsa M Arribas
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leonid Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Justin R Ryan
- Webster Foundation 3D Innovations Lab, Rady Children's Hospital, San Diego, CA, USA
- Department of Neurological Surgery, University of California San Diego Health, San Diego, CA, USA
| | - Lumarie Santiago
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Adnan M Sheikh
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Arizona - Phoenix, Phoenix, AZ, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Mohanadas HP, Nair V, Doctor AA, Faudzi AAM, Tucker N, Ismail AF, Ramakrishna S, Saidin S, Jaganathan SK. A Systematic Analysis of Additive Manufacturing Techniques in the Bioengineering of In Vitro Cardiovascular Models. Ann Biomed Eng 2023; 51:2365-2383. [PMID: 37466879 PMCID: PMC10598155 DOI: 10.1007/s10439-023-03322-x] [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: 01/19/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
Additive Manufacturing is noted for ease of product customization and short production run cost-effectiveness. As our global population approaches 8 billion, additive manufacturing has a future in maintaining and improving average human life expectancy for the same reasons that it has advantaged general manufacturing. In recent years, additive manufacturing has been applied to tissue engineering, regenerative medicine, and drug delivery. Additive Manufacturing combined with tissue engineering and biocompatibility studies offers future opportunities for various complex cardiovascular implants and surgeries. This paper is a comprehensive overview of current technological advancements in additive manufacturing with potential for cardiovascular application. The current limitations and prospects of the technology for cardiovascular applications are explored and evaluated.
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Affiliation(s)
| | - Vivek Nair
- Computational Fluid Dynamics (CFD) Lab, Mechanical and Aerospace Engineering, University of Texas Arlington, Arlington, TX, 76010, USA
| | | | - Ahmad Athif Mohd Faudzi
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia
| | - Nick Tucker
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Ahmad Fauzi Ismail
- School of Chemical and Energy Engineering, Advanced Membrane Technology Research Centre (AMTEC), Universiti Teknologi Malaysia, Skudai, Malaysia
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, Center for Nanofibers & Nanotechnology Initiative, National University of Singapore, Singapore, Singapore
| | - Syafiqah Saidin
- IJNUTM Cardiovascular Engineering Centre, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
| | - Saravana Kumar Jaganathan
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia.
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia.
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK.
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3
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Braverman AC. Aortic Dissection in Marfan Syndrome: Protect the Tube of Life. J Am Coll Cardiol 2023:S0735-1097(23)07568-X. [PMID: 37930286 DOI: 10.1016/j.jacc.2023.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
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4
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Coroyannakis C, Tome M, Watt-Coote I, Cauldwell M. Pregnancy following personalised aortic root support in Marfan syndrome. Obstet Med 2023; 16:200-202. [PMID: 37719992 PMCID: PMC10504882 DOI: 10.1177/1753495x221078447] [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: 04/08/2021] [Revised: 01/03/2022] [Accepted: 01/18/2022] [Indexed: 09/19/2023] Open
Abstract
Marfan syndrome (MFS) is linked with adverse pregnancy events, one of the most significant being aortic dissection. We present a case of a woman with MFS with prior aortic root dilatation who opted for a Personalised External Aortic Root Support (PEARS). To date, she is only the fifth woman to have had this valve-sparing procedure prior to pregnancy. We outline her care in a tertiary centre with multidisciplinary expertise, from preconception through to the postpartum period.
