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Huang LC, Shao ZH, Sun YX, Gan LX, Qian XY, Yu CT, Guo HW. Protective Coronary Artery Bypass Grafting Improves Surgical Outcomes in Acute Type A Aortic Dissection With Coronary Ostial Involvement. Ann Thorac Surg 2025:S0003-4975(25)00289-9. [PMID: 40187591 DOI: 10.1016/j.athoracsur.2025.03.025] [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] [Received: 09/27/2024] [Revised: 03/10/2025] [Accepted: 03/17/2025] [Indexed: 04/07/2025]
Abstract
BACKGROUND Acute type A aortic dissection (ATAAD) with coronary ostial involvement poses significant surgical challenges. We describe two surgical approaches to managing coronary involvement and assess their outcomes. METHODS Between January 2019 and December 2023, 617 acute type A aortic dissection patients with coronary involvement were enrolled. Based on our institutional surgical protocol, 507 patients underwent isolated coronary ostial reconstruction, whereas 110 received protective coronary artery bypass grafting (CABG) after coronary ostial reconstruction or closure in cases of severe coronary involvement (defined as Neri A with >50% ostial margin involvement, Neri B with distal entry, or Neri C). Serious adverse events were defined as operative mortality, mechanical support, or stroke. Logistic regression identified factors associated with serious adverse events. RESULTS Operative mortality occurred in 23 patients (3.73%), and 44 patients (7.13%) experienced serious adverse events. Despite more severe coronary involvement (P < .001) and coronary malperfusion (P < .001) at baseline, the protective CABG group showed significantly lower procedural myocardial injury (2.73% vs 9.27%, P = .037) and a trend toward fewer serious adverse events (2.73% vs 8.09%, P = .076). Logistic regression identified that protective CABG was associated with a reduced risk of serious adverse events (odds ratio, 0.24; 95% CI, 0.07-0.86; P = .028). The median follow-up was 25.95 months. Kaplan-Meier analysis revealed no significant difference in cumulative survival between the 2 groups (log-rank P = .70). CONCLUSIONS Our institutional surgical protocol demonstrates safety and effectiveness. The protective CABG approach was associated with a reduced risk of serious adverse events without impacting overall survival, supporting its more aggressive use in acute type A aortic dissection with severe coronary involvement.
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Affiliation(s)
- Ling-Chen Huang
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Ze-Hua Shao
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yang-Xue Sun
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Li-Xi Gan
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xiang-Yang Qian
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Cun-Tao Yu
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Hong-Wei Guo
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.
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Huang LC, Hu XM, Zhang AK, Shao ZH, Sun YX, Zhao D, Chang Y, Qian XY, Guo HW. Impact of non-significant right coronary ostial involvement on coronary events in type A aortic dissection surgery. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2025; 40:ivaf035. [PMID: 39992232 PMCID: PMC11922551 DOI: 10.1093/icvts/ivaf035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Revised: 02/07/2025] [Accepted: 02/20/2025] [Indexed: 02/25/2025]
Abstract
OBJECTIVES Coronary-related technical complications constantly occur during type A aortic dissection surgical repair and are potentially fatal, yet their risk factors require further investigation. The intricate morphology of coronary ostial involvement may have a substantial impact. METHODS From June 2019 to January 2024, consecutive type A aortic dissection patients who underwent open surgery were included. Patients were divided into the coronary involvement group (non-significant involvement: Neri A-dissected intima involving the margin of the coronary ostium; significant involvement: Neri B and Neri C) and the non-involvement group. Coronary events were defined as coronary-related technical complications necessitating bailout coronary revascularization or coronary ostial repair. Logistic regression analysis identified risk factors associated with coronary events. Overall survival was estimated using Kaplan-Meier method and Cox regression analysis. RESULTS Of 1168 patients, 660 patients had coronary involvement, while 508 did not. Coronary events occurred in 58 patients (4.97%), including 53 (4.54%) who required bailout coronary revascularization. Patients with coronary involvement had a higher incidence of coronary events (8.18% vs 0.79%, P < 0.001). Logistic regression analysis revealed that significant right coronary involvement was associated with coronary events (odds ratio: 20.58, 95% confidence interval: 7.37-57.50, P < 0.001). Notably, non-significant right coronary involvement, accounting for 44.61% of patients, was also associated with coronary events compared to those without involvement (odds ratio: 7.05, 95% confidence interval: 2.69-18.50, P < 0.001). CONCLUSIONS Coronary events occurred in 4.97% patients. Significant right coronary involvement is strongly associated with coronary events; non-significant right coronary involvement, which is relatively common in surgical patients, also poses a substantial risk for coronary events and warrants attention.
