Aortic Dissection Patients Research Articles

Clinical Analysis of Redo Aortic Root Replacement after Cardiac Surgery


 [Abstract] objectives To explore the etologies, surgical methods and outcomes of redo aortic root replacement after cardiac surgery. Methods Between February 2010 and February 2020, 41 patients who had at least one previous cardiac operation received aortic root replacement surgery in our hospita, including 27 males and 14 females with an average age of 49.5±10.2 years. Indications for reoperation include: aortic sinus dilation and ascending aortic aneurysm in 20 cases (48.8%), recurrent aortic dissection in 7 cases (17.0%), aortic pseudoaneurysm in 4 cases (9.8%), prosthetic valve endocarditis in 5 cases (12.2%) and 5 cases (12.2%) had paravalvular leakage. The redo operation was a midline thoracotomy, and Bentall operation was performed. In addition, 3 cases of mitral valve replacement surgery, 4 cases of mitral valvuloplasty, 8 cases of tricuspid valvuloplasty, 4 cases of coronary artery bypass graft surgery, 3 cases of Debakey I aortic dissection patients underwent Sun’s surgery simultaneously. Results The mean cardiopulmonary bypass time was 95~302 (168.1±41.2) min, and the mean aortic crossclamp time was 45~135 (84.5±22.3) min. Six patients (14.6%) died during the postoperative hospitalization. The main causes of death were heart failure in 3 patients and septic shock in 3 patients.The follow-up time was 3~62 (30.3±15.5) months. During the follow-up period, 3 cases died, including 1 case died of septic shock and 2 cases died of cerebral hemorrhage. Conclusions Redo aortic root replacement is difficult to deal with, and the risk is high. Preoperative evaluation is required, appropriate surgical approach, adequate myocardial protection, and a complete surgical plan are essential to ensure the success of the operation.

Four-dimensional flow analysis reveals mechanism and impact of turbulent flow in the dissected aorta.

This study aimed to explore the flow dynamics factors affecting turbulence formation in the false lumen (FL) of aortic dissection using four-dimensional flow magnetic resonance imaging (4D flow MRI). This study also aimed to uncover risk factors affecting late complications of aortic dissection. Thirty-three aortic dissection patients were examined using 4D flow MRI for quantitative flow dynamics (gross flow, velocity and regurgitant fraction) and turbulence visualization (helix and vortex with three-point visual grading) in the FL. The incidence of late complications (rupture or prophylactic intervention) was also obtained prospectively. The helix grade was correlated with FL gross flow (rS = 0.55, P < 0.001) and FL velocity (rS = 0.45, P = 0.008). The vortex grade was also correlated with FL gross flow (rS = 0.70, P < 0.001) and FL velocity (rS = 0.67, P < 0.001). Comparative analysis of patients with complications and stable patients revealed that patients with complications exhibited higher FL gross flow [41.7 (interquartile range, IQR 29.1-59.7) vs 17.7 (IQR 9.0-42.0) ml/s; P = 0.01], higher helix grade [2 (IQR 1.25-2) vs 0 (IQR 0-1); P = 0.001] and higher vortex grade [2 (IQR 1-2) vs 0 (IQR 0-2); P = 0.01]. Using 4D flow MRI analysis, we showed that turbulence formation depends on flow volume and velocity in the FL. Patients with high-volume turbulent flow in their FL are at higher risk of late complications; therefore, close follow-up and aggressive prophylactic intervention may improve their survival. Nippon Medical School Hospital Institutional Review Board approved this observational study in September 2018 (No. 30-08-986).

Assessment of Liver Function for Evaluation of Short- and Long-Term Outcomes in Type B Aortic Dissection Patients Undergoing Thoracic Endovascular Aortic Repair.