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Affiliation(s)
- Christina Coroyannakis
- Christina Coroyannakis, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - Maite Tome
- St George’s University Hospitals NHS Foundation Trust, London, UK
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5
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Zhu Y, Woo J. Response to: Correspondence on "Has personalised surgery made another advancement in aortic root surgery?" by Zhu and Woo. Heart 2023; 109:887. [PMID: 37080763 DOI: 10.1136/heartjnl-2023-322704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Affiliation(s)
- Yuanjia Zhu
- Cardiothoracic Surgery, Stanford University, Stanford, California, USA
- Bioengineering, Stanford University, Stanford, California, USA
| | - Joseph Woo
- Cardiothoracic Surgery, Stanford University, Stanford, California, USA
- Bioengineering, Stanford University, Stanford, California, USA
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6
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Austin C, Golesworthy T, Izgi C, Mohiaddin R, Pepper J, Treasure T. Correspondence on "Has personalised surgery made another advancement in aortic root surgery?" by Zhu and Woo. Heart 2023; 109:886. [PMID: 37080765 DOI: 10.1136/heartjnl-2023-322642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Affiliation(s)
- Conal Austin
- Cardiac Surgery, Guys and St Thomas' Hospital, London, UK
| | | | - Cemil Izgi
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Raad Mohiaddin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - John Pepper
- Cardiac Surgery, Royal Brompton Hospital and NIHR Imperial Biomedical Research Centre, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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7
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Van Hoof L, Lamberigts M, Noé D, El-Hamamsy I, Lansac E, Kluin J, de Kerchove L, Pepper J, Treasure T, Meuris B, Rega F, Verbrugghe P. Matched comparison between external aortic root support and valve-sparing root replacement. Heart 2023; 109:832-838. [PMID: 36650042 DOI: 10.1136/heartjnl-2022-321840] [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: 09/09/2022] [Accepted: 12/26/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Differences in indication and technique make a randomised comparison between valve-sparing root replacement (VSRR) and personalised external aortic root support (PEARS) challenging. We performed a propensity score (PS)-matched comparison of PEARS and VSRR for syndromic root aneurysm. METHODS Patients in the PEARS 200 Database and Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (undergoing VSRR) with connective tissue disease operated electively for root aneurysm <60 mm with aortic regurgitation (AR) <1/4 were included. Using a PS analysis, 80 patients in each cohort were matched. Survival, freedom from reintervention and from AR ≥2/4 were estimated using a Kaplan-Meier analysis. RESULTS Median follow-up was 25 and 55 months for 159 PEARS and 142 VSRR patients. Seven (4.4%) patients undergoing PEARS required an intervention for coronary injury or impingement, resulting in one death (0.6%). After VSRR, there were no early deaths, 10 (7%) reinterventions for bleeding and 1 coronary intervention. Survival for matched cohorts at 5 years was similar (PEARS 98% vs VSRR 99%, p=0.99). There was no difference in freedom from valve or ascending aortic/arch reintervention between matched groups. Freedom from AR ≥2/4 at 5 years in the matched cohorts was 97% for PEARS vs 92% for VSRR (p=0.55). There were no type A dissections. CONCLUSIONS VSRR and PEARS offer favourable mid-term survival, freedom from reintervention and preservation of valve function. Both treatments deserve their place in the surgical repertoire, depending on a patient's disease stage. This study is limited by its retrospective nature and different follow-ups in both cohorts.
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Affiliation(s)
- Lucas Van Hoof
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Marie Lamberigts
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Dries Noé
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Ismail El-Hamamsy
- Cardiovascular Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Emmanuel Lansac
- Cardiothoracic Surgery, University Hospital Pitié Salpêtrière, Paris, France
| | - Jolanda Kluin
- Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Laurent de Kerchove
- Cardiovascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - John Pepper
- Cardiac Surgery, Royal Brompton and Harefield NHS Trust, London, UK.,Cardiovascular Biomedical Research Unit (BRU), NIHR Imperial Biomedical Research Centre, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Bart Meuris
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Peter Verbrugghe
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
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8
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(Outcomes of personalised external aortic root support implantation in 100 patients in the Czech Republic). COR ET VASA 2022. [DOI: 10.33678/cor.2022.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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9
