Aortic Arch Research Articles

Unusual coexistence of congenitally corrected transposition of great arteries with type A interrupted aortic arch: A case report

Congenitally corrected transposition of the great arteries (CCTGA) accounts for <1% of all cases of congenital heart defect, a pathological condition characterized by the existence of both ventriculoarterial and atrioventricular (AV) discordance in the heart. CCTGA is more commonly associated with type B interrupted aortic arch (IAA) than type A variant. This is a more intricate and unusual presentation than dextro-transposition of the major arteries with an IAA. Herein, we present a case of an extraordinarily rare congenital cardiac complex defect. CCTGA and type A IAA were found in a 34-week preterm infant weighing 2.4 kg at delivery. Antenatally, the fetal echocardiogram suggested CCTGA in the form of an apically displaced left AV valve ventricular septal defect and transposed great arteries. The pulmonary trunk appeared larger than the aorta with three abnormal vessels. This study emphasizes the usefulness of sequential imaging modalities including fetal echocardiography to determine the majority of the anatomic details.

Hybrid Therapies for the Management of Aortic Dissection: Bridging Open Surgery and Endovascular Innovation

Aortic dissection is a life-threatening condition characterized by the separation of the layers within the aortic wall, leading to a false lumen with the potential for severe complications, including rupture, malperfusion, and death. The management of aortic dissection has evolved significantly, with hybrid therapies emerging as a promising approach, particularly for complex cases involving extensive aortic involvement or high surgical risk. Hybrid therapies combine open surgical techniques with endovascular interventions to optimize outcomes by leveraging the strengths of both modalities. This article provides a comprehensive review of the current state of hybrid therapies in aortic dissection management, including their indications, technical considerations, and clinical outcomes. We explore the role of hybrid procedures in both acute and chronic phases of aortic dissection, focusing on scenarios such as aortic arch and thoracoabdominal involvement. Additionally, we discuss patient selection criteria, advances in imaging for procedural planning, and the challenges of long-term surveillance. By synthesizing recent evidence, we aim to highlight the potential of hybrid approaches to improve survival and reduce morbidity in this complex patient population.

General Information and Applications of Najuta Fenestrated Stent Grafts for Aortic Arch Aneurysms

Endovascular stent graft repair was developed to minimize the invasiveness of open surgery for thoracic and abdominal aortic diseases. This approach involves covering the diseased segment with a stented artificial graft. However, in thoracic endovascular aortic repair (TEVAR) for aortic arch diseases, special consideration is needed to preserve the aortic arch vessels. Standard stent grafts often require additional procedures, such as bypass surgery, to reconstruct the arch vessels. The semi-custom-made Najuta fenestrated stent graft was developed to address this issue. It is a three-dimensional patient-specific stent graft with fenestrations that allow for the preservation of the arch vessels. This study discusses the unique features of the Najuta stent graft and the techniques for its deployment, and it provides an analysis of treatment outcomes based on the current literature.

Initial Outcomes of Physician-Modified Inner-Branched Endovascular Repair for Distal Aortic Arch Aneurysm

Background/Objectives: Few clinical studies have reported on physician-modified inner-branched endovascular repair (PMiBEVAR) for aortic arch aneurysm. Herein, we evaluate the outcomes of proximal landing zone 2 PMiBEVAR. Methods: This retrospective study analyzed data from six patients who underwent zone 2 PMiBEVAR for aortic arch aneurysms at a single center between October 2021 and June 2024. The outcomes were in-hospital mortality and postoperative complications. Results: The median follow-up period was 12.5 (7.3–25) months. Males constituted four out of six cases and females constituted two out of six cases. The patients had a median age of 78.5 (76.5–79.0) years, and the aneurysm diameter was 56 (50–61) mm. Technical success was achieved in 5/6 (83.3%) cases. The median modification and operative times were 56 (45–60) min and 92 (79–308), respectively. Postoperatively, delayed type Ia endoleak and vascular access-site pseudoaneurysm occurred in one patient each. However, no patients experienced other complications. The median hospital stay was 10 (7–41) days, and no deaths or reinterventions occurred after 30 days. During the post-discharge follow-up, the aneurysm diameter remained “unchanged” in four patients, including the one with delayed type Ia endoleak, while two patients experienced “shrinkage”. Conclusions: PMiBEVAR for distal aortic arch aneurysm might be effective in improving postoperative outcomes.