Background and Aims: Patients with decreased liver function suffer from poor outcomes when undergoing procedures. We aimed to explore the impact of liver fibrosis identified by aspartate transaminase-to-platelet ratio index (APRI) and poor liver functional reserve assessed by a model of end-stage liver disease (MELD) and albumin–bilirubin(ALBI) score on the prognosis of patients with type B aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR).Methods: A retrospective analysis of a prospectively maintained database from 2010 to 2017 was performed. APRI > 0.5 was used to identify those with significant liver fibrosis. Logistic and Cox regression analyses were performed to investigate the association between liver fibrosis, MELD, and ALBI with adverse events.Results: TEVAR was performed on 812 TBAD patients including 35 with liver fibrosis and 777 without. Twenty-four (3.0%) patients deceased during hospitalization and 69 (8.8%) patients died after a median 48.2 months follow-up. Multivariable analysis revealed that liver fibrosis, MELD, and ALBI were independently associated with in-hospital [fibrosis: odds ratio (OR) 23.73, 95% confidence interval (CI) 8.89–63.33, P < 0.001; MELD: OR 1.08, 95% CI 1.03–1.14, P = 0.003; ALBI: OR 4.45; 95% CI 1.56–12.67, P = 0.005] and follow-up mortality [fibrosis: hazard ratio (HR) 4.69, 95% CI 1.93–11.42, P = 0.001; MELD: HR 1.07, 95% CI 1.04–1.10, P < 0.001; ALBI: HR 2.88, 95% CI 1.53–5.43, P = 0.001]. The association was further corroborated by a subgroup analysis.Conclusion: Liver fibrosis and poor liver functional reserve could significantly increase the morbidity and mortality after TEVAR. APRI, MELD, and ALBI should be calculated and routinely used for preoperative risk stratification. Strict preoperative preparation and elaborate postoperative care are necessary to improve these patients' prognosis.

Impact of Lymphocyte-Related Blood Parameters on Short- and Long-Term Outcomes of Patients Undergoing Thoracic Endovascular Aortic Repair.

Lymphocyte-related blood parameters (LRBP), including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, and lymphocyte-monocyte ratio, could reflect a patient's overall inflammatory status. We aimed to clarify the association between preoperative LRBP and outcomes of type B aortic dissection (TBAD) patients undergoing thoracic endovascular aortic repair (TEVAR). A total of 841 patients were enrolled from 2010 to 2017. Twenty-six (3.1%) patients died during hospitalization and 71 (8.7%) patients died after a median follow-up of 47.3 months. Multivariate analyses showed that the NLR was the only independent predictor for in-hospital death (odds ratio, 1.15; 95% confidence interval [CI], 1.09-1.22; P < .001); 4.1 was identified as the optimum threshold for NLR after applying the X-tile program. Propensity score matching (PSM) was performed to diminish bias and yielded 174 matched pairs. Neutrophil-lymphocyte ratio >4.1 was demonstrated to be independently associated with follow-up mortality before (hazard ratio [HR], 2.53; 95% CI, 1.44-4.43; P = .001) and after PSM (HR, 3.11; 95% CI, 1.35-7.15; P = .008). The relationship between LRBP and follow-up reintervention or stroke were not significant (P > .05 for both). Elevated NLR was an independent indicator for in-hospital and follow-up mortality in patients with TBAD undergoing TEVAR; this might provide additional risk stratification.

Effect of Vessel Tortuosity on Stress Concentration at the Distal Stent-Vessel Interface: Possible Link With New Entry Formation Through Biomechanical Simulation.

A computational approach is used to investigate potential risk factors for distal stent graft-induced new entry (dSINE) in aortic dissection (AD) patients. Patient-specific simulations were performed based on computed tomography images acquired from six AD patients (three dSINE and three non-dSINE) to analyze the correlation between anatomical characteristics and stress/strain distributions. Sensitivity analysis was carried out using idealized models to independently assess the effect of stent graft length, stent tortuosity and wedge apposition angle at the landing zone on key biomechanical variables. Mismatch of biomechanical properties between the stented and nonstented regions led to high stress at the distal stent graft-vessel interface in all patients, as well as shear strain in the neighboring region, which coincides with the location of tear formation. Stress was observed to increase with the increase of stent tortuosity (from 263 kPa at a tortuosity angle of 50 deg to 313 kPa at 30 deg). It was further amplified by stent graft landing at the inflection point of a curve. Malapposition of the stent graft led to an asymmetrical segment within the aorta, therefore changing the location and magnitude of the maximum von Mises stress substantially (up to +25.9% with a +25 deg change in the distal wedge apposition angle). In conclusion, stent tortuosity and wedge apposition angle serve as important risk predictors for dSINE formation in AD patients.