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Van Hoof L, Verbrugghe P, Jones EAV, Humphrey JD, Janssens S, Famaey N, Rega F. Understanding Pulmonary Autograft Remodeling After the Ross Procedure: Stick to the Facts. Front Cardiovasc Med 2022; 9:829120. [PMID: 35224059 PMCID: PMC8865563 DOI: 10.3389/fcvm.2022.829120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/17/2022] [Indexed: 12/12/2022] Open
Abstract
The Ross, or pulmonary autograft, procedure presents a fascinating mechanobiological scenario. Due to the common embryological origin of the aortic and pulmonary root, the conotruncus, several authors have hypothesized that a pulmonary autograft has the innate potential to remodel into an aortic phenotype once exposed to systemic conditions. Most of our understanding of pulmonary autograft mechanobiology stems from the remodeling observed in the arterial wall, rather than the valve, simply because there have been many opportunities to study the walls of dilated autografts explanted at reoperation. While previous histological studies provided important clues on autograft adaptation, a comprehensive understanding of its determinants and underlying mechanisms is needed so that the Ross procedure can become a widely accepted aortic valve substitute in select patients. It is clear that protecting the autograft during the early adaptation phase is crucial to avoid initiating a sequence of pathological remodeling. External support in the freestanding Ross procedure should aim to prevent dilatation while simultaneously promoting remodeling, rather than preventing dilatation at the cost of vascular atrophy. To define the optimal mechanical properties and geometry for external support, the ideal conditions for autograft remodeling and the timeline of mechanical adaptation must be determined. We aimed to rigorously review pulmonary autograft remodeling after the Ross procedure. Starting from the developmental, microstructural and biomechanical differences between the pulmonary artery and aorta, we review autograft mechanobiology in relation to distinct clinical failure mechanisms while aiming to identify unmet clinical needs, gaps in current knowledge and areas for further research. By correlating clinical and experimental observations of autograft remodeling with established principles in cardiovascular mechanobiology, we aim to present an up-to-date overview of all factors involved in extracellular matrix remodeling, their interactions and potential underlying molecular mechanisms.
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Affiliation(s)
- Lucas Van Hoof
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verbrugghe
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Jay D. Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States
| | - Stefan Janssens
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Nele Famaey
- Biomechanics Section, KU Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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10
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Prapas S, Katsavrias K, Di Mauro M, Zografos P, Guarracini S, Papandreopoulou S, Calafiore AM. Wrapping of the moderately dilated ascending aorta by fresh autologous pericardium. J Card Surg 2022; 37:921-926. [DOI: 10.1111/jocs.16272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/01/2022] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sotirios Prapas
- Division of Cardiac Surgery A Henry Dunant Hospital Athens Greece
| | | | - Michele Di Mauro
- Cardio Thoracic Surgery Unit, Heart and Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM) Maastricht University Medical Centre (MUMC) Maastricht The Netherlands
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11
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Zeigler SM, Sloan B, Jones JA. Pathophysiology and Pathogenesis of Marfan Syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1348:185-206. [PMID: 34807420 DOI: 10.1007/978-3-030-80614-9_8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Marfan syndrome (MFS) is a systemic connective tissue disorder that is inherited in an autosomal dominant pattern with variable penetrance. While clinically this disease manifests in many different ways, the most life-threatening manifestations are related to cardiovascular complications including mitral valve prolapse, aortic insufficiency, dilatation of the aortic root, and aortic dissection. In the past 30 years, research efforts have not only identified the genetic locus responsible but have begun to elucidate the molecular pathogenesis underlying this disorder, allowing for the development of seemingly rational therapeutic strategies for treating affected individuals. In spite of these advancements, the cardiovascular complications still remain as the most life-threatening clinical manifestations. The present chapter will focus on the pathophysiology and clinical treatment of Marfan syndrome, providing an updated overview of the recent advancements in molecular genetics research and clinical trials, with an emphasis on how this information can focus future efforts toward finding betters ways to detect, diagnose, and treat this devastating condition.