The First Reported Case of Right Aortic Arch with Left Subclavian Artery Atresia Presenting with Heart Failure with Reduced Ejection Fraction: Exploring an Uncertain Causal Relationship

The largest artery in the body is the aorta. The ascending aorta, aortic arch, thoracic aorta, and abdominal aorta are the four sections that make up the aorta. The ascending aorta continues into the aortic arch. It moves inferiorly after arching superiorly, posteriorly, and to the left [1]. The right aortic arch is a rare anatomical anomaly of the aorta [2]. A case of a 43-year-old male was recently diagnosed with heart failure with reduced ejection fraction (HFrEF). Cardiac CT was performed as part of the ischemic heart disease evaluation. The cardiac CT revealed a right-sided aortic arch, along with the absence of the proximal segment of the left subclavian artery, and the perfusion of the left subclavian artery occurring via the left vertebral artery. This case represents the first documented instance in the literature of heart failure occurring concurrently with these vascular anomalies.

Safety of prolonged bilateral antegrade cerebral perfusion in aortic arch surgery with moderate hypothermia.

This study investigates the impact of bilateral antegrade cerebral perfusion time on outcomes in aortic arch surgery. In total, 961 patients underwent either hemi arch (n = 385) or total arch replacement (n = 576) with bilateral antegrade cerebral perfusion and moderate hypothermia management between 2006 and 2020 across 2 aortic centers. Antegrade cerebral perfusion time was categorized into 4 groups (≤30 min: n = 169, 30-60min: n = 298, 60-90min: n = 261, >90min: n = 233). Inverse probability treatment weighting yielded a well-balanced cohort among the 4 groups except for the cannulation site. Adjusted cubic spline and multivariable logistic analysis were performed, controlling for surgical procedure, cannulation site and cardiopulmonary bypass time, to identify the relationship between antegrade cerebral perfusion time and major in-hospital complications including mortality, stroke, acute renal failure, and prolonged ventilation. There remained a significant difference in surgical procedures and cardiopulmonary bypass time in the matched cohort. The incidences of mortality and stroke did not show significant trend (P = 0.052 and P = 0.717 respectively). Cubic spline curves showed that odds ratios did not increase linearly for any complications with increasing antegrade cerebral perfusion time. Furthermore, antegrade cerebral perfusion time, even exceeding 90 min, was not associated with complication rates (mortality: odds ratio = 1.459 [0.368-6.049], p = 0.595; stroke: 0.310 [0.058-1.635], p = 0.166; renal failure: 1.744 [0.521-6.094], p = 0.374; prolonged ventilation: 1.502 [0.535-4.286], p = 0.442), whereas cardiopulmonary bypass time was associated with mortality and prolonged ventilation. Even when antegrade cerebral perfusion time exceeded 90 min, it was not associated with major in-hospital complications, questioning its validity as a marker for surgical insult.

Sex-specific cardiovascular adaptations to simulated microgravity in Sprague-Dawley rats

Men and women have different cardiovascular responses to spaceflight; however, few studies have focused on direct comparisons between sexes. We investigated the mechanisms of aortic stiffening in socially and sexually mature 20-week-old male and female Sprague Dawley (SD) rats exposed to hindlimb unloading (HLU) for 14 days. Pulse wave velocity (PWV) was greater in the aortic arch of females after HLU versus control females (n = 6–8). HLU had no effect on aortic PWV in males (n = 5–6). Aortic α smooth muscle actin, myosin, collagen, elastin, and collagen-to-elastin ratio were not different in rats of either sex following HLU. The levels of G protein-coupled estrogen receptor (GPER) were lower in the aorta of SD females exposed to HLU compared with female controls but were not altered in males. HLU females also had lower aortic PPARγ, increased oxidative stress markers, and diastolic dysfunction compared with control females. GPER agonist G1 prevented the increase in PWV and 8-hydroxy-2’-deoxyguanosine without altering PPARγ or p47phox in HLU females (n = 4 in each group) suggesting that lower GPER may contribute to arterial stiffening in the setting of simulated microgravity. This study highlights sex-specific vascular adaptations to the state of simulated microgravity.