Comparison of diametric and volumetric changes in Stanford type B aortic dissection patients in assessing aortic remodeling post-stent graft treatment.

The study aims to analyze the correlation between the maximal diameter (both axial and orthogonal) and volume changes in the true (TL) and false lumens (FL) after stent-grafting for Stanford type B aortic dissection. Computed tomography angiography was performed on 13 type B aortic dissection patients before and after procedure, and at 6 and 12 months follow-up. The lumens were divided into three regions: the stented area (Region 1), distal to the stent graft to the celiac artery (Region 2), and between the celiac artery and the iliac bifurcation (Region 3). Changes in aortic morphology were quantified by the increase or decrease of diametric and volumetric percentages from baseline measurements. At Region 1, the TL diameter and volume increased (pre-treatment: volume =51.4±41.9 mL, maximal axial diameter =22.4±6.8 mm, maximal orthogonal diameter =21.6±7.2 mm; follow-up: volume =130.7±69.2 mL, maximal axial diameter =40.1±8.1 mm, maximal orthogonal diameter =31.9+2.6 mm, P<0.05 for all comparisons), while FL decreased (pre-treatment: volume =129.6±150.5 mL; maximal axial diameter =43.0±15.8 mm; maximal orthogonal diameter =28.3±12.6 mm; follow-up: volume =66.6±95.0 mL, maximal axial diameter =24.5±19.9 mm, maximal orthogonal diameter =16.9±13.7, P<0.05 for all comparisons). Due to the uniformity in size throughout the vessel, high concordance was observed between diametric and volumetric measurements in the stented region with 93% and 92% between maximal axial diameter and volume for the true/false lumens, and 90% and 92% between maximal orthogonal diameter and volume for the true/false lumens. Large discrepancies were observed between the different measurement methods at regions distal to the stent graft, with up to 46% differences between maximal orthogonal diameter and volume. Volume measurement was shown to be a much more sensitive indicator in identifying lumen expansion/shrinkage at the distal stented region.

Comparative analysis of postoperative sexual dysfunction and quality of life in type a aortic dissection patients of different ages

BackgroundTo compare postoperative sexual dysfunction (SD) and quality of life (QOL) in Type A Aortic Dissection (AAD) Patients of Different Ages.MethodsFrom January 2018 to December 2019, 204 AAD postoperative survivors in Union Hospital of Fujian Medical University were selected and were divided into young group (less than 50 years old) and elderly group (more than 50 years old). We evaluated SD according to the male International Erectile Dysfunction Index (IIEF-5) and female sexual function index (FSFI). The Short Form 12 Health Survey Questionnaire (SF-12) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were used to investigate the QOL, Quick Inventory Depressive Symptomatology-Self Report (QIDS-SR) and the Beck Depression Inventory-II (BDI-II) to investigate depressive symptoms.ResultsOne hundred seventy-five patients completed all the questionnaire (85.8%). The total SD prevalence rate was 38.9% (68 cases), with 27.4% of the young (20 cases) and 47.1% of the elderly (48 cases). The age of non-SD and SD patients was 49.0 ± 11.5 and 56.9 ± 10.8 years, respectively (P = 0.03). Compared with non-SD patients, the total physical health of SD patients was significantly worse (P = 0.04), however, the mental health was not significantly worse (P = 0.77); the depressive symptoms did not expressed a significant difference between the SD and non-SD groups (QIDS-SR P = 0.15, BDI-II P = 0.06). Total physical health scores in the young SD group did not show significant better than elderly SD group (P = 0.24), however, total mental health scores showed significantly worse (P = 0.04), depressive symptoms scores were significantly higher (QIDS-SR P = 0.03, BDI-II P = 0.04).ConclusionThe postoperative AAD SD prevalence of elderly is higher than that of young, and the total physical health of SD patients is poorer than those without SD patients. The young SD patients did not show a significant higher physical health scores than the elderly SD patients, instead, the young SD patients were more psychologically affected than the elderly SD patients, whose mental health was worse, and depression symptoms were more obvious, suggesting that the factors affecting the QOL of postoperative SD patients are related to physical factors, but the young postoperative SD patients mainly affected by psychological factors.

