Treatment Of Thoracic Aortic Aneurysms Research Articles

Results of hybrid surgery for treatment of thoracic aortic aneurysm

Introduction: Treatment of aortic aneurysms (AUS) is always a challenge for cardiologists. The incidence of aortic aneurysms is 5-10/100.000 people/ year, of which arch aneurysms account for 10% and have a risk of rupture and dissection leading to a high mortality rate similar to other aortic aneurysms. Aortic arch surgery is becoming more and more popular, and with the development of interventional techniques, the combination of transposition surgery of the arch branches and endovascular intervention called hybrid surgery (Hybrid Arch Repair- HAR) in the treatment of arch aneurysms is increasing, helping to increase treatment effectiveness without increasing complications for patients. Method: Cross-sectional study, 14 patients with thoracic aortic aneurysm underwent hybrid surgery at the Cardiovascular Center, E Hospital from January 2020 to December 2023. Result: In 14 patients, the average age was 66.2±8.4, with 92.9% of men. There were 5 cases of left common carotid-left subclavian artery transposition surgery to the right common carotid artery, 7 cases of total transposition surgery: brachiocephalic trunk (TABC), left common carotid-left subclavian artery to the ascending aorta, 2 cases of ascending segment replacement and transposition of all branches of the aorta. The average surgical time was 4.1±1.3 hours, the average mechanical ventilation time was 46.3±76.7 hours. The postoperative hospital stay was 15.1±7.1 days. The technical success rate was 92.9%. There were 2 deaths after surgery due to severe Covid pneumonia and sepsis. Conclusion: Hybrid surgery for thoracic aortic aneurysm initially achieved good results, without affecting patients with low complication and mortality rates. However, a larger number of patients and long-term follow-up are needed to accurately assess the effectiveness.

Long-Term Outcomes and Late Complications of Thoracic Endovascular Aortic Repair Using the GORE TAG or Conformable GORE TAG.

Previous clinical studies have reported on the short- and mid-term prognoses of thoracic endovascular aortic repair (TEVAR) using the GORE thoracic aortic graft (TAG) or conformable GORE TAG. We evaluated the long-term prognoses of patients who underwent TEVAR using the GORE TAG or conformable GORE TAG in a real-world setting. This retrospective observational study analyzed the data of all consecutive patients aged 20 years or older who underwent TEVAR using either the GORE TAG or the conformable GORE TAG at a single center. The surgical criteria did not deviate from global standards. In principle, TEVAR was performed with the TAG or conformable thoracic aortic graft (CTAG) according to the manufacturer's instructions. The primary outcomes of this study were the 10-year overall survival rate and the rate of freedom from aorta-related deaths at 10 years. Between January 2011 and December 2021, 331 patients underwent TEVAR, of whom 175 consecutive patients treated with TEVAR using either the GORE TAG or the conformable GORE TAG were enrolled. The mean age of the patients was 72.1 ± 9.3 years. In addition, the aneurysm and chronic dissection were 61.7% and 38.3%, respectively. Of all patients, 157 had a proximal landing zone ≥3, and 18 had a zone <3. The mean follow-up time was 46.5 ± 33.1 months. The 30-day mortality rate was 2.86%. The 3-, 5-, 7-, and 10-year overall survival rates were 76.9 ± 3.4%, 63.4 ± 4.1%, 55.9 ± 4.9%, and 42.4 ± 8.4%, respectively. The rate of freedom from aorta-related deaths at 3, 5, 7, and 9 years was 97.4 ± 1.3%, 95.0 ± 2.1%, 95.0 ± 2.1%, and 95.0 ± 2.1%, respectively. Late complications occurred in 23 (13.1%) patients. Endovascular re-intervention was performed because of endoleak, false lumen enlargement, or stent graft-induced new entry tear in 14 patients. Three patients required open conversion, and 6 were observed without re-intervention. Thoracic endovascular aortic repair using the GORE TAG or conformable GORE TAG is a safe and effective procedure for the treatment of thoracic aortic aneurysms and aortic dissection. Thoracic endovascular aortic repair using the GORE thoracic aortic graft (TAG) or conformable GORE TAG is a safe and effective procedure for the treatment of thoracic aortic aneurysms and aortic dissection. The 30-day mortality rate was 2.86%. During 10 years of follow-up, the overall survival rate was low; however, the risk of aorta-related deaths was also low. No significant differences in freedom from late complications and re-intervention are seen between the TAG and conformable thoracic aortic graft (CTAG) groups. Further investigations into the treatment of late complications are required.

METTL14 promotes ferroptosis in smooth muscle cells during thoracic aortic aneurysm by stabilizing the m6A modification of ACSL4.

