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Lin XF, Xie LF, Zhang ZF, He J, Xie YL, Dai XF, Chen LW. Quality of life in young patients with acute type a aortic dissection in China: comparison with Marfan syndrome and non-Marfan syndrome. BMC Cardiovasc Disord 2024; 24:132. [PMID: 38424531 PMCID: PMC10905939 DOI: 10.1186/s12872-024-03740-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND There is a paucity of Chinese studies evaluating the quality of life (QoL) in young acute type A aortic dissection (AAAD) patients with Marfan syndrome. METHODS Young adult AAAD patients (younger than 45 years old) underwent surgical treatment at our institution from January 2017 to December 2020 were consecutive enrolled. The hospital survivors completed 1 year of follow up. Patients were divided into two groups according to the presence or absence of Marfan syndrome (MFS). A 1:1 propensity score matching (PSM) with a caliper 0.2 was conducted to balance potential bias in baseline. The follow-up data were analyzed primarily for change in quality of life and anxiety status. RESULTS After PSM, 32 comparable pairs were matched. The baseline data were comparable and postoperative complications were similar between groups. In terms of SF-36 scale, the role physical, bodily pain, role emotional and mental health subscales were no significantly improved in MFS patients over time. At 1 year after discharged, the subscale of mental health and bodily pain were significantly lower in the MFS group than in the non-MFS group. In terms of HADS assessments, the level of anxiety in MFS patients was significantly higher than in non-MFS patients at 1 year after discharged. CONCLUSIONS The QoL in young AAAD patients with MFS is lower than those without MFS after surgery. This may be associated with the uncontrollable persistent chronic pain and the uncertainty and concerns for the disease's progression.
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Affiliation(s)
- Xin-Fan Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, P. R. China
| | - Lin-Feng Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, P. R. China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Zhao-Feng Zhang
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Jian He
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, P. R. China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Yu-Ling Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, P. R. China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Xiao-Fu Dai
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, P. R. China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, P. R. China.
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China.
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Lin X, Xie L, He J, Xie Y, Zhang Z, Chen L, Chen M. A nomogram-based model to predict postoperative transient neurological dysfunctions in patients receiving acute type A aortic dissection surgery. J Clin Hypertens (Greenwich) 2023; 25:1193-1201. [PMID: 37964741 PMCID: PMC10710554 DOI: 10.1111/jch.14744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/16/2023]
Abstract
The purposes of this study were to develop and validate a nomogram for predicting postoperative transient neurological dysfunctions (TND) in patients with acute type A aortic dissection (AAAD) who underwent modified triple-branched stent graft implantation. This retrospective study developed a nomogram-based model in a consecutive cohort of 146 patients. Patient characteristics, preoperative clinical indices, and operative data were analyzed. Univariate and multivariable analyses were applied to identify the most useful predictive variables for constructing the nomogram. Discrimination and the calibration of the model was evaluated through the receiver operating characteristic curve (ROC), the Hosmer-Lemeshow goodness-of-fit test and the decision curve analysis (DCA). At the same time, to identify and compare long-term cumulative survival rate, Kaplan-Meier survival curve was plotted. The incidence rate of postoperative TND observed in our cohort were 40.9%. Supra-aortic dissection with or without thrombosis, creatinine >115 μmol and albumin <39.7 g/L, selective antegrade cerebral perfusion (SACP) time >7 min and total operation time >303 min, were confirmed as independent predictors that enhanced the likelihood of TND. Internal validation showed good discrimination of the model with under the ROC curve (AUC) of 0.818 and good calibration (Hosmer-Lemeshow test, p > .05). DCA revealed that the nomogram was clinically useful. In the long-term survival there was no significant difference between patients with or without TND history. The results showed the predict model based on readily available predictors has sufficient validity to identify TND risk in this population, that maybe useful for clinical decision-making.
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Affiliation(s)
- Xin‐fan Lin
- Department of Cardiovascular SurgeryFujian Medical University Union HospitalFuzhouFujianPR China
| | - Lin‐feng Xie
- Department of Cardiovascular SurgeryFujian Medical University Union HospitalFuzhouFujianPR China
- Fujian Provincial Center for Cardiovascular MedicineFuzhouFujianPR China
| | - Jian He
- Department of Cardiovascular SurgeryFujian Medical University Union HospitalFuzhouFujianPR China
- Fujian Provincial Center for Cardiovascular MedicineFuzhouFujianPR China
| | - Yu‐ling Xie
- Fujian Provincial Center for Cardiovascular MedicineFuzhouFujianPR China
| | - Zhao‐feng Zhang
- Department of Cardiovascular SurgeryFujian Medical University Union HospitalFuzhouFujianPR China
- Fujian Provincial Center for Cardiovascular MedicineFuzhouFujianPR China
| | - Liang‐wan Chen
- Department of Cardiovascular SurgeryFujian Medical University Union HospitalFuzhouFujianPR China
- Fujian Provincial Center for Cardiovascular MedicineFuzhouFujianPR China
| | - Mei‐fang Chen
- Department of Cardiovascular SurgeryFujian Medical University Union HospitalFuzhouFujianPR China
- Fujian Provincial Center for Cardiovascular MedicineFuzhouFujianPR China
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Xu S, Lin Y, Lin L, Peng Y, Chen L. Predictive Value of Increased Perioperative Heart Rate for All-Cause Mortality After Cardiac Surgery: A Systematic Review and Meta-Analysis. Biol Res Nurs 2022; 24:379-387. [PMID: 35437047 DOI: 10.1177/10998004221085986] [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
Background: Accumulated studies have revealed that heart rates are associated with all-cause mortality in cardiac surgery patients, but the results remain controversial. This meta-analysis aimed to evaluate the predictive value of increased perioperative heart rate for all-cause mortality after cardiac surgery. Methods: We searched PubMed, Embase, Web of Science, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases for studies from inception to October 11, 2021. Two researchers independently screened the studies. Titles, authors, publication years, and hazard ratios were extracted. We used a random-effects model to combine the HRs and 95% confidence intervals. Several subgroup analyses were conducted. Statistical significance was set at p < .05. Results: Eleven studies were included in the meta-analysis of 33,849 patients and 3166 (9.4%) deaths. The HR of higher perioperative heart rates was 2.09 (95% CI 1.53-2.86, p < .001, I2 = 81%). The HR with a 10-bpm increase in preoperative heart rate was 1.19 (95% CI 1.11-1.26, p < .001, I2 = 51%). Subgroup analysis showed patients with higher preoperative heart rates had an HR of 1.88 (95% CI 1.51-2.34, p < .001, I2 = 0%), and patients with a higher postoperative heart rate had an HR of 2.29 (95% CI 1.28- 4.09, p < .0001, I2 = 91%) compared to patients with lower postoperative heart rates. Conclusion: Increased perioperative heart rate is associated with all-cause mortality in patients undergoing cardiac surgery.