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Affiliation(s)
- Ling-Chen Huang
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang-Min Hu
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ai-Kai Zhang
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ze-Hua Shao
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang-Xue Sun
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Zhao
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Chang
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang-Yang Qian
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Wei Guo
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Huang LC, Zhang AK, Hu XM, Shao ZH, Sun YX, Zhao D, Chang Y, Qian XY, Guo HW. Impact of concomitant coronary artery bypass grafting on the outcomes of total arch repair with frozen elephant trunk for type A aortic dissection. Eur J Cardiothorac Surg 2024; 66:ezae445. [PMID: 39660772 DOI: 10.1093/ejcts/ezae445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 10/29/2024] [Accepted: 12/07/2024] [Indexed: 12/12/2024] Open
Abstract
OBJECTIVES Coronary artery bypass grafting (CABG) is often performed alongside type A aortic dissection (TAAD) repair. However, the association between concomitant CABG and the clinical outcomes of TAAD repair remains uncertain. METHODS This study included 1002 consecutive TAAD patients who underwent total aortic arch replacement (TAR) with frozen elephant trunk from June 2019 to January 2024. Concomitant CABG during TAR and frozen elephant trunk was performed under 3 conditions: planned CABG for coronary ostial involvement, planned CABG for coronary artery disease and rescue CABG. Patients who underwent rescue CABG (N = 42) were compared with those who had planned CABG (N = 218) and those who did not undergo CABG (non-CABG: N = 742). Logistic regression, Kaplan-Meier and Cox regression analyses were employed. RESULTS Operative mortality rate was 2.40%; 42 (4.19%) patients underwent rescue CABG. The rescue CABG group had the highest operative mortality (23.81%) among the 3 groups (P < 0.001). Rescue CABG was associated with increased operative mortality compared with non-CABG [odds ratio: 18.96, 95% confidence interval (CI) 7.32-49.08, P < 0.001], whereas planned CABG was not significant. The median follow-up period was 24.80 (interquartile range 11.73-39.10) months. Kaplan-Meier analysis demonstrated poorer overall survival in the rescue CABG group (log-rank P-value < 0.001). Rescue CABG significantly increased all-cause late mortality compared with non-CABG (hazard ratio 13.69, 95% CI 6.53-28.70, P < 0.001), while planned CABG did not. The 2-year cumulative incidence of graft occlusion among CABG patients was 24.54%. CONCLUSIONS Rescue CABG is significantly associated with increased operative and all-cause mortality in patients undergoing TAR and frozen elephant trunk for TAAD. Further research is required to identify the causes of rescue CABG.
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Affiliation(s)
- Ling-Chen Huang
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ai-Kai Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang-Ming Hu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ze-Hua Shao
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang-Xue Sun
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Zhao
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Chang
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang-Yang Qian
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Wei Guo
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yokoi M, Ito T, Kawada Y, Yamamoto J, Yamada T, Kikuchi S, Kitada S, Goto T, Hattori H, Suda H, Seo Y. Myocardial Infarction with Non-obstructive Coronary Arteries Complicated by a Ventricular Septal Rupture: The Challenge of Achieving Hemodynamic Stability Using Impella Devices. Intern Med 2024; 63:3065-3070. [PMID: 38599873 PMCID: PMC11637791 DOI: 10.2169/internalmedicine.2945-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/28/2024] [Indexed: 04/12/2024] Open
Abstract
The prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) is reported to be as worse as myocardial infarction with obstructive coronary arteries. However, its mechanical complications are still poorly understood. A 71-year-old woman developed MINOCA after ascending aortic replacement surgery. During treatment, the patient experienced cardiogenic shock due to a ventricular septal rupture (VSR). The introduction of Impella devices reduced the left-to-right shunt and improved the patient's hemodynamics. Finally, a scheduled surgical repair was performed under stable conditions. In this report, we focused on the pathophysiology of MINOCA-related VSR and discussed the effectiveness of Impella devices as a bridge to surgical repair and circulatory backup during the perioperative period.