Granulocyte Colony-Stimulating Factor-Associated Aortitis Unveiled by 18 F-FDG PET/CT.

In oncology, G-CSF (granulocyte colony-stimulating factor) is often administered to counteract chemotherapy-induced neutropenia. Recent studies have highlighted a significant side effect, G-CSF-associated aortitis, with an incidence of ~0.4%. Identification of this condition's imaging characteristics is crucial for nuclear medicine specialists, given its substantial impact on clinical decision-making. It is notably prevalent in the follow-up of gynecologic malignancies and lymphoma. We detail a case of G-CSF-related aortitis in a metastatic ovarian cancer patient, diagnosed by increased 18 F-FDG uptake in the aortic arch on PET/CT, confirmed by contrast-enhanced CT and biopsy, which regressed spontaneously in under 5 weeks without corticosteroid treatment.

Evaluating neurological outcomes of and risk factors for hypoattenuated leaflet thickening following aortic root replacement and arch surgery.

In this retrospective study, we aimed to assess incidence, possible causes and clinical consequences of hypoattenuated leaflet thickening (HALT) following aortic root replacement with valved composite grafts and concomitant aortic arch repair. Between January 2016 and December 2022, 454 patients underwent Bentall procedures with arch replacements in hypothermic circulatory arrest at the University Aortic Centre MunichLMU, Germany. Sequential postoperative ECG-gated, high-resolution computed tomography angiographies were analyzed, and the presence of HALT correlated with neurologic events and transvalvular gradients over time. Furthermore, attention was given to intraoperative hemostatic product use and postoperative anticoagulation regimes. 327 out of 454 patients were included. The follow-up period averaged to 3.27 years. 28% of the patients showed radiographic signs of HALT, which was correlated with a significantly higher incidence of transient neurological events as compared to those without (38 versus 8 events, p < 0.01). However, there were no significant differences with respect to the postoperative anticoagulation regimen or transvalvular gradients between the two groups. Only the intraoperative administration of prothrombin complex concentrate was significantly higher in patients with postoperative HALT. HALT is observed in a high percentage of cases following aortic root replacement combined with complex aortic procedures. Furthermore, it is associated with an increased risk of neurological events but only a weak correlation was demonstrated with the perioperative coagulation management. While no long-term implications were noted, these findings suggest the necessity for further investigations, longer follow-up periods, and more comprehensive diagnostic approaches.

White Tea Reduces Dyslipidemia, Inflammation, and Oxidative Stress in the Aortic Arch in a Model of Atherosclerosis Induced by Atherogenic Diet in ApoE Knockout Mice.

Objective: In this study, we aimed to evaluate the potential effects of white tea (WT) in the atherosclerosis process characterized by oxidative stress, inflammation, and dyslipidemia. Methods: In our study, apolipoprotein E knockout (ApoE-/-) mice (RRID: IMSR_JAX:002052) and C57BL/6J mice (RRID: IMSR_JAX:000664) were used. In the atherosclerosis model induced by an atherogenic diet (AD), WT was administered via oral gavage at two different concentrations. The animals were sacrificed by decapitation under anesthesia, and their serum and aortic tissues were collected. Total cholesterol (TC), triglyceride (TG), interleukin (IL)-1β, IL-6, IL-10, IL-12, tumor necrosis factor-α (TNF-α), interferon-γ, myeloperoxidase, paraoxonase-1, lipoprotein-associated phospholipase A2, oxidized low-density lipoprotein (Ox-LDL), lectin-like oxidized LDL receptor (LOX-1), a disintegrin, and metalloprotease (ADAM) 10 and 17 activities were determined via colorimetric, enzyme-linked immunoassay, and fluorometric methods. Results: WT supplementation decreased serum Ox-LDL, LOX-1, TC, and TG levels by approximately 50%. TNF- and IL-6 levels were reduced by approximately 30% in the aortic arch. In addition, ADAM10/17 enzyme activities were found to be reduced by approximately 25%. However, no change in the AD-induced fibrotic cap structure was observed in the aortic root. Conclusions: The findings indicate that white tea effectively reduced oxidative stress, inflammation, and dyslipidemia in atherosclerosis but does not affect atheroma plaque morphology.