Surgeon-modified fenestrated stent graft deployment in type B aortic dissection.

The treatment of aortic dissections and aneurysms may be challenging for vascular surgeons. Currently, thoracic endovascular aortic repair is usually the first treatment option for descending aortic pathologies. Left subclavian artery coverage during this procedure is often required to achieve a sufficient proximal landing zone. Most surgeons agree that the left subclavian artery can be selectively covered, but revascularization is preferred to reduce the risk of neurological or ischemic complications. The chimney method, hybrid operations with extra-anatomic bypass, back table or in situ fenestrations are assistive techniques in this procedure. Herein, we present a surgeon-modified fenestrated stent graft for a type B aortic dissection patient.

A Brief Reconnoitre about Effects of MMP9 on Aortic Dissection

Objective: Matrix metalloproteinases (MMPs) are the extracellular matrix regulators that frequently investigate cardiovascular diseases and cancer metastasis. Our study aimed to examine specific polymorphisms in the MMP9 gene in our patients with aortic dissection and compare the effect of MMP9 on aortic dissection with expression datasets. Materials and Methods: Q279R and P574R polymorphisms were analyzed in 44 aortic dissection patients and 40 healthy donors via polymerase chain reaction-restriction fragment length polymorphism. (PCR-RFLP) methods. Q279R and P574R prevalence was statistically compared with the medical data of the patients. Additionally, we collected datasets of aortic dissection from NCBI GEO to reanalyze GEO2R and RStudio to see metalloproteinase activity on samples. Later, enrichment analysis was processed on widely used databases. Results: Genotypic distribution of alleles was similar in the two study groups. In addition to this, female CG carriers had a higher risk of developing aortic dissection than those of males. As the results of the protein-protein interaction analysis of MMP9 and patients’ clinical data, hypertension was found to be the significant outcome of P574R variation in the patients. In array analysis, MMP9 expression did not change critically, but TIMPs had been downregulated in many samples. Also, MMP9 targeted miRNA expression levels were detected as low in aortic tissue and blood. Conclusion: Q279R and P574R are two polymorphisms that do not directly affect MMP9 protein structure. Consequently, studied polymorphisms and performed meta-analysis show that MMP9 does not spark off the phenotype but sets the stage for aortic dissection development as seen in the statistical results. Furthermore, enrichment analysis on datasets shows MMP9 was not a primary reason for vascular remodeling.

Association of Etoricoxib treatment and incident hypoxia in patients with aortic dissection undergoing endovascular aortic repair

ObjectiveThe current study was to evaluate the association of Etoricoxib treatment and incident hypoxia among type-B aortic dissection (AD) patients undergoing endovascular aortic repair (EVAR). MethodsPatients undergoing EVAR were retrospectively recruited. Based on Etoricoxib use, patients were divided into the non-treated and Etoricoxib-treated groups. Baseline characteristics including demographics, laboratory parameters, characteristics of aortic computer tomography and echocardiography, medications used, and procedural characteristics were collected from the electronic health record. ResultsCompared to non-treated group (n = 36), prevalence of obesity and fever at baseline was higher in Etoricoxib-treated group (n = 24; P < 0.05). Mean number of neutrophils, and mean serum CRP and D-dimer levels were higher in Etoricoxib-treated group (P < 0.05). The overall incidence of hypoxia was lower in Etoricoxib-treated group (44.4% vs 33.4%, P < 0.05). Increase in neutrophils count, serum CRP and D-dimer levels was associated with incident hypoxia, with an odds ratio (OR) of 1.36 (95% confidence interval [CI] 1.07–1.65), 1.44 (95% CI 1.12–1.78) and 1.25 (95% CI 1.01–1.47) respectively. In unadjusted model, Etoricoxib use was associated with a 44% lower odds of incident hypoxia. After adjustment for inflammatory markers, the association between Etoricoxib and incident hypoxia was non-significant, with OR of 0.95% and 95% CI of 0.78–1.06. ConclusionCompared to patients who did not receive Etoricoxib during hospitalization, those treated with Etoricoxib had lower incidence of hypoxia, which might be attributed to its anti-inflammatory effects.