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Affiliation(s)
- Masashi Yokoi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yu Kawada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Junki Yamamoto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Toshiyuki Yamada
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Shohei Kikuchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Shuichi Kitada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Hideo Hattori
- Department of Pathology and Molecular Diagnostics, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Hisao Suda
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
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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 2024; 168:977-989.e24. [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] [MESH Headings] [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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Rotundu A, Nedelcu AH, Tepordei RT, Moraru MC, Chiran DA, Oancea A, Maștaleru A, Costache AD, Chirica C, Grosu C, Mitu F, Leon MM. Medical-Surgical Implications of Branching Variation of Human Aortic Arch Known as Bovine Aortic Arch (BAA). J Pers Med 2024; 14:678. [PMID: 39063932 PMCID: PMC11278178 DOI: 10.3390/jpm14070678] [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: 06/03/2024] [Revised: 06/16/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: The aortic arch (AA) branching model is challenging, considering the multiple anatomical variations documented in existing research. The bovine aortic arch (BAA) is the most prevalent anatomical variation among these. This variant of AA branching has long been considered a nonsymptomatic malformation, having been discovered incidentally during imaging investigations for other causes. However, more recent studies have demonstrated that BAA shows a frequent association with coarctation of the aorta (CoA), thoracic aortic disease (TAD), and stroke. At the same time, given the current context of increasing activity in the fields of interventional and surgical procedures in the aorta and its branches, it is very important to know the medical-surgical implications of this anatomical variant. (2) Methods: We conducted a comprehensive review using PubMed and Embase, focusing specifically on randomized trials and cohort analyses that examined the medical-surgical implications of BAA. We assessed information related to studied groups, medical procedures, and study outcomes. Initially, we identified 8454 studies, and after rigorous evaluation, we narrowed down our review to 25 articles. (3) Discussions: The intervention consisted of assessing the risks associated with BAA through different imaging investigation methods such as computer tomographic angiography (CTA), magnetic resonance imaging (MRI), or ultrasonography (US). The following results were evaluated: the prevalence of the BAA, the importance of imaging investigations in establishing the diagnosis and the therapeutic management and monitoring the evolution of patients with the BAA, the association of the BAA with CoA, TAD, and stroke, and the potential risks of interventional treatment in patients with the BAA. (4) Conclusions: The prevalence of the BAA differs both between different ethnic groups and between genders. Advanced imaging methods such as CTA and 4D flow MRI allow detailed descriptions of supra-aortic vascular anatomy and information about blood flow velocities, direction, and turbulence in the AA. US remains an easy and valuable imaging investigation, with the potential to detect and correctly diagnose the BAA and its hemodynamic implications. Anatomical variations in the AA are associated with increased rates of TAD, CoA, and stroke, necessitating early diagnosis and increased supervision of patients with such incidentally observed abnormalities. In addition, there is a need to further develop and refine the surgical techniques used and personalize them to the individual characteristics of patients with the BAA.
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Affiliation(s)
- Andreea Rotundu
- Doctoral School, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universității Street, 700115 Iasi, Romania; (A.R.); (C.C.)
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.O.); (A.M.); (A.-D.C.); (F.M.); (M.M.L.)
| | - Alin Horatiu Nedelcu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (R.T.T.); (M.C.M.); (D.A.C.)