Can we diagnose aortic arch obstruction in a fetus with an atrioventricular septal defect?

Aortic arch obstruction and/or coarctation of aorta is uncommon (5-20%) in balanced atrioventricular septal defects. Although technically challenging, prenatal diagnosis of aortic arch obstruction in atrioventricular septal defect is critical for delivery planning and improves prenatal counselling regarding the timing of cardiac surgery. We sought to identify prenatal predictors of coarctation of aorta in atrioventricular septal defect. Retrospective review of patients prenatally diagnosed with atrioventricular septal defect at two institutions. Ninety-five fetuses with atrioventricular septal defect were identified and sufficient outcome data and diagnostic acoustic windows were available in 62. Six patients (10%) had coarctation of aorta after birth. Among the 38 patients with Trisomy 21, four (11%) had coarctation of aorta. On multivariable analysis, the proximal transverse aortic arch z score and ratio of left:right atrioventricular valve were independent predictors of coarctation of aorta with good interobserver reproducibility. Either proximal transverse aortic arch z score < -2, or ratio of left:right atrioventricular valve <0.7, predicted aortic arch obstruction with 100% sensitivity and 89% specificity. Proximal transverse aortic arch z score and lower ratio of left:right atrioventricular valve diameter are independent predictors of postnatal coarctation of aorta in fetal patients with atrioventricular septal defect. The next step is the prospective application of these parameters to create an algorithm directing fetal counselling in terms of delivery location, and expected timing of surgical interventions.

Identification of Myeloid Protein Kinase C - Epsilon as a Novel Atheroprotective Gene.

Protein Kinase C - epsilon (PKCɛ) is involved in diverse cellular processes such as migration, growth, differentiation, and survival. Public geneset analysis of human atherosclerotic plaque tissue revealed that PKCɛ expression is inversely correlated with plaque size and vulnerability. Similarly, peritoneal macrophages (MØ) from hypercholesterolemic mice have significantly lower PKCɛ expression. As MØ play a major role in atherogenesis, we generated a mouse strain with PKCɛ selectively deleted in the myeloid lineage (PKCɛ fl/fl LysMCre - mɛKO ). qPCR revealed no basal differences between genotypes in the expression of lipid uptake receptors, efflux transporters, or inflammatory markers. However, upon lipid loading, mɛKO MØs retained significantly more cholesterol than WT. Human-like hypercholesterolemia was induced in WT and mɛKO mice and assessed for lesion area and plaque morphology in aortic arches and aortic roots. We found that, compared to WT, the lesion area in mɛKO mice was significantly larger, more necrotic, had larger foam cells, and thinner collagen caps. These results demonstrate that loss of myeloid PKCɛ promotes atherosclerosis as determined by a variety of criteria. Together, these data identify myeloid PKCɛ as a novel atheroprotective gene, laying the foundation for mechanistic studies on the signaling networks responsible for the phenotype.

Prosedur Pemeriksaan MSCT Cardiac pada Klinis Heart Failure dengan Disertai Atrial Fibrilasi di Instalasi Radiologi RS Universitas Sebelas Maret