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Affiliation(s)
- Shurong Xu
- School of Nursing, 74551Fujian Medical University, Fuzhou, China
| | - Yanjuan Lin
- Department of Nursing, Union Hospital, 117890Fujian Medical University, Fuzhou, China
| | - Lingyu Lin
- School of Nursing, 74551Fujian Medical University, Fuzhou, China
| | - Yanchun Peng
- Department of Cardiac Surgery, Union Hospital, 117890Fujian Medical University, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Union Hospital, 117890Fujian Medical University, Fuzhou, China
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An Z, Sun YY, Fan RX, Yu SQ, Zhu JM, Han QQ, Han L. Extensive Arch Repair with a Novel Two-Branched Stent Graft in Acute Type A Aortic Dissection. Ann Thorac Cardiovasc Surg 2022; 28:255-261. [PMID: 35228411 PMCID: PMC9433888 DOI: 10.5761/atcs.oa.21-00261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: In this study, we compared the early results between the extensive arch repair with a novel two-branched stent graft (TSG) and the traditional technique. Methods: Between 2013 July and 2015 March, 63 acute type A aortic dissection (ATAAD) patients from four cardiac centers with indications for extensive arch repair were included in this study. Finally, 28 patients were involved in the traditional procedure (TP) group (23 males with the age of 49.75 ± 9.26 years) and 35 patients were involved in the TSG group (29 males with the age of 53.82 ± 8.17 years). Results: The operation was successful in all patients. The selective cerebral perfusion time, total operation time, and chest drainage within 24 hours after the operation in the TSG group were significantly less than those in the TP group (P ≤0.05). The mean follow-up time was 11.17 ± 1.74 months in the TP group and 11.94 ± 4.29 months in the TSG group. No statistical differences were found in aortic diameter, false lumen diameter, and true lumen diameter at the diaphragmatic level during the follow-up. Conclusion: Our technique with a novel TSG simplified the extensive arch repair procedure and was an effective way for the treatment of ATAAD.
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Affiliation(s)
- Zhao An
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang-Yong Sun
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Rui-Xin Fan
- Department of Cardiovascular Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shi-Qiang Yu
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Jun-Ming Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qing-Qi Han
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
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Xie W, Ke Y, You Q, Li J, Chen L, Li D, Fang J, Chen X, Zhou Y, Chen L, Hong H. Single-Cell RNA Sequencing and Assay for Transposase-Accessible Chromatin Using Sequencing Reveals Cellular and Molecular Dynamics of Aortic Aging in Mice. Arterioscler Thromb Vasc Biol 2021; 42:156-171. [PMID: 34879708 DOI: 10.1161/atvbaha.121.316883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The impact of vascular aging on cardiovascular diseases has been extensively studied; however, little is known regarding the cellular and molecular mechanisms underlying age-related vascular aging in aortic cellular subpopulations. Approach and Results: Transcriptomes and transposase-accessible chromatin profiles from the aortas of 4-, 26-, and 86-week-old C57/BL6J mice were analyzed using single-cell RNA sequencing and assay for transposase-accessible chromatin sequencing. By integrating the heterogeneous transcriptome and chromatin accessibility data, we identified cell-specific TF (transcription factor) regulatory networks and open chromatin states. We also determined that aortic aging affects cell interactions, inflammation, cell type composition, dysregulation of transcriptional control, and chromatin accessibility. Endothelial cells 1 have higher gene set activity related to cellular senescence and aging than do endothelial cells 2. Moreover, construction of senescence trajectories shows that endothelial cell 1 and fibroblast senescence is associated with distinct TF open chromatin states and an mRNA expression model. CONCLUSIONS Our data provide a system-wide model for transcriptional and epigenetic regulation during aortic aging at single-cell resolution.
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Affiliation(s)
- Wenhui Xie
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Medical University, Fujian Institute of Geriatrics, Department of Cardiology, Department of Cardiac Surgery, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yilang Ke
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Medical University, Fujian Institute of Geriatrics, Department of Cardiology, Department of Cardiac Surgery, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qinyi You
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Medical University, Fujian Institute of Geriatrics, Department of Cardiology, Department of Cardiac Surgery, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jing Li
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Medical University, Fujian Institute of Geriatrics, Department of Cardiology, Department of Cardiac Surgery, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lu Chen
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Medical University, Fujian Institute of Geriatrics, Department of Cardiology, Department of Cardiac Surgery, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Dang Li
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Medical University, Fujian Institute of Geriatrics, Department of Cardiology, Department of Cardiac Surgery, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jun Fang
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Medical University, Fujian Institute of Geriatrics, Department of Cardiology, Department of Cardiac Surgery, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaofeng Chen
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Medical University, Fujian Institute of Geriatrics, Department of Cardiology, Department of Cardiac Surgery, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuanyuan Zhou
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Medical University, Fujian Institute of Geriatrics, Department of Cardiology, Department of Cardiac Surgery, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liangwan Chen
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Medical University, Fujian Institute of Geriatrics, Department of Cardiology, Department of Cardiac Surgery, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Huashan Hong
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Medical University, Fujian Institute of Geriatrics, Department of Cardiology, Department of Cardiac Surgery, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, China
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Branch stent-grafting for endovascular repair of chronic aortic arch dissection. J Thorac Cardiovasc Surg 2021; 162:12-22.e1. [DOI: 10.1016/j.jtcvs.2019.10.184] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/27/2022]
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Identification of transfer RNA-derived fragments and their potential roles in aortic dissection. Genomics 2021; 113:3039-3049. [PMID: 34214628 DOI: 10.1016/j.ygeno.2021.06.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/19/2021] [Accepted: 06/27/2021] [Indexed: 12/15/2022]
Abstract
Emerging evidence suggests that majority of the transfer RNA (tRNA)-derived small RNA, including tRNA-derived fragments (tRFs) and tRNA halves (tiRNAs), play a significant role in the molecular mechanisms underlying some human diseases. However, expression of tRFs/tiRNAs and their potential roles in aortic dissection (AD) remain unclear. This study examined the expression characteristics and explored the functional roles of tRFs/tiRNAs in AD using RNA-sequencing, bioinformatics, real-time quantitative reverse transcription polymerase chain reaction, and loss- and gain-of-function analysis. Results revealed that a total of 41 tRFs/tiRNAs were dysregulated in the AD group compared to the control group. Among them, 12 were upregulated and 29 were downregulated (fold change≥1.5 and p < 0.05). RT-qPCR results revealed that expressions of tRF-1:30-chrM.Met-CAT was significantly upregulated, while that of tRF-54:71-chrM.Trp-TCA and tRF-1:32-chrM.Cys-GCA were notably downregulated; expression patterns were consistent with the RNA sequencing data. Bioinformatic analysis showed that a variety of related pathways might be involved in the pathogenesis of AD. Functionally, tRF-1:30-chrM.Met-CAT could facilitate proliferation, migration, and phenotype switching in vascular smooth muscle cells (VSMCs), which might serve as a significant regulator in the progression of AD. In summary, the study illustrated that tRFs/tiRNAs expressed in AD tissues have potential biological functions and may act as promising biomarkers or therapeutic targets for AD.