Short-term outcomes of acute coronary involvement in type A aortic dissection without myocardial ischemia: a multiple center retrospective cohort study

BackgroundTo evaluate the early prognosis and management of acute coronary involvement (ACI) in type A aortic dissection (ATAAD) patients without myocardial ischemia (MI).MethodsWe conducted a retrospective cohort study on a multicenter database. A total of 931 ATAAD patients without MI underwent thoracic aortic surgery between 2018 and 2019 in the Acute Aortic Syndrome Cooperation Network (AASCN) and were enrolled in our study. Patients were divided into two groups: ACI group and non-ACI group.ResultsThere were 139 ACI patients (14.9%) and 792 non-ACI patients (85.1%) in our cohort. ACI group had higher 30-day mortality after surgery than non-ACI group (log-rank test: P = 0.028,Cox regression: hazard ratio [HR], 2.3; 95% confidence interval [95% CI], 1.1–5.39; P = 0.047), especially in sub-group of advanced age (53–80 years; HR, 4.0; 95% CI, 1.3–12.8; P = 0.017), low diastolic blood pressure (29-69 mmHg, HR, 3.8; 95% CI, 1.3–11.2; P = 0.018), low systolic blood pressure (51–119 mmHg, HR, 3.6; 95% CI, 1.1–12.4; P = 0.040), high body mass index (BMI;27.25–47.52 kg/m2; HR, 3.7; 95% CI, 1.3–10.7; P = 0.015) and high hemoglobin (>145 g/L; HR, 4.3; 95% CI, 1.2–16.0; P = 0.030). Acute renal failure was significant more in ACI group than non-ACI group (24.5% vs. 15.9%; P = 0.014).ConclusionsACI increases the short-term postoperative mortality and acute renal failure in ATAAD patients without MI. ATAAD patients with ACI may need a narrower control range of blood pressure even if without myocardial ischemia.Trial registrationChiCTR1900022637. Retrospectively registered 19 April 2019.

Predictive Factors for In-Hospital Preoperative Rupture in Hyperacute Type A Aortic Dissection.

This study aims to figure out risk factors of in-hospital preoperative rupture of hyperacute type A aortic dissection (haTAAD) patients and build a prediction and risk stratification model. From January 2011 to December 2019, 830 patients diagnosed as haTAAD from Nanjing Drum Tower Hospital were enrolled. Among them, 799 patients received prompt surgery and 31 suffered aortic rupture before operation. The association between in-hospital preoperative rupture and perioperative parameters were examined. Best subset selection was used for feature selection and ROC curve was used to identify the model. Age, winter season, back pain, preoperative hypotension, albumin and globulin ratio, high serum phosphorus level are risk factors for in-hospital preoperative rupture of haTAAD. On the basis of six variables with AUC 0.828, a nomogram was established. According to the robustness test, actual in-hospital preoperative ruptures were fitted well. The in-hospital rupture prediction model was developed using logistic regression analysis. High serum phosphorus level is one of the strongest predictors. This nomogram may be useful when evaluating the risk of aortic dissection in-hospital rupture in future trials.

Unique characteristics of the type B aortic dissection patients with malperfusion in the Vascular Quality Initiative