Thoracic aortic aneurysm (TAA) is a vascular disease associated with high mortality rates. Ferroptosis has been shown to mediate the transformation of vascular smooth muscle cells (VSMCs). However, the regulatory mechanisms by which ferroptosis influences TAA remain unclear. In this study, we induced TAA mouse models using angiotensin II (Ang II) and evaluated the impact of ferroptosis on the pathological changes observed in TAA mice, employing liproxstatin-1 as a treatment. Additionally, we assessed the regulatory effect of METTL14 on the ferroptosis of VSMCs after treating them with ferroptosis activator (IKE). RNA binding protein immunoprecipitation (RIP) and RNA pull-down assays were conducted to investigate the interaction between ACSL4 mRNA and the proteins METTL14 or IGF2BP2. The results indicated that the level of ferroptosis was elevated in the thoracic aorta of TAA mice, and METTL14 was upregulated in TAA models and IKE-induced VSMCs. Knockdown of METTL14 was found to inhibit the progression of TAA by reducing the ferroptosis of VSMCs. Furthermore, IGF2BP2 recognized METTL14-modified ACSL4 mRNA and regulated its stability, thereby mediating the ferroptosis of VSMCs. Collectively, the effects of METTL14 on VSMC ferroptosis present therapeutic potential for the treatment of TAA.

A multiphasic model for determination of mouse ascending thoracic aorta mass transport properties with and without aneurysm.

Thoracic aortic aneurysms (TAAs) are associated with aortic wall remodeling that affects transmural transport or the movement of fluid and solute across the wall. In previous work, we used a Fbln4E57K/E57K (MU) mouse model to investigate transmural transport changes as a function of aneurysm severity. We compared wild-type (WT), MU with no aneurysm (MU-NA), MU with aneurysm (MU-A), and MU with an additional genetic mutation that led to increased aneurysm penetrance (MU-XA). We found that all aneurysmal aortas (MU-A and MU-XA) had lower fluid flux compared to WT. Non-aneurysmal aortas (MU-NA) had higher 4kDa FITC-dextran solute flux than WT, but aneurysmal MU-A and MU-XA aortas had solute fluxes similar to WT. Our experimental results could not isolate competing factors, such as changes in aortic geometry and solid material properties among these mouse models, to determine how intrinsic transport properties change with aneurysm severity. The objective of this study is to use biphasic and multiphasic models to identify changes in transport material properties. Our biphasic model indicates that hydraulic permeability is significantly decreased in the severe aneurysm model (MU-XA) compared to non-aneurysmal aortas (MU-NA). Our multiphasic model shows that effective solute diffusivity is increased in MU-NA aortas compared to all others. Our findings reveal changes in intrinsic transport properties that depend on aneurysm severity and are important for understanding the movement of fluids and solutes that may play a role in the diagnosis, progression, or treatment of TAA.

Tactics for Treating Thoracic Aortic Aneurysms using Hybrid and Endovascular Techniques in Patients with Concomitant Coronary Heart Disease

The presence of ischemic heart disease (IHD) in patients with aortic dissection increases the risk of intraoperative and postoperative complications during aortic repair. Researches on the effect of IHD on the treatment outcomes of patients with type B aortic dissection have not been carried out often. Only single publications based on relatively small statistical material are devoted to this problem in the literature. The cohort of patients with aortic dissection and IHD is extremely complex, and surgical correction of this comorbid condition is still a controversial topic. The aim. To analyze the impact of IHD with prior correction of coronary artery lesions on the results of hybrid and endovascular treatment of patients with thoracic aortic aneurysms. Materials and methods. From 2017 to 2023, on the basis of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, 245 patients with thoracic aortic aneurysm were treated using hybrid and endovascular techniques. Of these, 14 (5.7%) patients with coronary malperfusion underwent previous cor-rection of IHD either alone or in combination with prosthetics of the aortic valve, ascending aorta and arch of the aorta, initial section of the descending aorta (elephant trunk) with a good outcome. The comparison group included 30 (12.2%) patients who underwent endovascular or hybrid correction of the descending thoracic aorta without coronary pathology. Results. In the experimental group, 5 complications (42.9%) were detected (3 in the intraoperative period and 2 in the postoperative period). The frequency of complications of a similar nature in patients without concomitant IHD (com-parison group) was 13.3%. Endoleak type 1 was also dominant in this group. In most cases, it was eliminated by balloon dilatation of the stent graft. Only in 1 case, Endoleak type 1b was the reason for re-intervention with placement of an additional stent after 6 months. Conclusions. Studies show that the presence of even corrected IHD complicates the course of endovascular and hy-brid surgical treatment of thoracic aortic aneurysms, as evidenced by significantly higher rates of postoperative compli-cations, longer length of stay in the intensive care unit, as well as time on mechanical ventilation. Preliminary myocardial revascularization in patients with IHD should be one of the main conditions for the endovas-cular treatment of aortic aneurysms, taking into account the specifics of performing such operations and the possibility of fatal complications with hemodynamically significant narrowing of the coronary arteries.