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Hydrogen Sulfide Attenuates Aortic Remodeling in Aortic Dissection Associating with Moderated Inflammation and Oxidative Stress through a NO-Dependent Pathway. Antioxidants (Basel) 2021; 10:antiox10050682. [PMID: 33925479 PMCID: PMC8145450 DOI: 10.3390/antiox10050682] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 01/16/2023] Open
Abstract
Aortic dissection (AD) is a highly lethal vascular disease characterized by separation of the constituent layers of the aortic wall. An increasing body of research indicates that inflammatory response and oxidative stress are implicated in vascular remodeling, which plays a key role in the development of AD. Hydrogen sulfide (H2S) has been found to protect against various types of cardiovascular disease, including myocardial infarction, arthrosclerosis, and hypertension. However, research on the effect of H2S on AD is insufficient. This study therefore elucidated the effect of H2S on the development and progression of AD, and the potential mechanism involved. Using β-aminopropionitrile fumarate (BAPN) and angiotensin II (Ang-II)-induced AD animal models, the administration of NaHS (as H2S donor, 56 μmol/kg body weight/day) was found to retard the development of AD. Murine VSMCs (Movas) exposed to interleukin-6 (IL-6) (20 ng/mL) to induce phenotypic switch. Histological analyses indicated that H2S administration inhibited the accumulation of inflammatory cells in the aortic wall and the related expression of inflammatory genes. Additionally, H2S treatment elevated aortic superoxide dismutase (SOD) activity and ablated malonaldehyde (MDA) and nitric oxide (NO) levels. In mechanistic terms, H2S attenuated IL-6 induced a pathological VSMC phenotypical switch through NO modulation by N(G)-monomethyl-L-arginine acetate salt (L-NMMA) stimulation. H2S inhibits AD formation by decreasing the inflammatory response, and oxidative stress, and by positively participating in vascular remodeling. These findings suggest a role for H2S as a novel and promising therapeutic strategy to prevent AD development.
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Lin Y, Chen Y, Peng Y, Xu S, Li S, Huang X, Chen L. Symptoms of post-traumatic stress disorder and associated risk factors in type A aortic dissection. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:286-293. [PMID: 33616350 DOI: 10.23736/s0021-9509.21.11553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Surgery is the primary option of acute type A aortic dissection (AAAD) treatment. However, the unique traumatic stress of cardiovascular disease and surgery brings physical and psychological suffering to the patients and causes post-traumatic stress disorder (PTSD). The aim of this study was to investigate the rate of PTSD in AAAD patients after surgery and identify the risk factors of this complication. METHODS A prospective cohort design was used. All patients who underwent AAAD surgery from September 2017 to June 2019 were included. Resilience, anxiety, and depression level were assessed before patients discharged from the hospital. Additionally, the PTSD symptoms were assessed three months after discharge from hospital. The data were analyzed by SPSS 24.0 (IBM, Armonk, NY, USA) and P<0.05 was considered as statistically significant. RESULTS Two hundred and twenty-four patients were included in this study. The incidence of PTSD was 21.4%. Symptoms were highly prevalent with reexperience and increased alertness. "Primary or below" AAAD patients had a significantly higher score in "increased alertness" (P<0.05). Depressive symptoms (B=1.621, β=0.398, P<0.001), female gender (B=-7.539, β=-0.311, P<0.001) were the risk factors associated with PTSD, while optimism (B=-0.920, β=-0.169, P=0.012) was the protective factor in AAAD patients. CONCLUSIONS AAAD patients exhibited high prevalence of PTSD, which was highly prevalent with reexperience and increased alertness. Higher depressive level, female gender, and lower optimism were associated with higher risk of PTSD. The findings suggest that medical staff should assess the psychological health status of AAAD patients timely and identify high-risk patients early to improve the outcome.
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Affiliation(s)
- Yanjuan Lin
- Department of Nursing, Union Hospital, Fujian Medical University, Fuzhou, China -
| | - Yiping Chen
- Department of Nursing, Fujian Medical University, Fuzhou, China
| | - Yanchun Peng
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Shurong Xu
- Department of Nursing, Fujian Medical University, Fuzhou, China
| | - Sailan Li
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xizhen Huang
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
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Wu Q, Xiao J, Qiu Z, Yan L, Shen Y, He J, Chen LW. Long-term outcomes of treatment with different stent grafts in acute DeBakey type I aortic dissection. J Card Surg 2020; 35:3078-3087. [PMID: 33032378 DOI: 10.1111/jocs.14996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND We developed an integrated triple-branched stent to treat acute DeBakey type I aortic dissection (AD) and modified it to enhance its adaptability. However, whether the patients treated by the modified stent would achieve better long-term prognosis is unknown. METHODS This study enrolled 147 patients with acute DeBakey type I AD. The original integrated triple-branched stents were used in 57 patients (Group A) between July 2012 and August 2013, and the modified stents in 90 patients (Group B) between September 2013 and March 2015. Clinical characteristics, surgical data, postoperative complications, mortality, and follow-up data of the two groups were analyzed. RESULTS The two groups presented comparable early death rates (Group A = 7.0%, Group B = 5.9%; p = .719). The incidence of postoperative acute kidney injury (AKI) was lower in Group B (10.0%) versus Group A (24.6%) (p = .018). Compared with the original integrated triple-branched stent graft, the modified stent could reduce the risk of early postoperative AKI (OR [95% CI] = 0.36 [0.14, 0.94]). Early endoleak rates were significantly lower in Group B (1.0%) compared to Group A (9.4%) (p = .004). During follow-up, there were five deaths in Group A (9.4%) and six deaths in Group B (7.2%) (p = .646). Chronic kidney injury (7.5% vs. 3.6%; p = .311), delayed endoleak (11.3% vs. 4.8%; p = .157), and late reinterventions (7.5% vs. 2.4%; p = .155) in the two groups were similar. CONCLUSIONS In patients with acute DeBakey type I AD, the modified stent showed feasible and safe treatment outcomes and reduced early endoleak rates. However, the long-term effects were similar to the original treatment.