ObjectiveType B aortic dissection (TBAD) complicated by malperfusion carries high morbidity and mortality. The present study was undertaken to compare the characteristics of malperfusion and uncomplicated cohorts and to evaluate the long-term differences in survival using a granular, national registry. MethodsPatients with TBAD entered into the thoracic endovascular aortic repair/complex endovascular aortic repair module of the Vascular Quality Initiative from 2010 to 2019 were included. The demographic, radiographic, operative, postoperative, in-hospital, and long-term reintervention data were compared between the malperfusion and uncomplicated TBAD groups using t tests and χ2 analysis, as appropriate. Overall survival was compared using Cox regression to generate survival curves. ResultsOf the 2820 included patients, 2267 had uncomplicated TBAD and 553 had malperfusion. The patients with malperfusion were younger (age, 55.8 vs 61.2 years; P < .001), were more often male (79.7% vs 68.1%; P < .001), had a higher preoperative creatinine (1.8 vs 1.1 mg/dL; P < .001), had more often presented with an American Society of Anesthesiologists class of 4 or 5 (81.9% vs 58.4%; P < .001), and had more often presented with urgent status (77.4% vs 32.8%; P < .001). In contrast, the uncomplicated TBAD group had had more medical comorbidities, including coronary artery disease and chronic obstructive pulmonary disease, and a larger aortic diameter (4.0 cm vs 4.9 cm; P < .001). The malperfusion group more frequently had proximal zones of disease in zones 0 to 2 (38.6% vs 31.5%; P = .002) and distal zones of disease in zones 9 and above (78.7% vs 46.2%; P < .001), with a greater number of aortic zones traversed (7.7 vs 5.1; P < .001) and a greater frequency of dissection extension into branch vessels (61.8% vs 23.1%; P < .001). Patients with malperfusion also exhibited greater case complexity, with a greater need for branch vessel stenting and longer procedure times. The overall incidence of postoperative complications was greater in the malperfusion group (39.4% vs 17.1%; P < .001) and included a greater rate of spinal cord ischemia (6.3% vs 2.2%; P < .001), acute kidney injury (10.4% vs 0.9%; P < .001), and in-hospital mortality (11.6% vs 5.6%; P < .001). In-hospital reintervention was also greater for the malperfusion patients (14.5% vs 7.4%; P < .001), although the incidence of long-term reinterventions was similar between the two groups (8.7% vs 9.7%; P = .548). A proximal zone of disease in zone 0 to 2 was associated with decreased survival. In contrast, a distal zone of disease in 9 and above, in-hospital reintervention, and long-term follow-up were associated with increased survival. Despite these differences, long-term survival did not differ between the malperfusion and uncomplicated groups (P = .320.) ConclusionsPatients presenting with TBAD and malperfusion represent a unique cohort. Despite the greater need for branch vessel stenting and in-hospital reintervention, they had similar long-term reintervention rates and survival compared with those with uncomplicated TBAD. These data lend insight with regard to the observed differences between uncomplicated and malperfusion TBAD.

Thoracic endovascular aortic repair for type B aortic dissection patients: 11-year experience from a Chinese Tertiary Center.

Thoracic endovascular aortic repair for type B aortic dissection patients: 11-year experience from a Chinese Tertiary Center.

Association between glucose variability and postoperative delirium in acute aortic dissection patients: an observational study

BackgroundBlood glucose variability is associated with poor prognosis after cardiac surgery, but the relationship between glucose variability and postoperative delirium in patients with acute aortic dissection is unclear. The study aims to investigate the association of blood glucose variability with postoperative delirium in acute aortic dissection patients.MethodsWe prospectively analyzed 257 patients including 103 patients with delirium. The patients were divided into two groups according to whether delirium was present. The outcome measures were postoperative delirium, the length of the Intensive Care Unit stay, and the duration of hospital stay. Multivariable Cox competing risk survival models was used to assess.ResultsA total of 257 subjects were enrolled, including 103 patients with delirium. There were statistically significant differences between the two groups in body mass index, history of cardiac surgery, first admission blood glucose, white blood cell counts, Acute Physiology and Chronic Health Evaluation II score, hypoxemia, mechanical ventilation duration, and the length of Intensive Care Unit stay(P < 0.05). The delirium group exhibited significantly higher values of the mean of blood glucose (MBG) and the standard deviation of blood glucose (SDBG) than in the non-delirium group(P < 0.05). In model 1, the adjusted hazard ratio (AHR) of the standard deviation of blood glucose was 1.436(P < 0.05). In Model 2, the standard deviation of blood glucose (AHR = 1.418, 95%CI = 1.195–1.681, P < 0.05) remained significant after adjusting for confounders. The area under the curve of the SDBG was 0.763(95%CI = 0.704–0.821, P < 0.01). The sensitivity was 81.6%, and the specificity was 57.8%.ConclusionsGlucose variability is associated with the risk of delirium in patients after aortic dissection surgery, and high glycemic variability increases the risk of postoperative delirium.