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Affiliation(s)
- Sanford M Zeigler
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Brandon Sloan
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jeffrey A Jones
- Division of Cardiothoracic Surgery, Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
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12
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Abstract
Marfan syndrome (MFS) is an autosomal dominant, age-related but highly penetrant condition with substantial intrafamilial and interfamilial variability. MFS is caused by pathogenetic variants in FBN1, which encodes fibrillin-1, a major structural component of the extracellular matrix that provides support to connective tissues, particularly in arteries, the pericondrium and structures in the eye. Up to 25% of individuals with MFS have de novo variants. The most prominent manifestations of MFS are asymptomatic aortic root aneurysms, aortic dissections, dislocation of the ocular lens (ectopia lentis) and skeletal abnormalities that are characterized by overgrowth of the long bones. MFS is diagnosed based on the Ghent II nosology; genetic testing confirming the presence of a FBN1 pathogenetic variant is not always required for diagnosis but can help distinguish MFS from other heritable thoracic aortic disease syndromes that can present with skeletal features similar to those in MFS. Untreated aortic root aneurysms can progress to life-threatening acute aortic dissections. Management of MFS requires medical therapy to slow the rate of growth of aneurysms and decrease the risk of dissection. Routine surveillance with imaging techniques such as transthoracic echocardiography, CT or MRI is necessary to monitor aneurysm growth and determine when to perform prophylactic repair surgery to prevent an acute aortic dissection.
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13
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Buratto E, Konstantinov IE. Valve-sparing aortic root surgery in children and adults with congenital heart disease. J Thorac Cardiovasc Surg 2021; 162:955-962. [DOI: 10.1016/j.jtcvs.2020.08.116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
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14
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Inflammatory response after ExoVasc<sup>® </sup>personalized external aortic root support (PEARS) procedure in patients with Marfan syndrome or non-Marfan genetic aortopathy. COR ET VASA 2021. [DOI: 10.33678/cor.2021.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Van Hoof L, Rega F, Golesworthy T, Verbrugghe P, Austin C, Takkenberg JJM, Pepper JR, Treasure T. Personalised external aortic root support for elective treatment of aortic root dilation in 200 patients. Heart 2021; 107:1790-1795. [PMID: 34326135 DOI: 10.1136/heartjnl-2021-319300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/05/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In personalised external aortic root support (PEARS), a custom-made, macroporous mesh is used to stabilise a dilated aortic root and prevent dissection, primarily in patients with genetically driven aortopathies. Data are needed on the safety and postoperative incidence of aortic events. METHODS We present a multicentre cohort study evaluating the first 200 consecutive patients (median age 33 years) undergoing surgery with an intention to perform PEARS for aortic root dilatation in 23 centres between 2004 and 2019. Perioperative outcomes were collected prospectively while clinical follow-up was retrieved retrospectively. Median follow-up was 21.2 months. RESULTS The main indication was Marfan syndrome (73.5%) and the most frequent concomitant procedure was mitral valve repair (10%). An intervention for myocardial ischaemia or coronary injury was needed in 11 patients, 1 case resulting in perioperative death. No ascending aortic dissections were observed in 596 documented postoperative patient years. Late reoperation was performed in 3 patients for operator failure to achieve complete mesh coverage. Among patients with at least mild aortic regurgitation (AR) preoperatively, 68% had no or trivial AR at follow-up. CONCLUSIONS This study represents the clinical history of the first 200 patients to undergo PEARS. To date, aortic dissection has not been observed in the restrained part of the aorta, yet long-term follow-up is needed to confirm the potential of PEARS to prevent dissection. While operative mortality is low, the reported coronary complications reflect the learning curve of aortic root surgery in patients with connective tissue disease. PEARS may stabilise or reduce aortic regurgitation.