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Affiliation(s)
- Qingsong Wu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Jun Xiao
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhihuang Qiu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Liangliang Yan
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yue Shen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Jian He
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Liang-Wan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
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Qi L, Wu K, Shi S, Ji Q, Miao H, Bin Q. Thrombospondin-2 is upregulated in patients with aortic dissection and enhances angiotensin II-induced smooth muscle cell apoptosis. Exp Ther Med 2020; 20:150. [PMID: 33093888 PMCID: PMC7571314 DOI: 10.3892/etm.2020.9279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/01/2020] [Indexed: 12/16/2022] Open
Abstract
Thrombospondin-2 (TSP-2) is an important extracellular matrix protein that is involved in a variety of cardiovascular diseases, including viral myocarditis and abdominal aortic aneurysm. The present study aimed to investigate TSP-2 expression in patients with aortic dissection (AD). Aortas were obtained from patients with AD and healthy donors, and TSP-2 expression level in all samples was measured by western blotting and immunofluorescence assays. Blood samples were also collected from patients with AD and non-AD (NAD) subjects. Circulating TSP-2, tumor necrosis factor (TNF)-α and interleukin (IL)-6 levels in each sample were detected using ELISAs. In addition, the effect of TSP-2 on angiotensin II (Ang II)-induced smooth muscle cell (SMC) apoptosis was assessed in vitro. Compared with healthy donors, aortic TSP-2 expression level was significantly increased in patients with AD. Furthermore, TSP-2 was secreted primarily by SMCs, but also by endothelial cells. TSP-2 plasma expression level was also elevated in patients with AD compared with non-AD subjects. Furthermore, TSP-2 serum expression level was positively correlated with TNF-α and IL-6 expression levels in patients with AD. In addition, recombinant mouse TSP-2 treatment increased Bax mRNA expression and decreased Bcl2 mRNA expression in Ang II-treated SMCs; however, the effects were reversed following treatment with the NF-κB p65 signaling pathway inhibitor JSH-23 or with the anti-TNF-α and anti-IL-6 neutralizing antibodies. The present study demonstrated that TSP-2 expression was increased in the aortic tissues and plasma of patients with AD. These findings suggested that TSP-2 may participate in the progression of AD by activating the NF-κB p65 signaling pathway and amplifying the inflammatory response.
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Affiliation(s)
- Liping Qi
- Department of Cardiology, The Second Clinical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Kui Wu
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, Beijing 100029, P.R. China
| | - Shutian Shi
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, Beijing 100029, P.R. China
| | - Qingwei Ji
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, Beijing 100029, P.R. China
| | - Huangtai Miao
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, Beijing 100029, P.R. China
| | - Que Bin
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, Beijing 100029, P.R. China
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Zhang L, Yu C, Yang X, Sun X, Qiu J, Jiang W, Wang D. Normothermic iliac perfusion improves early outcomes after thoraco-abdominal aortic aneurysm repair. Eur J Cardiothorac Surg 2020; 55:1054-1060. [PMID: 30590503 DOI: 10.1093/ejcts/ezy440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study is to evaluate the safety and efficacy of thoraco-abdominal aortic aneurysm repair with normothermic iliac perfusion. METHODS One hundred and ninety patients who underwent aortic replacement for the Crawford type II thoraco-abdominal aortic aneurysm between January 2005 and June 2017 were assigned to 2 groups: normothermic iliac perfusion (group A, n = 75) and deep hypothermic circulatory arrest (group B, n = 115). We selected 58 pairs of patients for propensity score matching. We analysed early operative death, a composite of complications and mid-term survival. RESULTS After propensity score matching, no early operative death occurred in group A (0.0%), and group B had 4 cases of early operative death (6.9%), with a statistically significant difference (P = 0.047). The composite of complications was reported in 11 patients in group A (21.0%) and in 21 patients in group B (36.2%) (P = 0.038). Age >50 years [odds ratio (OR) 6.50, 95% confidence interval (CI) 2.32-16.36; P = 0.020], deep hypothermia (OR 12.13, 95% CI 1.64-23.13; P = 0.003) and chronic renal insufficiency (OR 8.21, 95% CI 2.34-43.33; P < 0.001) were independent risk factors for early operative death. The 3-year, 5-year and 7-year survival rates were 98.3%, 98.3% and 86.9% in group A and 86.9%, 86.9% and 86.9% in group B, respectively (P = 0.471). The 7-year cumulative incidence function rates for reintervention were 0.026% in group A and 0.048% in group B (P = 0.625). CONCLUSIONS Normothermic iliac perfusion provides a viable alternative for thoraco-abdominal aortic aneurysm repair, which reduced early operative death and composited complications.
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Affiliation(s)
- Liang Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Cuntao Yu
- Department of Aortic Surgery, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiubin Yang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xiaogang Sun
- Department of Aortic Surgery, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Juntao Qiu
- Department of Aortic Surgery, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Wenxiang Jiang
- Department of Aortic Surgery, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - De Wang
- Department of Aortic Surgery, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Relationship of Platelet Counts and Inflammatory Markers to 30-Day Mortality Risk in Patients with Acute Type A Aortic Dissection. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1057496. [PMID: 32382526 PMCID: PMC7191390 DOI: 10.1155/2020/1057496] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/17/2022]
Abstract
Markers of prothrombotic state and inflammation are associated with the prognosis of patients with acute type A aortic dissection (AAAD). However, it is unclear that the relationship between these biomarkers and their combined impact on risk stratification. The present study evaluated the prognostic value of platelet counts, lymphocyte to neutrophil ratio (LNR), and lymphocyte to monocyte ratio (LMR), alone and in combination. A retrospective analysis of clinical data of 744 AAAD patients was conducted to identify whether these biomarkers were related to the 30-day mortality risk. A Kaplan-Meier analysis and log-rank test were used to compare survival between groups. A Cox hazard regression multivariable analysis was performed for 30-day mortality. Individual biomarker (platelet count, LNR, or LMR) was unable to predict 30-day mortality. However, combinations of all three biomarkers provided additive predictive value over either marker alone, the receiver operating characteristic (ROC) model had a prediction probability of 0.739 when platelet counts, LNR, and LMR were included. Cox hazard regression multivariable analysis showed that combinations of all three biomarkers were the strongest predictor of 30-day mortality (p < 0.021). Combined with these three easily measurable biomarkers at admission, they could help identify AAAD patients with a high risk of 30-day mortality.