Background:Cardiac MSCT is a CT scan examination that can show the structure of the heart chamber and blood vessels. The cardiac MSCT examination procedure in clinical heart failure accompanied by atrial fibrillation at the Radiology Installation of Sebelas Maret University Hospital uses a pitch parameter setting of 0.2 and selection of the contrast scanning reconstruction phase interval based on the results of the calcium score phase interval. This study aims to describe the cardiac MSCT examination procedure and the reasons for using the pitch parameter of 0.2 and determining the contrast scanning phase interval based on the results of the calcium score phase interval in clinical heart failure accompanied by atrial fibrillation. Method:This type of research is qualitative research with a case study approach. Data collection is carried out using observation, interview and documentation methods, then the data obtained is analyzed using an interactive data model, namely data collection, data reduction, data presentation and drawing conclusions. Results:Cardiac MSCT examination procedure in clinical heart failure accompanied by atrial fibrillation at the Sebelas Maret University Radiology Installation, the patient was not given betablocker drugs due to arrhythmia abnormalities. The protocol for this examination is topogram, calcium scoring and contrast cardiac scanning. Topogram parameters at 100 kV, and 60mA as high as the sternal notch to the diaphragm. Calcium scoring parameters at 80-90 kV, slice thickness 3mm with prospective ECG gatting method, scanning area for calcium scoring from the aortic arch to the cardiac basal. Cardiac contrast scanning parameters at 70-90 kV, slice thickness 0.8, tube rotation 0.33 and pitch 0.2 with an area from the aortic arch to the cardiac basal. Triggering scan is placed on the descending aorta as high as the main pulmonary artery. The use of a pitch of 0.2 can provide a longer ECG RR interval range in unstable patient pulses, thereby minimizing interpolation artifacts and facilitating the selection of contrast scanning reconstruction phase intervals. The use of calcium scorring phase interval results for selecting the contrast scanning reconstruction phase interval can facilitate the determination of the appropriate phase so that no artifacts are found due to errors in selecting the reconstruction phase interval, because in patients with atrial fibrillation, wave irregularities will result in differences in location between phase intervals. Conclusions:The use of pitch 0.2 aims to obtain a wider range of ECG RR intervals, thus minimizing the occurrence of interpolation artifacts in unstable patient heart rates. The use of calcium scorring reconstruction phase interval results as a guideline for setting the reconstruction phase interval in contrast scanning can facilitate the placement of appropriate and precise interval locations, so that no artifacts are found.

Anatomic characteristics of the right aortic arch with aberrant left subclavian artery in patients who do and do not undergo vascular ring repair.

It is unclear if certain anatomic characteristics in patients with a right aortic arch with aberrant left subclavian artery (RAA ALSCA) are associated with undergoing surgical repair. This was a single-center retrospective study of patients with RAA ALSCA and computed tomography or cardiovascular magnetic resonance from July 2013-September 2023. The size of the proximal ALSCA or diverticulum of Kommerell (DoK), thoracic inlet index, angle of the proximal ALSCA/DoK from the aortic arch, the position of descending aorta, location of the DoK, and tracheal size were compared between patients who did or did not undergo surgery. Of 163 patients meeting inclusion criteria, 56​% underwent surgery. Surgical patients had a larger indexed proximal ALSCA/DoK diameter and area, a higher indexed distance between the tip of the DoK and the opposite aortic wall, a greater proximal-to-distal LSCA ratio, a less acute angle of the proximal ALSCA/DoK from the aortic arch, a more leftward DoK location, and a lower thoracic inlet index compared to non-surgical patients. A larger indexed proximal ALSCA/DoK diameter, with an optimal threshold of ≥13.78​mm/m2, and a more leftward DoK location were independently associated with surgery. The reoperation rate was 11​%, and was associated with a less acute angle of the proximal ALSCA from the aortic arch. A larger proximal ALSCA/DoK size and a more leftward DoK location were associated with surgical repair of RAA ALSCA, while a less acute angle of proximal ALSCA from the aortic arch was associated with reoperation.

Branched and fenestrated endovascular aortic repair in complex aortic diseases: innovative progress and clinical application

Recently, significant progress has been made in the field of endovascular repair of complex aortic disease involving the major branches (aortic arch disease and complex abdominal aortic aneurysms). Open surgery was considered the "gold standard" for the treatment of these complicated aortic diseases, but was challenged by the huge surgical trauma and high risk of post-operative complications. However, the rapid development of branched and fenestrated endografts has provided an alternative safe and effective minimally invasive treatment for patients who cannot tolerate open surgery. Preliminary evidence has also shown that branched and fenestrated endografts have achieved significant technical success rates and clinical outcomes and have gradually become an important direction of innovation and development for endovascular repair of complex aortic disease. Nevertheless, both branched and fenestrated endografts are currently in the early stages of experience and a series of high-quality research studies are needed in the future to further compare them with open surgery and within different endovascular techniques.