- Radiology Clinic, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Razvan Tudor Tepordei
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (R.T.T.); (M.C.M.); (D.A.C.)
| | - Marius Constantin Moraru
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (R.T.T.); (M.C.M.); (D.A.C.)
| | - Dragos Andrei Chiran
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (R.T.T.); (M.C.M.); (D.A.C.)
| | - Andra Oancea
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.O.); (A.M.); (A.-D.C.); (F.M.); (M.M.L.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Alexandra Maștaleru
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.O.); (A.M.); (A.-D.C.); (F.M.); (M.M.L.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Alexandru-Dan Costache
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.O.); (A.M.); (A.-D.C.); (F.M.); (M.M.L.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Costin Chirica
- Doctoral School, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universității Street, 700115 Iasi, Romania; (A.R.); (C.C.)
| | - Cristina Grosu
- Department of Neurology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Department of Neurology, Rehabilitation Hospital, 700661 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.O.); (A.M.); (A.-D.C.); (F.M.); (M.M.L.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Maria Magdalena Leon
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.O.); (A.M.); (A.-D.C.); (F.M.); (M.M.L.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
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7
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Ren Y, Zhang Y, Li B, Liu J, Rao Q, Zhou Q, Run Q. Biomarker Screening by LCMS and Liquid Chip Technology in Acute Aortic Dissection. Ann Vasc Surg 2024; 102:192-201. [PMID: 37926136 DOI: 10.1016/j.avsg.2023.09.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/25/2023] [Accepted: 09/16/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Aortic dissection (AD) is a serious disease. Previous study, the use of peripheral blood biomarkers to diagnose AD showed strong clinical feasibility, but the possible molecular mechanism is unclear. METHODS Sera from 79 healthy subjects, 73 patients with well-established AD, and 74 patients with well-established acute myocardial infarction (AMI) were investigated by Liquid Chromatograph-Mass Spectrometer to detect metabolites (AFMK, Glycerophosphocholine, Inosine, SPH). The cell factor expression in the 3 group were detected by Liquid Chip Technology. RESULTS The serum content trends of 4 metabolic indexes in patients with AMI and AD group were used as the diagnostic models, and the effective diagnosis rate was 97.8%. The diagnosis rate is 89.8% in distinguishing patients with AMI from patients with AD. The expression in serum of the 3 groups showed that there were significant differences in the expression of 23 cytokines. By correlation analysis, it was found that miP-1, IL-7, MIP-1β, EGF and other cytokines were significantly correlated with the 4 metabolic molecules. CONCLUSIONS AFMK, Glycerophosphocholine, Inosine, Sphingfungin B (SPH) metabolites are potential biomarkers for AD, and the influence of related metabolic process may be related to the expression of miP-1, IL-7, MIP-1β, EGF, and other cytokines.
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Affiliation(s)
- Yong Ren
- Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Yue Zhang
- Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Bin Li
- Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China.
| | - Juan Liu
- Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Qun Rao
- Department of Clinical Laboratory, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Qing Zhou
- Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Qi Run
- Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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8
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Gaudino M, Flather M, Capodanno D, Milojevic M, Bhatt DL, Biondi Zoccai G, Boden WE, Devereaux PJ, Doenst T, Farkouh M, Freemantle N, Fremes S, Puskas J, Landoni G, Lawton J, Myers PO, Redfors B, Sandner S. European Association of Cardio-Thoracic Surgery (EACTS) expert consensus statement on perioperative myocardial infarction after cardiac surgery. Eur J Cardiothorac Surg 2024; 65:ezad415. [PMID: 38420786 DOI: 10.1093/ejcts/ezad415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/14/2023] [Accepted: 12/12/2023] [Indexed: 03/02/2024] Open
Abstract
Cardiac surgery may lead to myocardial damage and release of cardiac biomarkers through various mechanisms such as cardiac manipulation, systemic inflammation, myocardial hypoxia, cardioplegic arrest and ischaemia caused by coronary or graft occlusion. Defining perioperative myocardial infarction (PMI) after cardiac surgery presents challenges, and the association between the current PMI definitions and postoperative outcomes remains uncertain. To address these challenges, the European Association of Cardio-Thoracic Surgery (EACTS) facilitated collaboration among a multidisciplinary group to evaluate the existing evidence on the mechanisms, diagnosis and prognostic implications of PMI after cardiac surgery. The review found that the postoperative troponin value thresholds associated with an increased risk of mortality are markedly higher than those proposed by all the current definitions of PMI. Additionally, it was found that large postoperative increases in cardiac biomarkers are prognostically relevant even in absence of additional supportive signs of ischaemia. A new algorithm for PMI detection after cardiac surgery was also proposed, and a consensus was reached within the group that establishing a prognostically relevant definition of PMI is critically needed in the cardiovascular field and that PMI should be included in the primary composite outcome of coronary intervention trials.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Davide Capodanno
- Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - William E Boden
- VA New England Healthcare System, Boston University School of Medicine, Boston, MA, USA
| | - P J Devereaux
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Michael Farkouh
- Academic Affairs, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Nicholas Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Stephen Fremes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY, USA
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Jennifer Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick O Myers
- Department of Cardiac Surgery, CHUV-Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, NY, USA
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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9
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Fu Y, Huang S, Zhao D, Qiu P, Hu J, Liu X, Lu X, Feng L, Hu M, Cheng Y. Establishing and Validating a Morphological Prediction Model Based on CTA to Evaluate the Incidence of Type-B Dissection. Diagnostics (Basel) 2023; 13:3130. [PMID: 37835873 PMCID: PMC10572133 DOI: 10.3390/diagnostics13193130] [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: 08/21/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Background: Many patients with Type B aortic dissection (TBAD) may not show noticeable symptoms until they become intervention and help prevent critically ill, which can result in fatal outcomes. Thus, it is crucial to screen people at high risk of TBAD and initiate the necessary preventive and therapeutic measures before irreversible harm occurs. By developing a prediction model for aortic arch morphology, it is possible to accurately identify those at high risk and take prompt action to prevent the adverse consequences of TBAD. This approach can facilitate timely the development of serious illnesses. Method: The predictive model was established in a primary population consisting of 173 patients diagnosed with acute Stanford TBAD, with data collected from January 2017 and December 2018, as well as 534 patients with healthy aortas, with data collected from April 2018 and December 2018. Explicitly, the data were randomly separated into the derivation set and validation set in a 7:3 ratio. Geometric and anatomical features were extracted from a three-dimensional multiplanar reconstruction of the aortic arch. The LASSO regression model was utilized to minimize the data dimension and choose relevant features. Multivariable logistic regression analysis and backward stepwise selection were employed for predictive model generation, combining demographic and clinical features as well as geometric and anatomical features. The predictive model's performance was evaluated by examining its calibration, discrimination, and clinical benefit. Finally, we also conducted internal verification. Results: After applying LASSO logistic regression and backward stepwise selection, 12 features were entered into the prediction model. Age, aortic arch angle, total thoracic aorta distance, ascending aorta tortuosity, aortic arch tortuosity, distal descending aorta tortuosity, and type III arch were protective factors, while male sex, hypertension, aortic arch height, and aortic arch distance were risk factors. The model exhibited satisfactory discrimination (AUC, 0.917 [95% CI, 0.890-0.945]) and good calibration in the derivation set. Applying the predictive model to the validation set also provided satisfactory discrimination (AUC, 0.909 [95% CI, 0.864-0.953]) and good calibration. The TBAD nomogram for clinical use was established. Conclusions: This study demonstrates that a multivariable logistic regression model can be used to predict TBAD patients.
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Affiliation(s)
- Yan Fu
- Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; (Y.F.)
| | - Siyi Huang
- Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; (Y.F.)
| | - Deyin Zhao
- Second Ward of General Surgery, Suzhou Hospital of Anhui Medical University (Suzhou Municipal Hospital of Anhui Province), Suzhou 234000, China;
| | - Peng Qiu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Jiateng Hu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xiaobing Liu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Lvfan Feng
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai 200031, China
| | - Min Hu
- Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; (Y.F.)
| | - Yong Cheng
- Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China; (Y.F.)