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Affiliation(s)
- Lucas Van Hoof
- Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Conal Austin
- Department of Paediatric Cardiology and Cardiothoracic Surgery, St Thomas' Hospital, London, UK
| | - Johanna J M Takkenberg
- Department of Cardio-Thoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - John R Pepper
- Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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16
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Van Hoof L, Rega F, Treasure T, Pepper J. What's in a wrap? J Thorac Cardiovasc Surg 2021; 164:e77-e78. [PMID: 33888309 DOI: 10.1016/j.jtcvs.2021.03.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Lucas Van Hoof
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, United Kingdom
| | - John Pepper
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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17
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Nemec P, Pepper J, Fila P. Personalized external aortic root support. Interact Cardiovasc Thorac Surg 2020; 31:342-345. [PMID: 32761056 DOI: 10.1093/icvts/ivaa111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Implantation of a personalized external aortic root support (PEARS) can prevent dilatation of the aortic root and ascending aorta in patients with aortopathy of various aetiologies. Because PEARS is an emerging technology, all aspects concerning indications, surgical technique and safety should be elucidated. Our goal was to summarize all of these aspects so that physicians and patients would have sufficient information to evaluate this alternative approach. METHODS Between April 2004 and March 2020, 317 patients underwent PEARS operations at 25 surgical centres in 9 countries. RESULTS The most common indication was Marfan syndrome (57%). The single perioperative death represented a mortality of 0.3%. The long-term experience comprises 871 patient/years with 1 patient living for 15 years and 19 patients living for more than 10 years. CONCLUSIONS PEARS seems to be a promising method of treatment of dilatation of the aortic root and/or ascending aorta. Multicentre observational studies are needed to gain more experience because this operation is still uncommon and the number of operations per surgeon/centre is low.
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Affiliation(s)
- Petr Nemec
- Centre of Cardiovascular Surgery and Transplantations, Brno, Czech Republic
| | | | - Petr Fila
- Centre of Cardiovascular Surgery and Transplantations, Brno, Czech Republic
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18
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Prodanov P, Linkova H, Petr R, Fojt R, Motovska Z, Knot J, Rohac F, Koznar B, Majid M, Widimsky P, Kacer P. A contemporary approach to a young female patient with Loeys-Dietz syndrome and an uncomplicated type B aortic dissection: a case report. J Cardiothorac Surg 2020; 15:231. [PMID: 32867844 PMCID: PMC7457485 DOI: 10.1186/s13019-020-01274-0] [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: 06/07/2020] [Accepted: 08/24/2020] [Indexed: 11/20/2022] Open
Abstract
Background Aortic dissection is a relatively uncommon, but often catastrophic disease that requires early and accurate diagnosis. It often presents in patients with congenital connective tissue disorders. The current aortic surgical techniques are related with serious early and late complications. This case report emphasizes the importance of early diagnosis of aortic root dilatation and the risk of dissection, especially in patients with congenital connective tissue disorders. We present an alternative, contemporary and multidisciplinary approach based on the present state of knowledge. Case presentation We present a rare case of a young female patient with Loeys-Dietz syndrome who was admitted with an uncomplicated aortic dissection (Stanford type B / DeBakey type III) and a dilated aortic root. After a period of close surveillance and extensive vascular imaging, thoracic endovascular aortic repair was deemed to be technically not possible. Medical treatment was optimized and our patient successfully underwent a personalised external aortic root support procedure (PEARS) as a contemporary alternative to existing aortic root surgical techniques. Conclusions This case highlights the importance of interdisciplinary approach, close follow-up and multimodality imaging. The decision to intervene in a chronic type B aortic dissection is still challenging and should be made in experienced centers by an interdisciplinary team. However, if an acute complication occurs, thoracic endovascular aortic repair TEVAR is the method of choice. In all cases optimal medical treatment is important. There is increasing evidence that personalized external aortic root support procedure PEARS is effective in stabilizing the aortic root and preventing its dilatation and dissection not only in patients with Marfan syndrome, but also in other cases of aortic root dilation of other etiologies. Moreover, many publications have reported the additional benefit of reduction or even eradication of aortic regurgitation by improving coaptation of the aortic valve leaflets in dilated aortas.
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Affiliation(s)
- Petko Prodanov
- Department of Cardiac surgery, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic.