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Zhang L, Wu MT, Zhu GL, Feng JX, Song C, Li HY, Jing ZP, Yeung KK, Lu QS. Off-the-Shelf Devices for Treatment of Thoracic Aortic Diseases: Midterm Follow-up of TEVAR With Chimneys or Physician-Made Fenestrations. J Endovasc Ther 2019; 27:132-142. [PMID: 31789078 DOI: 10.1177/1526602819890107] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the midterm outcomes of thoracic endovascular aortic repair (TEVAR) using chimney grafts (ch-TEVAR) or thoracic stent-grafts with fenestrations made on the back table (f-TEVAR) to treat thoracic aortic dissection (TAD) and thoracic aortic aneurysm (TAA). Materials and Methods: A retrospective analysis was conducted of 474 consecutive patients (mean age 62.3±10.7 years; 346 men) treated with either f-TEVAR (n=110) or ch-TEVAR (n=364) for 352 TADs (81 f-TEVAR and 271 ch-TEVAR) or 122 TAAs (29 f-TEVAR and 93 ch-TEVAR) from 2008 to 2016. The primary endpoints at 30 days and during follow-up were overall mortality, aorta-related mortality, and major complications. The secondary endpoints were endoleak and reintervention. The patency of the target branches, cost of hospitalization, and the use of antiplatelet drugs were also analyzed. Results: Intraoperative type I endoleaks were treated in 69 (14.6%) cases (4 f-TEVAR and 65 ch-TEVAR, p<0.01) to achieve 100% technical success. Four (0.8%) patients died within 30 days [1 (0.9%) f-TEVAR and 3 (0.8%) ch-TEVAR]. Perioperative cerebral ischemia (1 fatal stroke) occurred in 9 (1.9%) patients: (1 f-TEVAR and 8 ch-TEVAR, p=0.39). During the mean follow-up of 50.6±20.0 months (49.5±18.3 months in f-TEVAR and 50.9±20.6 months in ch-TEVAR), 11 (2.3%) patients died of an aorta-related event. Type I endoleak was present in 40 (8.4%) patients (1 f-TEVAR and 39 ch-TEVAR, p<0.01). Eleven (2.3%) patients experienced stent-graft migration and 13 (2.7%) had a retrograde dissection. One hundred (16.9%) of the 593 branch stents occluded (4/75 in the f-TEVAR group and 96/518 in the ch-TEVAR group, p<0.01). The branch reintervention rate was 7.2% (34/474). The f-TEVAR group had a significantly higher probability of freedom from branch occlusion (92%) than the ch-TEVAR group (83%, p=0.007). Conclusion: Off-the-shelf techniques employing chimney grafts and homemade fenestrations are both suitable options for TAD and TAA involving the supra-aortic branches, with a low incidence of reintervention. Fenestrated TEVAR seems to have more favorable short- and midterm outcomes. Further study of these off-the-shelf techniques for aortic arch repair is warranted.
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Affiliation(s)
- Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Meng-tao Wu
- Department of Vascular Surgery, the Second Hospital of Shandong University, Ji’nan, Shandong Province, China
| | - Guang-lang Zhu
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Jia-xuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Chao Song
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Hai-yan Li
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Zai-ping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Kak Khee Yeung
- Department of Vascular Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Qing-sheng Lu
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
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He J, Peng J, Li W, Zheng D, Cai S, Xu W, Huang J, Fan X. "Aorta-clamp" technique for surgical repair of acute type A aortic dissection-5 min circulatory arrest at 30 °C. J Thorac Dis 2019; 11:4717-4724. [PMID: 31903261 PMCID: PMC6940206 DOI: 10.21037/jtd.2019.10.47] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Deep hypothermic circulatory arrest (HCA), which causes perioperative complications, is the foundation of surgical treatment for acute type A aortic dissection (AAAD). To extensively replace the dissected aorta and avoid the negative impacts of HCA, we developed an "aorta-clamp" technique and examined its efficacy in repairing AAAD. Methods From November 2014 to August 2016, we recruited 59 consecutive patients (51.3±10.9 years) with AAAD into this study. We performed total arch replacement combined with an elephant trunk implantation using the "aorta-clamp" technique under a 30 °C HCA with continual bilateral antegrade cerebral perfusion. Results The average HCA time was 4.9±1.0 min. Twenty-three patients had increased serum creatinine (sCr) before surgery, suggesting an AAAD-associated acute kidney injury (AKI). The sCr level returned to normal in five patients after operation and in 15 before discharge. Six patients (10.2%) with preoperative AKI required postoperative dialysis, and two of these patients (3.4%) died of multiple organ failure. Two patients (3.4%) required re-exploration due to bleeding. One patient (1.7%) exhibited temporary neurologic deficits. There were no late deaths. Computed tomography (CT) examination confirmed the patency of the anastomotic sites and thrombus obliteration of the residual false lumen. Conclusions Using the "aorta-clamp" technique with continual bilateral antegrade cerebral perfusion, total arch replacement combined with an elephant trunk implantation can be performed under five minutes of mild (30 °C) HCA. Our data suggest that this technique for the surgical repair of AAAD is a safe, feasible and effective surgical approach with satisfactory early outcomes.
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Affiliation(s)
- Jie He
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, China.,Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jihai Peng
- Department of Rehabilitation, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wei Li
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Dingwen Zheng
- Department of Cardiovascular Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Shihao Cai
- Department of Cardiovascular Surgery, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen 361005, China
| | - Wenliu Xu
- Department of Cardiothoracic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jinsong Huang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xiaoping Fan
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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Lin Y, Chen Y, Zhang H, Peng Y, Li S, Huang X, Chen Q. Predictors of return to work after open triple-branched stent graft placement for acute type A aortic dissection. Interact Cardiovasc Thorac Surg 2019; 30:99-106. [PMID: 31566219 DOI: 10.1093/icvts/ivz236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/21/2019] [Accepted: 08/29/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractOBJECTIVESTo investigate the rate of returning to work within 12 months after open triple-branched stent graft placement in acute type A aortic dissection (AAAD) patients and the reasons why patients did not return to work.METHODSWe conducted this cohort study of AAAD patients who were discharged alive from the hospital at Fujian Cardiac Center during the period 2013–2018. The collected data included the patients’ baseline characteristics, employment status at 12 months after AAAD and variables classifying the potential reasons for those who did not return to work at 12 months. We applied logistic regression to estimate the factors associated with returning to work at 12 months.RESULTSOne year after AAAD hospitalization, of the 326 AAAD patients, 81 (24.8%) returned to work, 231 (70.9%) did not and 14 (4.3%) died. Among the 231 patients who did not return to work, 105 (45.5%) were unable to work because of AAAD and 36 (15.6%) lost job owing to AAAD. After adjustment for other risk factors, age, female sex, type of work, operating time, aortic cross-clamp time and length of intensive care unit (ICU) stay were still significantly associated with a lower chance of returning to work.CONCLUSIONSLess than 25% of the previously employed patients returned to work at 12 months after AAAD. Older age, female sex, manual or semi-skilled professional work, a longer operating time, a longer aortic cross-clamp time and a longer length of ICU stay were associated with a lower likelihood of returning to work.