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10
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Feng D, Huang S, Wang Q, Lang X, Liu Y, Zhang K. Hotspots and development frontiers of postoperative complications of AD: Bibliometric analysis - a review. Medicine (Baltimore) 2023; 102:e33160. [PMID: 36897695 PMCID: PMC9997838 DOI: 10.1097/md.0000000000033160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/13/2022] [Indexed: 03/11/2023] Open
Abstract
The research on the postoperative complications of aortic dissection (AD) has received great attention from scholars all over the world, and the number of research articles in this field has consistently increased year after year. However, no bibliometric reports have been published yet to analyze the scientific output and the current situation in this field. The Bibliometrix R-package, VOSviewer, and CiteSpace software were used to conduct a bibliometric analysis of the hotspots and development frontiers of AD. A total of 1242 articles were retrieved. The USA, China, and Japan had the highest number of publications. The five keywords with the highest frequency were "analysis," "incidence," "acute type," "graft," and "risk factor." The results also indicated that the research in related fields had shifted from surgical treatment and utilizing experience to the evidence-based exploration of risk factors and the construction of prediction models to help better manage postoperative complications of AD. This is the first bibliometric analysis of global publications on the postoperative complications of AD. The current research hotspots focus on three areas: common postoperative complications of AD, exploration of the related risk factors, and management of complications. Future research could focus on identifying risk factors through meta-analysis and using a multicenter database for AD as well as building relevant models to predict the development of complications to better facilitate the clinical management of AD patients.
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Affiliation(s)
- Danni Feng
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sufang Huang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quan Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaorong Lang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuchen Liu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kexin Zhang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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11
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Hao J, Liu S, Sun T, Lei L. Case report: Acute right ventricular dysfunction after surgery in a pregnant patient with congenital heart disease and aortic dissection. Front Cardiovasc Med 2023; 10:1146158. [PMID: 37034325 PMCID: PMC10076818 DOI: 10.3389/fcvm.2023.1146158] [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: 01/17/2023] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
Pregnant women with aortic dissection are hemodynamically outmost complex patients. The two major diagnoses that should be considered in pregnant patients with congenital heart disease (CHD) and acute type A aortic dissection presenting with postoperative right ventricular dysfunction are pulmonary thromboembolism and right ventricular infarction. We present a rare case of postoperative right ventricular dysfunction in pregnant women with CHD and acute aortic dissection, which was diagnosed by pulmonary computed tomography angiography and treated by percutaneous coronary intervention.
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Affiliation(s)
- Junhai Hao
- Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Siyi Liu
- Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Tucheng Sun
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Correspondence: Tucheng Sun Liming Lei
| | - Liming Lei
- Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Laboratory of South China Structural Heart Disease, Guangzhou, China
- Correspondence: Tucheng Sun Liming Lei
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12
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Zhu J, Tong G, Zhuang D, Yang Y, Liang Z, Liu Y, Yu C, Zhang Z, Chen Z, Liu J, Yang J, Li X, Fan R, Sun T, Wu J. Surgical treatment strategies for patients with type A aortic dissection involving arch anomalies. Front Cardiovasc Med 2022; 9:979431. [PMID: 36176996 PMCID: PMC9513207 DOI: 10.3389/fcvm.2022.979431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The aim of the study was to investigate surgical modalities and outcomes in patients with type A aortic dissection involving arch anomalies. Method Patients with type A aortic dissection who underwent surgical treatment at our center between January 2017 and 31 December 2020 were selected for this retrospective analysis. Data including computed tomography (CT), surgical records, and cardiopulmonary bypass records were analyzed. Perioperatively survived patients were followed up, and long-term mortality and aortic re-interventions were recorded. Result A total of 81 patients with arch anomalies were included, 35 with “bovine” anomalies, 23 with an aberrant right subclavian artery, 22 with an isolated left vertebral artery, and one with a right-sided arch + aberrant left subclavian artery. The strategies of arch management and cannulation differed according to the anatomic variation of the aortic arch. In total, seven patients (9%) died after surgery. Patients with “bovine” anomalies had a higher perioperative mortality rate (14%) and incidence of neurological complications (16%). Overall, four patients died during the follow-up period, with a 6-year survival rate of 94.6% (70/74). A total of four patients underwent aortic re-intervention during the follow-up period; before the re-intervention, three received the en bloc technique (13.6% 3/22) and one received hybrid therapy (11.1% 1/9). Conclusion With complete preservation and reconstruction of the supra-arch vessels, patients with type A aortic dissection combining arch anomalies can achieve a favorable perioperative prognostic outcome. Patients who received the en bloc technique are more likely to require aortic re-intervention than patients who underwent total arch replacement with a four-branched graft vessel. Cannulation strategies should be tailored according to the variation of anatomy, but routine cannulation with the right axillary artery can still be performed in most patients with arch anomalies, even for patients with an aberrant right subclavian artery.