| | - Hana Linkova
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Robert Petr
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Richard Fojt
- Department of Cardiac surgery, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Zuzana Motovska
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Jiri Knot
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Filip Rohac
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Boris Koznar
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Mariwan Majid
- Department of Cardiac surgery, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Petr Widimsky
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Petr Kacer
- Department of Cardiac surgery, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
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19
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Saidy NT, Shabab T, Bas O, Rojas-González DM, Menne M, Henry T, Hutmacher DW, Mela P, De-Juan-Pardo EM. Melt Electrowriting of Complex 3D Anatomically Relevant Scaffolds. Front Bioeng Biotechnol 2020; 8:793. [PMID: 32850700 PMCID: PMC7396698 DOI: 10.3389/fbioe.2020.00793] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022] Open
Abstract
The manufacture of fibrous scaffolds with tailored micrometric features and anatomically relevant three-dimensional (3D) geometries for soft tissue engineering applications remains a great challenge. Melt electrowriting (MEW) is an advanced additive manufacturing technique capable of depositing predefined micrometric fibers. However, it has been so far inherently limited to simple planar and tubular scaffold geometries because of the need to avoid polymer jet instabilities. In this work, we surmount the technical boundaries of MEW to enable the manufacture of complex fibrous scaffolds with simultaneous controlled micrometric and patient-specific anatomic features. As an example of complex geometry, aortic root scaffolds featuring the sinuses of Valsalva were realized. By modeling the electric field strength associated with the MEW process for these constructs, we found that the combination of a conductive core mandrel with a non-conductive 3D printed model reproducing the complex geometry minimized the variability of the electric field thus enabling the accurate deposition of fibers. We validated these findings experimentally and leveraged the micrometric resolution of MEW to fabricate unprecedented fibrous aortic root scaffolds with anatomically relevant shapes and biomimetic microstructures and mechanical properties. Furthermore, we demonstrated the fabrication of patient-specific aortic root constructs from the 3D reconstruction of computed tomography clinical data.
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Affiliation(s)
- Navid T Saidy
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia.,School of Dentistry, The University of Queensland, Herston, QLD, Australia
| | - Tara Shabab
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia
| | - Onur Bas
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia.,ARC ITTC in Additive Biomanufacturing, Queensland University of Technology, Musk Avenue, Brisbane, QLD, Australia
| | - Diana M Rojas-González
- Medical Materials and Implants, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany
| | - Matthias Menne
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Tim Henry
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia
| | - Dietmar W Hutmacher
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia.,ARC ITTC in Additive Biomanufacturing, Queensland University of Technology, Musk Avenue, Brisbane, QLD, Australia.,Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | - Petra Mela
- Medical Materials and Implants, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany.,Department of Biohybrid and Medical Textiles (BioTex), AME-Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Elena M De-Juan-Pardo
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia.,Translational 3d Printing Laboratory for Advanced Tissue Engineering (T3mPLATE), Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, WA, Australia.,Department of Mechanical Engineering, School of Engineering, The University of Western Australia, Perth, WA, Australia
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20
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Mechano-biological adaptation of the pulmonary artery exposed to systemic conditions. Sci Rep 2020; 10:2724. [PMID: 32066803 PMCID: PMC7026065 DOI: 10.1038/s41598-020-59554-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/29/2020] [Indexed: 12/30/2022] Open
Abstract
Cardiac surgeries may expose pulmonary arterial tissue to systemic conditions, potentially resulting in failure of that tissue. Our goal was to quantitatively assess pulmonary artery adaptation due to changes in mechanical environment. In 17 sheep, we placed a pulmonary autograft in aortic position, with or without macroporous mesh reinforcement. It was exposed to systemic conditions for 6 months. All sheep underwent 3 ECG-gated MRI’s. Explanted tissue was subjected to mechanical and histological analysis. Results showed progressive dilatation of the unreinforced autograft, while reinforced autografts stabilized after two months. Some unreinforced pulmonary autograft samples displayed more aorta-like mechanical behavior with increased collagen deposition. The mechanical behavior of reinforced autografts was dominated by the mesh. The decrease in media thickness and loss of vascular smooth muscle cells was more pronounced in reinforced than in unreinforced autografts. In conclusion, altering the mechanical environment of a pulmonary artery causes changes in its mechano-biological properties.