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Affiliation(s)
- Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yiping Chen
- Nursing School of Fujian Medical University, Fuzhou, China
| | - Haoruo Zhang
- Nursing School of Fujian Medical University, Fuzhou, China
| | - Yanchun Peng
- Nursing School of Fujian Medical University, Fuzhou, China
| | - Sailan Li
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xizhen Huang
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qiong Chen
- Nursing School of Fujian Medical University, Fuzhou, China
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Ye J, Wang M, Jiang H, Ji Q, Huang Y, Liu J, Zeng T, Xu Y, Wang Z, Lin Y, Wan J. Increased levels of interleukin-22 in thoracic aorta and plasma from patients with acute thoracic aortic dissection. Clin Chim Acta 2018; 486:395-401. [PMID: 29104039 DOI: 10.1016/j.cca.2017.10.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/25/2017] [Accepted: 10/31/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Interleukin (IL)-22 plays important roles in the development of arterial disease, including atherosclerosis and hypertension. However, the relationship between IL-22 and acute thoracic aortic dissection (TAD) remains unknown. METHODS Blood samples were collected from patients with chest pain who underwent computed tomography angiography of the thoracic aorta but had no known preoperative diagnosis of coronary artery disease, peripheral artery disease, arthritis, and/or membranous nephropathy. Patients were divided into non-AD (NAD) and TAD groups, and the plasma concentrations of IL-22, IL-6 and tumor necrosis factor (TNF)-α were measured. In addition, aortic tissue samples from acute TAD patients and normal donors were collected, and the expression levels of IL-22 and IL-22 receptor 1 (IL-22R1) were measured. RESULTS IL-22, IL-6 and TNF-α levels were significantly higher in acute TAD patients than in NAD patients (IL-22, NAD group: 27.0 (19.1, 38.6) pg/ml vs. TAD group: 32.9 (20.6, 58.3) pg/ml, p<0.0001). The correlation analysis showed that IL-22 levels were positively correlated with levels of IL-6, TNF-α, fasting glucose, blood pressure, white blood cells, C-reactive proteins and D-dimers. Binary logistic regression analyses showed that IL-22 was independently associated with the presence of acute TAD (OR 1.169, 95% CI 1.069 to 1.277; p=0.001). In addition, compared with aortic tissue of normal controls, TAD aortas showed increased expression of IL-22 and IL-22R1, especially in the torn section (IL-22, non-torn section: 2.8±0.5/HPF vs. torn section 2.8±0.5/HPF, p<0.001). Additionally, macrophage but not T lymphocyte infiltration was significantly increased in the torn section (Macrophage, non-torn section: 2.2±0.6/HPF vs. torn section 5.7±1.2/HPF, p<0.001; T lymphocyte, non-torn section: 2.7±0.9/HPF vs. torn section 2.4±0.5/HPF, p=0.28), as evidenced by increased positive staining for the macrophage marker CD68, as opposed to the T cell marker CD3. CONCLUSION IL-22 levels may correlate with the presence of acute TAD.
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Affiliation(s)
- Jing Ye
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan 430060, China; Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Menglong Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Huimin Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Qingwei Ji
- Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing 100029, China
| | - Ying Huang
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Jianfang Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Tao Zeng
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Yao Xu
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Zhen Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Yingzhong Lin
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan 430060, China; Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China.
| | - Jun Wan
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan 430060, China.
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Zeng T, Shi L, Ji Q, Shi Y, Huang Y, Liu Y, Gan J, Yuan J, Lu Z, Xue Y, Hu H, Liu L, Lin Y. Cytokines in aortic dissection. Clin Chim Acta 2018; 486:177-182. [PMID: 30086263 DOI: 10.1016/j.cca.2018.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/03/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023]
Abstract
Aortic dissection (AD) is one of the most dangerous forms of vascular disease, characterized by endometrial rupture and intramural hematoma formation. Generally, the pathological process is complicated and closely related to the infiltration of inflammatory cells into the aortic wall and apoptosis of vascular smooth muscle cells. Currently, multiple cytokines, including interleukins, interferon, the tumor necrosis factor superfamily, colony stimulating factor, chemotactic factor, growth factor and so on, have all been demonstrated to play a critical role in AD. Additionally, studies of the link between cytokines and AD could deepen our understanding of the disease and may guide future treatment therapies; therefore, this review focuses on the role of cytokines in AD.
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Affiliation(s)
- Tao Zeng
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Lei Shi
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qingwei Ji
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China; Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing 100029, China
| | - Ying Shi
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ying Huang
- Department of Ultrasound, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Yu Liu
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jianting Gan
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jun Yuan
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhengde Lu
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yan Xue
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Haiying Hu
- Department of Cardiology, Handan First Hospital, Handan 056002, China
| | - Ling Liu
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
| | - Yingzhong Lin
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
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Qiao F, Su C, Han Q, Tan M, Wang J, Liu Y, Lu F, Han L, Xu Z. Hybrid Reconstruction of the Aortic Arch Using a Double-Branched Stent-Graft in a Canine Model. J INVEST SURG 2018; 32:491-500. [PMID: 29469632 DOI: 10.1080/08941939.2018.1436206] [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: 10/18/2022]
Abstract
Purpose: To report the results of a hybrid approach to aortic arch repair using an innovative unibody double-branched stent graft in a canine model.Materials and methods: The stent-graft system consists of two parts: the main body and two branches for reconstruction of the supra-arch branches. There is a 2-cm-long suturing portion at the proximal end of the main body. Twenty adult German sheep dogs underwent a hybrid surgical treatment to place the stent-grafts into the proximal descending aorta and the supra-arch branches. Outcomes were assessed by operative mortality, complications, imaging studies, and histomorphometric analyses.Results: Placement of the stent-graft was performed successfully in all dogs without complications. One dog died of respiratory failure due to early extubation. The other dogs survived to 6 months without complications, at which time they were sacrificed. The mean cardiopulmonary bypass time was 80.3 ± 7.3 mins and hypothermic circulatory arrest time was 10.7 ± 1.9 min. The average blood loss was 373.5 mL. At 6 months, postoperative aortic imaging indicated that the main body and branches of the stent-graft were fully open and in satisfactory position. No migration, deformation, or endovascular leakage was observed. Histomorphometric results showed normal arrangement of medial and adventitial elastic fibers, moderately proliferated intima, with or without neo-microvessels, and microscopic morphological changes in internal elastic lamina.Conclusions: These results demonstrate that it is possible and safe to reconstruct the aortic arch with the novel open-branched stent-graft placement.