Addressing complications of large bore access in endovascular and cardiovascular procedures: An illustration of treatment options.

Endovascular procedures requiring large bore access, such as Transcatheter Aortic Valve Replacement (TAVR), Thoracic Endovascular Aortic Repair (TEVAR), and Endovascular Aneurysm Repair (EVAR), have become increasingly common. Despite advancements, complications from these procedures pose clinical challenges, especially in elderly and frail patients. The clinical objective of this paper is to demonstrate the complexities and innovative management strategies for complications that arise from large bore access. This report presents two cases illustrating percutaneous management of complications arising from large bore access during endovascular interventions. The first case involves a 74-year-old Asian female with a history of type A aortic dissection, who underwent TEVAR using a Gore TBE endograft. Post-procedure, the patient developed hemorrhagic shock due to disruption of the right external iliac artery. Interventions included upsizing the left femoral artery sheath, CODA balloon inflation in the distal aorta, and deployment of multiple VBX stents. The second case features a 24-year-old Caucasian female with a large pseudoaneurysm at the cannulation site in the aortic arch following a heart transplant. Successful TEVAR was performed to exclude the pseudoaneurysm. Closure of the right femoral artery access using 6 French ProGlide sutures was complicated, requiring balloon angioplasty to create an opening in the common femoral artery. These cases highlight the challenges and innovative strategies in managing complications associated with large bore access during endovascular procedures. Insights gained from these experiences contribute to the armamentarium of interventionists, offering valuable guidance in addressing similar scenarios.

Initial Multicenter Experience With the New Castor Arch Branched Device in Europe: A Middle-term Results Study.

Published reports demonstrate that the use of Castor stent-graft is a promising treatment of aortic pathologies with the need to land in zone 2. However, there is a lack of publications on the medium-term results of Castor in the European population. This research evaluates the mid-term results of the Castor stent-graft in several Polish centers for the treatment of aortic pathologies and enriches the current knowledge of Castor stent-grafts. Twenty-one patients from 5 polish vascular surgery centers in subacute phase of type B aortic dissection (TBAD) with at least 1 classic risk factor of aneurysmatic degeneration, thoracic aortic aneurysms (TAAs) exceeding 5.5 cm, subacute phase of intramural hematomas (IMHs) and penetrating aortic ulcerations (PAUs) with at least 1 indication to endovascular treatment. Structure of the aortic arch and factors of aneurysmal degeneration for TBAD were highlighted. Early complications, long-term complications, and reinterventions after Castor device implantation are reported in the study. Twenty (95.24%) patients survived, of which a technical success involving implantation of the Castor device in the correct location with a patent branch for the left subclavian artery, and no endoleaks were noted in 19 (90.48%) patients. After the procedure, there were 2 (9.52%) cases of type I endoleak (in which technical success was not achieved) and 2 (9.52%) cases of bird beak. In addition, 1 case of access site hematoma, 1 case of pseudoaneurysm, and 1 case of access iliac artery rupture requiring implantation of a Viabahn device were observed. During the follow-up period (mean 14 months; range = 1-40 months), 1 patient required reintervention due to type I endoleak and 1 patient due to left subclavian artery (LSA) branch thrombosis. Two patients required subsequent branched endovascular aortic repair procedure due to unfavorable remodeling and fast aneurysm formation in visceral aorta, regardless of Castor results. The Castor device is an easy-to-use stent-graft with good medium-term results. It is an excellent option in cases requiring LSA revascularization during TEVAR. In this study, we investigate the medium-term results of the Castor stent graft in patients with type B aortic dissection, thoracic aortic aneurysm, intramural hematoma and penetrating aortic ulceration. The medium-term results of treatment with the Castor device are not yet well studied. Currently, there are only a small number of publications on the safety, complications and success of Castor device implantation.