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21
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Yuan X, Nienaber C. Aortic imaging and biomechanics in Marfan syndrome: keep it simple but not too simple. Eur Heart J 2019; 40:2055-2057. [PMID: 31114857 DOI: 10.1093/eurheartj/ehz315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospital NHS Foundation Trust, London, UK.,Department of Cardiology, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, UK
| | - Christoph Nienaber
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospital NHS Foundation Trust, London, UK.,Department of Cardiology, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, UK
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22
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Wagner AH, Zaradzki M, Arif R, Remes A, Müller OJ, Kallenbach K. Marfan syndrome: A therapeutic challenge for long-term care. Biochem Pharmacol 2019; 164:53-63. [PMID: 30926475 DOI: 10.1016/j.bcp.2019.03.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/25/2019] [Indexed: 12/14/2022]
Abstract
Marfan syndrome (MFS) is an autosomal dominant genetic disorder caused by mutations in the fibrillin-1 gene. Acute aortic dissection is the leading cause of death in patients suffering from MFS and consequence of medial degeneration and aneurysm formation. In addition to its structural function in the formation of elastic fibers, fibrillin has a major role in keeping maintaining transforming growth factor β (TGF-β) in an inactive form. Dysfunctional fibrillin increases TGF-β bioavailability and concentration in the extracellular matrix, leading to activation of proinflammatory transcription factors. In turn, these events cause increased expression of matrix metalloproteinases and cytokines that control the migration and infiltration of inflammatory cells into the aorta. Moreover, TGF-β causes accumulation of reactive oxygen species leading to further degradation of elastin fibers. All these processes result in medial elastolysis, which increases the risk of vascular complications. Although MFS is a hereditary disease, symptoms and traits are usually not noticeable at birth. During childhood or adolescence affected individuals present with severe tissue weaknesses, especially in the aorta, heart, eyes, and skeleton. Considering this, even young patients should avoid activities that exert additional stress and pressure on the aorta and the cardiovascular system. Thus, if the diagnosis is made and prophylactic treatment is initiated in a timely fashion, MFS and its preliminary pathophysiologic vascular remodeling can be successfully ameliorated reducing the risk of life-threatening complications. This commentary focuses on new research opportunities and molecular findings on MFS, discusses future challenges and possible long-term therapies.
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Affiliation(s)
- A H Wagner
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, Heidelberg University, Germany.
| | - M Zaradzki
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - R Arif
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - A Remes
- Department of Internal Medicine III, University Hospital Kiel, Kiel, Germany
| | - O J Müller
- Department of Internal Medicine III, University Hospital Kiel, Kiel, Germany
| | - K Kallenbach
- INCCI HaerzZenter, Department of Cardiac Surgery, Luxembourg, Luxembourg
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23
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Fuster V. Editor-in-Chief's Top Picks From 2018. J Am Coll Cardiol 2019; 73:826-867. [PMID: 30784677 DOI: 10.1016/j.jacc.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Each week, I record audio summaries for every article in JACC, as well as an issue summary. Although this process is quite time-consuming, I have become familiar with every paper that we publish. Thus, I have personally selected the top 100 papers (both Original Investigations and Review Articles) from 15 distinct specialties each year. In addition to my personal choices, I have included papers that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. In order to present the full breadth of this important research in a consumable fashion, we will present these abstracts in this issue of JACC. The highlights comprise the following sections: Basic & Translational Research, Cardiac Failure, Cardiomyopathies/Myocardial & Pericardial Diseases, Cardio-oncology, Congenital Heart Disease, Coronary Disease & Interventions, CVD Prevention & Health Promotion, CV Medicine & Society, Hypertension, Imaging, Metabolic & Lipid Disorders, Rhythm Disorders, Valvular Heart Disease, and Vascular Medicine (1-100).
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24
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Gökalp AL, Takkenberg JJ. Decision-Making in Thoracic Aortic Aneurysm Surgery—Clinician and Patient View. Semin Thorac Cardiovasc Surg 2019; 31:638-642. [DOI: 10.1053/j.semtcvs.2019.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/12/2019] [Indexed: 01/16/2023]
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25
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Borger MA. Aortic Root Support in Marfan Patients: Time for a Closer Look? J Am Coll Cardiol 2018; 72:1106-1108. [PMID: 30165981 DOI: 10.1016/j.jacc.2018.05.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Michael A Borger
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
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