Endovascular Repair for Acute Type B Aortic Dissection With Unfavorable Proximal Landing Zone

BackgroundThe study aimed to compare the safety and effectiveness between fenestrated technique with or without chimney stent and single-branched stent graft for isolated left subclavian artery revascularization during endovascular repair of acute type B aortic dissection with unfavorable proximal landing zone. MethodsFrom January 2016 to December 2019, 65 acute type B aortic dissection patients with unfavorable proximal landing zone were treated with either the fenestrated technique (n = 34, group A) or single-branched stent graft (n = 31, group B). Type I endoleak, retrograde type A dissection, stroke, left subclavian artery patency, 30-day mortality, and aortic remodeling were systematically recorded and retrospectively analyzed. ResultsTechnical success rates for groups A and group B were 94.12% and 100%, respectively. Left subclavian artery primary patency was achieved for all enrolled patients. The incidence of type I endoleak, retrograde type A dissection, stroke, and 30-day mortality was 5.9%, 5.9%, 2.9%, and 2.9% in group A, respectively, but none were encountered in group B. Left subclavian artery occlusion was observed in 3 patients in group A and 2 patients in group B during a mean follow-up of 16.18 ± 2.08 months and 15.19 ± 2.68 months, respectively. After the procedure, significant aortic remodeling was detected in both groups during follow-up. ConclusionsBoth techniques are feasible and safe for isolated left subclavian artery revascularization during endovascular repair for acute type B aortic dissection. Apart from the associated perioperative risks of complications and mortality for the fenestrated technique, both procedures contributed to favorable aortic remodeling.

Impact of direct carotid artery perfusion in acute type A aortic dissection involving the common carotid artery.

ObjectivesAcute type A aortic dissection complicated with brain ischemia is associated with significantly higher mortality risks. Even if rescued with central aortic repair, some patients develop permanent postoperative neurological deficiency postoperatively. We recently introduced direct common carotid artery perfusion for acute type A aortic dissection involving the common carotid artery. This study introduced this technique to prevent postoperative neurological deficiency by comparing brain protection strategies.MethodsAmong 91 acute type A aortic dissection patients treated at our hospital during August 2015–October 2020, the common carotid artery was involved in 19 (21%), which had > 90% stenosis in either of the carotid arteries on preoperative contrast-enhanced computed tomography. Twelve patients underwent conventional selective cerebral perfusion during August 2015–December 2018 and seven patients underwent direct carotid artery perfusion during January 2019–October 2020. We assessed patient characteristics, surgical courses, clinical outcomes, and neurological outcomes.ResultsThe mean age was 69 (range 39–84) years; 17 patients were male (89%). Eight patients (42%) had neurological symptoms. Concomitant procedures, postoperative neurological symptoms, and late mortality were significantly associated with conventional selective cerebral perfusion. Five selective cerebral perfusion patients experienced worsened neurological symptoms and two died of broad cerebral ischemia. No direct carotid artery perfusion patient died during hospitalization or experienced worsened neurological outcomes.ConclusionsDirect carotid artery perfusion may be useful in aortic dissection with brain ischemia because it does not aggravate neurological symptoms and is not associated with intraoperative cerebral infarction. However, it may be ineffective when cerebral infarction has already developed.

MiR-140-5p inhibits the proliferation, migration and invasion of vascular smooth muscle cells by suppressing the expression of NCKAP1.

The occurrence of aortic dissection is related to the proliferation and metastasis of vascular smooth muscle cells. In our present study, we found that the expression of miR-140-5p was inhibited in the wall of abdominal aorta of aortic dissection patients. However, the mechanism of miR-140-5p in the development of aortic dissection is unclear. We detected the expression of miR-140-5p and NCK Associated Protein 1 (NCKAP1) in blood vessel of aortic dissection patients and normal people by PCR. Next, we established the miR-140-5p overexpression and miR-140-5p inhibition vascular smooth muscle cells (CRL-1999 cells). The BrdU assays, wound healing assays and transwell assays were performed to detect the proliferation and invasion ability of these cells. Finally, luciferase reporter assay was performed to detect the relationship between miR-140-5p and NCKAP1. The expression of miR-140-5p was suppressed in blood vessel of aortic dissection patients, and the levels of NCKAP1 in those tissues were upregulated. Overexpression of miR-140-5p inhibited the proliferation, migration and invasion of vascular smooth muscle cells. miR-140-5p targeted and suppressed the expression of NCKAP1. miR-140-5p repressed the proliferation, migration and invasion of vascular smooth muscle cells by targeting and inhibiting the expression of NCKAP1. Furthermore, the results of our study suggest new strategies and targets for the clinical treatment of arterial dissection.