TEVAR versus open aortic arch replacement in ex vivo perfused human thoracic aortas.

This study aims to assess the outcomes of therapeutic options for aortic arch pathologies by comparing thoracic endovascular aortic repair (TEVAR) with open arch replacement (OAR) using woven polyester grafts from a mechanical and biomechanical perspective, with emphasis on ex vivo perfused human thoracic aortas reproducing heart rate and stroke volume conditions. Eleven non-diseased thoracic aortas from human cadavers were divided into TEVAR (n=5) and OAR (n=6) and tested using a custom-built mock circulation loop. Pressure, diameter, and stroke volume were monitored during perfusion before and after the intervention. Samples undergoing TEVAR showed a higher ascending systolic pressure post-intervention than OAR (TEVAR: 137±9mmHg vs OAR: 126±6mmHg, p=0.017). After the intervention, a significant discrepancy in the mean pressure differences between the ascending and descending aorta ΔP was observed (TEVAR: 9±3mmHg vs OAR: 1±2mmHg, p=0.004). Input impedance at zero frequency, approximating Windkessel resistance, was higher for TEVAR than for OAR (TEVAR: 1.78±0.04 vs OAR: 1.66±0.03mmHgs/ml, p=0.004). A correlation was found between the resistance and the negative peak of the time-normalized wave intensity analysis (Kendall's coefficient τ=-0.35 and p=0.023). Another correlation was observed between resistance and ΔP (τ=0.51, p=0.001). Looking at the replication of heart rate and stroke volume over the course of the study, the observed differences can largely be attributed to the type of intervention. The results suggest that TEVAR has adverse effects compared to OAR, particularly with regard to left ventricular afterload. Clinicians should consider the possibility of increased afterload and altered wave dynamics when deciding on TEVAR, particularly in patients with pre-existing impaired cardiovascular conditions.

Impact of concomitant coronary artery bypass grafting on the outcomes of total arch repair with frozen elephant trunk for type an aortic dissection.

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. This study included 1,002 consecutive TAAD patients who underwent total aortic arch replacement (TAR) with frozen elephant trunk (FET) from June 2019 to January 2024. Concomitant CABG during TAR and FET was performed under three 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. 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 three 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%. Rescue CABG is significantly associated with increased operative and all-cause mortality in patients undergoing TAR and FET for TAAD. Further research is required to identify the causes of rescue CABG.

FAK activity exacerbates disturbed flow-mediated atherosclerosis via VEGFR2-Cbl-NF-κB signaling.

Atherosclerosis develops at predictable sites in the vasculature where branch points and curvatures create non-laminar disturbed flow. This disturbed flow causes vascular inflammation by increased endothelial cell (EC) barrier permeability and the expression of inflammatory genes such as vascular cell adhesion molecule-1 (VCAM-1). Vascular endothelial growth factor receptor 2 (VEGFR2) is important for flow-induced EC inflammation; however, there are still some gaps in the signaling pathway. Focal adhesion kinase (FAK) is a protein tyrosine kinase whose expression has been implicated in flow-mediated signaling in ECs. However, the link between FAK and VEGFR2 in flow-mediated inflammation signaling has remained unelucidated. Here we found that priming of VEGFR2 with VEGF was critical for flow-mediated activation of FAK and NF-κB. Mechanistically, FAK activation triggers tyrosine phosphorylation of Casitas B-lineage lymphoma (CBL; an E3 ubiquitin ligase) that interacts with VEGFR2 under flow conditions. Further, Apoe-/- mice fed a western diet (WD) exhibited increased FAK activity within the atheroprone disturbed flow region of the inner aortic arch compared to the outer arch. Disturbed flow-induced FAK activation is associated with elevated VEGFR2 on the surface of ECs of the inner aortic arch, but not in the outer arch. Taken together, these data suggest that suppression of augmented FAK activity under disturbed flow may prove beneficial in reducing pro-inflammatory signaling of the endothelial layer.