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13
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Jung JC, Park KH. Coronary artery disease in aortic aneurysm and dissection. Indian J Thorac Cardiovasc Surg 2021; 38:115-121. [PMID: 35463718 PMCID: PMC8980968 DOI: 10.1007/s12055-021-01265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/17/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022] Open
Abstract
Coexisting coronary artery disease is a significant risk factor of untoward outcomes after surgical and endovascular aortic repair. This article reviewed the data, consensus, and remaining controversy about the diagnosis and management of coexisting coronary artery disease in the patients who require intervention for aortic aneurysm and dissection. It can be summarized as follows: (1) the current guidelines generally recommend the same diagnostic algorithm, including indications of coronary artery angiography, as one for non-surgical patients; (2) they also recommend the same indications of coronary revascularization; and (3) there are minor, but important, remaining issues regarding the details of management and surgical techniques most of which are still at the discretion of individual surgeons and institutions. Because it is not likely to get large-scale investigational data about these issues, the collection of individual experiences should be promoted in future scientific meetings to build up the consensus.
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Affiliation(s)
- Joon Chul Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 Republic of Korea
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 Republic of Korea
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14
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Zhu J, Kuang J, Li C, Wang Q, Sun T, Wu J, Fan R. Von Willebrand factor and acute type a aortic dissection——VAD study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Boldyrev SY, Suslova VN, Pekhterev VA, Barbukhatti KO, Porkhanov VA. [Complete detachment of the right coronary artery in a patient with acute aortic dissection type A]. Khirurgiia (Mosk) 2020:74-76. [PMID: 32352673 DOI: 10.17116/hirurgia202004174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Extremely rare and formidable complication of acute aortic dissection type A in a young patient is reported in the article. Clinical symptoms and features of surgical technique are described.
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Affiliation(s)
- S Yu Boldyrev
- Research Institute - Ochapovsky Regional Clinic Hospital No. 1 of the Ministry of Health of Krasnodar Region, Krasnodar, Russia.,Kuban State Medical University of the Ministry of Health of Russia, Department of Cardiac Surgery and Cardiology, Advanced Training Faculty, Krasnodar, Russia
| | - V N Suslova
- Kuban State Medical University of the Ministry of Health of Russia, Department of Cardiac Surgery and Cardiology, Advanced Training Faculty, Krasnodar, Russia
| | - V A Pekhterev
- Research Institute - Ochapovsky Regional Clinic Hospital No. 1 of the Ministry of Health of Krasnodar Region, Krasnodar, Russia
| | - K O Barbukhatti
- Research Institute - Ochapovsky Regional Clinic Hospital No. 1 of the Ministry of Health of Krasnodar Region, Krasnodar, Russia.,Kuban State Medical University of the Ministry of Health of Russia, Department of Cardiac Surgery and Cardiology, Advanced Training Faculty, Krasnodar, Russia
| | - V A Porkhanov
- Research Institute - Ochapovsky Regional Clinic Hospital No. 1 of the Ministry of Health of Krasnodar Region, Krasnodar, Russia
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16
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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: 842] [Impact Index Per Article: 140.3] [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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17
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Ghoreishi M, Wise ES, Croal-Abrahams L, Tran D, Pasrija C, Drucker CB, Griffith BP, Gammie JS, Crawford RS, Taylor BS. A Novel Risk Score Predicts Operative Mortality After Acute Type A Aortic Dissection Repair. Ann Thorac Surg 2018; 106:1759-1766. [DOI: 10.1016/j.athoracsur.2018.05.072] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 05/10/2018] [Accepted: 05/25/2018] [Indexed: 11/17/2022]