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Affiliation(s)
- Fan Qiao
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Cunhua Su
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.,Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing, Jiangsu Province, China
| | - Qingqi Han
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Mengwei Tan
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jun Wang
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fanglin Lu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
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20
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Aalaei-Andabili SH, Scali S, Klodell C, Lee T, Hess P, Martin T, Beck A, Feezor R, Alhussaini M, Arnaoutakis G, Beaver T. Outcomes of Antegrade Stent Graft Deployment During Hybrid Aortic Arch Repair. Ann Thorac Surg 2017; 104:538-544. [DOI: 10.1016/j.athoracsur.2016.11.087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 10/19/2022]
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21
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Huang F, Chen Q, Lai QQ, Huang WH, Wu H, Li WC. Preoperative evaluation value of aortic arch lesions by multidetector computed tomography angiography in type A aortic dissection. Medicine (Baltimore) 2016; 95:e4984. [PMID: 27684852 PMCID: PMC5265945 DOI: 10.1097/md.0000000000004984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to preoperatively evaluate the value of aortic arch lesions by multidetector computed tomography (MDCT) angiography in type A aortic dissection (AD).From January 2013 to December 2015, we enrolled 42 patients with type A AD who underwent MDCT angiography in our hospital. The institutional database of patients was retrospectively reviewed to identify MDCT angiography examinations for type A AD. Surgical corrections were conducted in all patients to confirm diagnostic accuracy.In this study, the diagnostic accuracy of MDCT angiography was 100% in all 42 patients. The intimal tear site locations that were identified in patients included the ascending aorta (n = 25), aortic arch (n = 12), and all other sites (n = 5). Compared with the control group, there were significant differences in the aortic arch anatomy among the cases. Regarding the distance between the left common carotid and left subclavian arteries, compared with the control group, most cases with type A AD had a significant variation.MDCT angiography plays an important role in detecting aortic arch lesions of type A AD, especially in determining the location of the intimal entry site and change of branch blood vessels. Surgeons can formulate an appropriate operating plan, according to the preoperative MDCT diagnosis information.
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Affiliation(s)
- Fang Huang
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Qing-quan Lai
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou
- Correspondence: Qing-quan Lai, Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, P.R. China (e-mail: )
| | - Wen-han Huang
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou
| | - Hong Wu
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou
| | - Wei-cheng Li
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou
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22
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Lu S, Yang S, Lai H, Zheng J, Hong T, Sun X, Wang C. Open aortic arch reconstruction for acute type a aortic dissection: a single-center experience with 267 consecutive patients. J Cardiothorac Surg 2016; 11:111. [PMID: 27444037 PMCID: PMC4957365 DOI: 10.1186/s13019-016-0500-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to analyze the mortality and morbidity of patients undergoing open aortic arch reconstruction for acute type A aortic dissection. METHODS Between September 2005 and January 2012, 267 consecutive patients underwent open aortic arch reconstruction for acute type A aortic dissection at our center. The mean age was 51.2 ± 10.0 years, and 200 patients were male. Sixty-three and 184 patients underwent hemiarch replacement and total arch replacement, respectively, whereas the remaining 20 patients underwent single- or triple-branched stent graft implantation. Long-term mortality was estimated by Kaplan-Meier method. RESULTS The in-hospital and operative mortality rates within 30 days were 11.2 % and 8.2 %, respectively. The cardiopulmonary bypass, myocardial ischemic, and antegrade cerebral perfusion times were 150.2 ± 43.3, 71.9 ± 33.2, and 33.6 ± 14.4 min, respectively. The overall in-hospital and intensive care unit durations and mean ventilation time were 23.9 ± 18.4 and 9.5 ± 12.7 days and 122.7 ± 183.4 h, respectively. We observed new postoperative permanent neurological dysfunction in 29 patients and temporary neurological dysfunction in 17 patients. The mean follow-up duration was 52.4 ± 27.9 months; 76.4 % of patients completed follow-up and 143 remained alive. Overall long-term survival was 82.2 % at 5 years. CONCLUSIONS The open aortic arch reconstruction technique for acute type A dissection carries a relatively high in-hospital mortality risk, although the late results are encouraging. Patients with an advanced age or impaired renal function may opt for endovascular or modified single- or triple-branched stent graft implantation therapy.
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Affiliation(s)
- Shuyang Lu
- Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shouguo Yang
- Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Lai
- Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiayu Zheng
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Hong
- Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoning Sun
- Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China. .,Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. .,, Fenglin Road 180, Xuhui District, Shanghai, 200032, China.
| | - Chunsheng Wang
- Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China. .,Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. .,, Fenglin Road 180, Xuhui District, Shanghai, 200032, China.
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23
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Lu Q, Feng J, Zhou J, Zhao Z, Li H, Teng Z, Jing Z. Endovascular repair by customized branched stent-graft: A promising treatment for chronic aortic dissection involving the arch branches. J Thorac Cardiovasc Surg 2015; 150:1631-8.e5. [DOI: 10.1016/j.jtcvs.2015.08.032] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/30/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
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24
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Shi E, Gu T, Yu Y, Wang C, Yu L, Fang Q, Zhang Y. Simplified total arch repair with a stented graft for acute DeBakey type I dissection. J Thorac Cardiovasc Surg 2014; 148:2147-54. [DOI: 10.1016/j.jtcvs.2014.02.077] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/27/2014] [Accepted: 02/26/2014] [Indexed: 11/25/2022]
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25
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Yang SM, Xu P, Li CX, Huang Q, Gao HB, Li ZF, Chang Q. A modified total arch replacement combined with a stented elephant trunk implantation for acute type A dissection under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion. J Cardiothorac Surg 2014; 9:140. [PMID: 25174987 PMCID: PMC4203861 DOI: 10.1186/s13019-014-0140-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 08/04/2014] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Since the optimal management of patients with acute aortic dissection is unclear, this study analyzed total arch replacement combined with stented elephant trunk implantation in the treatment of acute type A aortic dissection. METHODS Between February 2008 and February 2013, 86 consecutive patients admitted to our hospital for acute type A dissection underwent total arch replacement combined with stented elephant trunk implantation under deep hypothermic circulatory arrest. The Bentall, David, and Wheat procedure was performed on 46, 12 and two patients, respectively. Ascending aorta replacement was performed on 26 patients, while two patients in Bentall group and 7 in ascending aorta replacement group underwent coronary artery bypass grafting as a concomitant procedure. RESULTS Sixty-nine patients were male and 17 patients were female, with an average age of 45.2 ± 2.3 years. The in-hospital mortality rate was 5.8%. Two patients presented with persisting paraplegia. The cardiopulmonary bypass time was 186.3 ± 45.2 minutes and the myocardium ischemia time was 102.6 ± 28.1 minutes. Selective antegrade cerebral perfusion time was 29.4 ± 10.3 minutes. Low-body circulatory arrest time was 18.5 ± 8.4 minutes. Mechanical ventilation time was 80.7 ± 11.3 hours. ICU and hospital stays were 5.3 ± 4.8 and 16.8 ± 5.5 days, respectively. Seven patients underwent reoperation for bleeding. During a mean follow-up of 28.5 months, two patients died and 2 patients were lost to follow-up. Obliteration of the false lumen around the stented graft and at the diaphragmatic level occurred in 97.1% (68 of 70) and 70% (49 of 70) of the patients. CONCLUSIONS Modified total arch replacement combined with stented elephant trunk implantation using selective antegrade cerebral perfusion is a safe and effective alternative for patients with acute type A dissection and produces satisfactory clinical outcomes in our center.