Application of sutureless integrated stented graft in patients with aortic dissection

Objective: To preliminarily investigate effectiveness and safety of sutureless integrated stented graft (SIS graft) on aortic dissection patients undergoing surgeries. Methods: In October 2019, 2 patients with aortic dissection were treated by SIS graft in Shenzhen Fuwai Hospital. Data of the operations and follow-up were recorded. Results: Patient 1 (male, 42 years old) was treated with aortic sinus repair, ascending aortic replacement, total arch replacement combined with frozen elephant trunk implantation. Time of cardiopulmonary bypass and circulatory arrest was 81 minutes and 9.5 minutes,respectively. The lowest nasopharynx temperature was 27.3 ℃. This patient was followed up for 10 months and no postoperative complication was found. Six-month postoperative aortic CT angiography (CTA) revealed SIS graft was patent and no anastomosis fistula or stent leakage occurred. True lumen of stented area was full-filled and false lumen disappeared. Incomplete false lumen thrombosis was seen in un-stented thoracic aorta, but no progressive aortic enlargement appeared. Patient 2 (male, 61 years old) was treated with ascending aortic replacement, ascending aorta to right femoral artery bypass graft, total arch replacement combined with frozen elephant trunk implantation. Time of cardiopulmonary bypass and circulatory arrest was 77 minutes and 7 minutes,respectively. The lowest nasopharynx temperature was 27.3 ℃. This patient was also followed up for 10 months and was free of postoperative complications. Six-month postoperative aortic CTA revealed SIS graft was patent and there was no anastomosis fistula or stent leakage. Perfusion of true lumen in thoracic aorta and branches of abdominal aorta improved significantly and complete false lumen thrombosis could be seen in thoracic aorta. Progressive aortic enlargement was not detected. Conclusion: Application of SIS graft can reduce circulatory arrest time and avoid deep hypothermia, which will decrease risks of postoperative complications, and this graft can simplify surgery procedure. However, further clinical trial for effectiveness and safety of SIS graft should be applied.

Association of body mass index with in-hospital major adverse outcomes in acute type A aortic dissection patients in Fujian Province, China: a retrospective study

BackgroundAbnormal body mass index (BMI) has been related to a higher risk of adverse outcomes in patients undergoing cardiac surgery. However, the effects of BMI in patients with acute type A aortic dissection (AAAD) on postoperative outcomes remain unclear. This study aimed to explore the relationships between BMI and in-hospital major adverse outcomes (MAO) in AAAD patients.MethodsPatients who underwent AAAD surgery at Cardiac Medical Center of Fujian Province from June 2013 to March 2020 were retrospectively evaluated. They were divided into three groups on the basis of Chinese BMI classification established by the World Health Organization: normal weight group (BMI 18.5–23.9 kg/m2), overweight group (BMI 24–27.9 kg/m2), and obese group (BMI >28 kg/m2). Patients’ baseline characteristics, preoperative, operative, and postoperative data were collected. A multivariable logistic regression analysis model was performed to identify the association between BMI and MAO in AAAD patients.ResultsOf 777 cases, 31.9% were normal weight, 52.5% were overweight, and 15.6% were obese. A total of 160(20.6%) patients died in-hospital. There was a significant difference between the three groups for MAO (62.9% vs 72.1% vs 77.7%, respectively, P = 0.006). The incidence of postoperative complications did not differ among the three groups, except for postoperative bleeding, and prolonged mechanical ventilation, the proportion of which were higher in the overweight and obese groups. Besides, multivariable logistic regression analysis demonstrated that a higher risk of MAO in the overweight [odds ratios (ORs):1.475, 95%CI:1.006–2.162], and obese patients (ORs:2.147, 95%CI:1.219–3.782) with reference to the normal weight patients, and age, white blood cell, prior stroke and cardiopulmonary bypass time were also associated with in-hospital MAO (P<0.05).ConclusionsBMI is independently associated with higher in-hospital MAO in patients who underwent AAAD surgery.