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18
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Bellanti E, Bagozzi L, Gerosa G, Bottio T. Treatment of aortic dissection involving the right coronary. J Thorac Cardiovasc Surg 2018; 156:2084-2086. [PMID: 30017441 DOI: 10.1016/j.jtcvs.2018.05.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/20/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Ermanno Bellanti
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lorenzo Bagozzi
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Tomaso Bottio
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
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19
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Hashiyama N, Goda M, Uchida K, Isomatsu Y, Suzuki S, Mo M, Nishida T, Masuda M. Stanford type B aortic dissection is more frequently associated with coronary artery atherosclerosis than type A. J Cardiothorac Surg 2018; 13:80. [PMID: 29945663 PMCID: PMC6020428 DOI: 10.1186/s13019-018-0765-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between aortic dissection and coronary artery disease is not clear. The purpose of this study was to clarify the difference in the rate of coronary artery atherosclerosis between Stanford type A and type B aortic dissection by reviewing our institutional database. METHODS One hundred and forty-five patients (78 males, 67 females; mean age: 60 ± 12 years) admitted to our hospital with acute aortic dissection who underwent coronary angiography during hospitalization from 2000 through 2002 were enrolled in this study. The background characteristics, coronary risk factors, and coronary angiography findings (number of significant stenoses, stenoses according to Bogaty standards, extent index) of patients were compared between type A (Group A; n = 71) and type B dissection (Group B; N = 74). RESULTS Significantly more patients had prior histories of complications from ischemic heart disease in Group B than in Group A (P = 0.04), with no significant differences in comparison to other risk factors observed except for hypertension. Significantly (p = 0.005) more stenoses were observed in Group B (1.54 ± 0.04) than in Group A (0.38 ± 0.1). A significantly higher (P < 0.05) index score indicating the severity of coronary atherosclerosis was observed in Group B (1.49 ± 0.09) than in Group A (0.72 ± 0.07). CONCLUSIONS Stanford type B acute aortic dissection was significantly more frequently associated with coronary artery atherosclerosis than type A.
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Affiliation(s)
- Naoki Hashiyama
- Department of Cardiovascular Surgery, Yokohama Minami-kyosai Hospital, Mutsuurahigashi 1-21-1, Kanazawa-ku, Yokohama, 236-0037, Japan
| | - Motohiko Goda
- Department of Cardiovascular Surgery, Yokohama City University Hospital, Fukuura 3-9, Kanazawaku, Yokohama, 236-0004, Japan.
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yukihisa Isomatsu
- Department of Cardiovascular Surgery, Yokohama City University Hospital, Fukuura 3-9, Kanazawaku, Yokohama, 236-0004, Japan
| | - Shinichi Suzuki
- Department of Cardiovascular Surgery, Yokohama City University Hospital, Fukuura 3-9, Kanazawaku, Yokohama, 236-0004, Japan
| | - Makoto Mo
- Department of Cardiovascular Surgery, Yokohama Minami-kyosai Hospital, Mutsuurahigashi 1-21-1, Kanazawa-ku, Yokohama, 236-0037, Japan
| | - Takahiro Nishida
- Department of Cardiovascular Surgery, Yokohama Citizen's Municipal Hospital, Yokohama, Japan
| | - Munetaka Masuda
- Department of Cardiovascular Surgery, Yokohama City University Hospital, Fukuura 3-9, Kanazawaku, Yokohama, 236-0004, Japan.,Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
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20
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Balsam LB, DeAnda A. Postoperative myocardial infarction after acute type A dissection: Another day, another database? J Thorac Cardiovasc Surg 2016; 153:528-529. [PMID: 28012696 DOI: 10.1016/j.jtcvs.2016.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Leora B Balsam
- Department of Cardiothoracic Surgery, New York University-Langone Medical Center, New York, NY.
| | - Abe DeAnda
- Division of Cardiothoracic Surgery, University of Texas Medical Branch-Galveston, Galveston, Tex
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