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Affiliation(s)
- Su-Min Yang
- Department of Cardiovascular Surgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao 266003, Shandong, China.
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26
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Kent WDT, Appoo JJ, Bavaria JE, Herget EJ, Moeller P, Pochettino A, Wong JK. Results of type II hybrid arch repair with zone 0 stent graft deployment for complex aortic arch pathology. J Thorac Cardiovasc Surg 2014; 148:2951-5. [PMID: 25125209 DOI: 10.1016/j.jtcvs.2014.06.070] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 06/02/2014] [Accepted: 06/05/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To review the early results of a less invasive, single-stage hybrid arch procedure involving replacement of the ascending aorta, arch debranching, and zone 0 antegrade stent graft deployment. METHODS Between May 2007 and January 2012, 20 patients with both acute and chronic aortic pathology were managed at 2 institutions with a type 2 hybrid arch procedure. Indications included diffuse atherosclerotic aneurysm, false lumen expansion of chronic aortic dissections, penetrating atherosclerotic ulcer, and acute type A dissection. Mean age was 67 ± 16.8 years with a mean European System for Cardiac Operative Risk Evaluation II score of 29.5 ± 19.4. Postoperative clinical and imaging follow-up was complete to a mean 18.5 ± 15.3 months. RESULTS Successful zone 0 stent graft deployment was achieved in all cases. There was 1 in-hospital mortality (5%). A second death occurred at 40 days postoperation. Other complications included a permanent neurologic deficit in 1 patient (5%), transient paraplegia in 4 patients (20%), and 3 patients had respiratory complications (15%). There were no cases of renal failure requiring dialysis. Stent-related complications were identified in 4 patients (20%), including 3 type I endoleaks, none of which were at zone 0. There was 1 type II endoleak and a case of stent infolding. Two patients required a second successful endografting procedure. CONCLUSIONS This single-stage hybrid arch procedure offers an alternative approach to complex diffuse aortic pathology involving the arch. Replacement of the ascending aorta provides a safe location for zone 0 stent graft deployment, eliminating complications of proximal deployment in a native diseased aorta.
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Affiliation(s)
- William D T Kent
- Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Jehangir J Appoo
- Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
| | | | - Eric J Herget
- Division of Interventional Radiology, Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Patrick Moeller
- Hospital of the University of Pennsylvania, Philadelphia, Pa
| | | | - Jason K Wong
- Division of Interventional Radiology, Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
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27
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A new vascular coupling device: Assessment of MRI issues at 3-tesla. Magn Reson Imaging 2014; 32:585-9. [DOI: 10.1016/j.mri.2014.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 12/23/2013] [Accepted: 01/14/2014] [Indexed: 11/22/2022]
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28
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Zheng J, Lu S, Sun X, Hong T, Yang S, Lai H, Wang C. Surgical management for acute type A aortic dissection in patients over 70 years-old. J Cardiothorac Surg 2013; 8:78. [PMID: 23577777 PMCID: PMC3639068 DOI: 10.1186/1749-8090-8-78] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 04/09/2013] [Indexed: 01/23/2023] Open
Abstract
Background This study aimed to retrospectively investigate our experience of surgical treatment for acute type A aortic dissection in patients older than 70 years. Methods From September 2005 to January 2012, eleven patients who were older than 70 years underwent surgical treatment for type A aortic dissection at our center and were included in this study. Total arch replacement was performed in three patients, seven patients underwent subtotal arch replacement and one with single-branched stent graft implantation. One patient underwent a valve-sparing (David) procedure while another underwent a concomitant aortic valve replacement (Wheat procedure). One patient required coronary artery bypass grafting. All operations were performed under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion. Results There was one in-hospital death (9.1%) and no operative mortality within 30 days. Cardiopulmonary bypass time, myocardial ischemic time and antegrade cerebral perfusion time accounted for 151.4±33.5 minutes, 68.5±41.4 minutes and 30.3±12.9 minutes, respectively. Overall in-hospital duration, intensive care unit (ICU) time and mean ventilation time were 40.9±40.3 days, 16.5±22.5 days and 90.5±139.4 hours, respectively. New postoperative permanent neurological dysfunction and temporary neurological dysfunction were observed in one patient (9.1%) and in three patients (27.3%), respectively. Mean follow-up was 49.0±19.9 months and nine patients are still alive, one patient died of cancer after 24 months postoperation. Conclusions Surgical management for acute type A dissection in patients older than 70 years is a safe alternative with acceptable risk of death and the early and late results are satisfactory.
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Affiliation(s)
- Jiayu Zheng
- Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
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29
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Hua F, Shen Z, Yu Y, Ye W, Huang H. Application of Open Triple-Branched Aortic Arch Stent Graft for Acute Stanford Type A Aortic Dissection. Vasc Endovascular Surg 2013; 47:109-14. [PMID: 23322718 DOI: 10.1177/1538574412473184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fei Hua
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhenya Shen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yunsheng Yu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wenxue Ye
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haoyue Huang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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30
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Kent WD, Herget EJ, Wong JK, Appoo JJ. Ascending, Total Arch, and Descending Thoracic Aortic Repair for Acute DeBakey Type I Aortic Dissection Without Circulatory Arrest. Ann Thorac Surg 2012; 94:e59-61. [PMID: 22916780 DOI: 10.1016/j.athoracsur.2012.02.080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 01/09/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
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31
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Johnson PT, Black JH, Zimmerman SL, Fishman EK. Thoracic Endovascular Aortic Repair: Literature Review With Emphasis on the Role of Multidetector Computed Tomography. Semin Ultrasound CT MR 2012; 33:247-64. [DOI: 10.1053/j.sult.2012.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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32
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Yoshioka D, Takahashi T, Suhara H, Higuchi T, Sijo T, Yajima S, Ishizaka T, Satoh H. Total arch replacement for a subacute type A dissection in a patient with a terminal tracheostoma after total laryngectomy: report of a case. Surg Today 2011; 42:785-7. [PMID: 22127538 DOI: 10.1007/s00595-011-0071-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 07/07/2011] [Indexed: 10/15/2022]
Abstract
Standard full median sternotomy for total arch replacement in tracheostomy patients may lead to mediastinitis and graft infection. Several approaches for typical cardiac surgery, including a T-shaped sternotomy, have been used in patients with both terminal and transient tracheostomas; however, these procedures offer inadequate surgical exposure of the arch vessels. We herein report the case of a 67-year-old man with a subacute type A aortic dissection with a terminal tracheostoma after total laryngectomy, who successfully underwent total arch replacement by a fourth intercostal thoracotomy performed using an anterior bilateral approach and the arch-first technique. To our knowledge, this is the first report of a case of total arch replacement in a patient with subacute aortic dissection and a terminal tracheostoma.
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Affiliation(s)
- Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka National Hospital, 2-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
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