Thoracic aortic aneurysms, a single center's 10-years experience and analysis of outcomes.

Thoracic aortic aneurysms (TAAs) are an increasingly prevalent pathology with significant associated morbidity and mortality. Thoracic endovascular aortic repair (TEVAR) is the primary line of treatment. The purpose of this study was to analyse a single center's experience in the treatment of TAAs and identify possible risk factors for worse outcomes. A retrospective review of our institutional database was done to identify all patients treated for TAAs in a 10-year period, from 1 January 2012 to 31 December 2022. Data were extracted from patients' medical records. Primary outcome was all-cause mortality and secondary outcomes were procedure related morbidity (vascular access complications, medullary ischaemia, stroke, endoleaks, migration, aneurysm sac enlargement >5mm) and need for reintervention at 1-, 6- and 12-month follow-up. A descriptive and inferential analysis of the data was performed. Statistical analyses were conducted using the IBM Statistical Package for Social Sciences (SPSS) software. We identified 34 patients treated for TAAs in this period. Mean age was 68years [47-87] and 79.4% of patients were male. Mean aneurysm diameter was 63mm [35-100], 55.9% fusiform and 44.1% saccular. The majority (91.2%) were located at the descending thoracic aorta and 3 (8.8%) of them extended to the aortic arch. The most common aetiology was degenerative in 22 patients (64.7%), followed by aortic dissection in 8 patients (23.5%). Elective surgery was performed in 19 (61.3%) patients and 12 (38.7%) had urgent repair. TEVAR was the treatment of choice in 24 (77.4%) patients, and the remaining 7 (22.6%) were treated with hybrid surgery. Mean length of hospital stay was 10days [2-80] (6 days for elective repair versus 16days for urgent repair, p = .016). Follow-up period ranged from 1month to 10years. At 1 year follow-up, all-cause mortality was 15%, morbidity was 30% (with 6 (22%) patients having a type Ia endoleak) and need for reintervention was 22%. Aneurysm diameter was a significant risk factor for procedure related morbidity (median diameter of 73.5mm versus 56.0mm in patients with no morbidity; p = .027). The presence of type Ia endoleak was significantly associated with higher reintervention rates (p = .001), but not with higher mortality rates (p = .515). Age, female sex, aetiology and urgent repair weren't associated with any significant differences in the outcomes. TEVAR proved to be effective in the treatment of TAAs, with good outcomes at short and mid-term follow-up. TAAs should be diagnosed earlier and be promptly treated when meeting criteria to prevent worse outcomes.

Integrative multi-omics analyses reveal vesicle transport as a potential target for thoracic aortic aneurysm

BackgroundThoracic aortic aneurysm (TAA) refers to dilation and enlargement of the thoracic aorta caused by various reasons. Most patients have no apparent symptoms in the early stage and are subject to a poor prognosis once the aneurysm ruptures. It is crucial to identify individuals who are predisposed to TAA and to discover effective therapeutic targets for early intervention. MethodsWe conducted a label-free quantitative proteomic analysis among aorta tissue samples from TAA patients to screen differentially expressed proteins (DEPs) and key co-expression modules. Two datasets from Gene Expression Omnibus (GEO) database were included for integrative analysis, and the identified genes were subjected to immunohistochemistry (IHC) validation. Detailed vesicle transport related enrichment analysis was conducted and two FDA-approved drugs, chlorpromazine (CPZ) and chloroquine (CQ), were selected for in vivo inhibition of vesicle transport in mice TAA model. The diameter of thoracic aorta, mortality and histological differences after interventions were evaluated. ResultsWe found significant enrichments in functions involved with vesicle transport, extracellular matrix organizing, and infection diseases in TAA. Endocytosis was the most essential vesicle transport process in TAA formation. Interventions with CPZ and CQ significantly reduced the aneurysm diameter and elastin degradation in vivo and enhanced the survival rates of TAA mice. ConclusionsWe systematically screened the aberrantly regulated bioprocesses in TAA based on integrative multi-omics analyses, identified and demonstrated the importance of vesicle transport in the TAA formation. Our study provided pilot evidence that vesicular transport was a potential and promising target for the treatment of TAA.

Animal Models, Pathogenesis, and Potential Treatment of Thoracic Aortic Aneurysm.

Thoracic aortic aneurysm (TAA) has a prevalence of 0.16-0.34% and an incidence of 7.6 per 100,000 person-years, accounting for 1-2% of all deaths in Western countries. Currently, no effective pharmacological therapies have been identified to slow TAA development and prevent TAA rupture. Large TAAs are treated with open surgical repair and less invasive thoracic endovascular aortic repair, both of which have high perioperative mortality risk. Therefore, there is an urgent medical need to identify the cellular and molecular mechanisms underlying TAA development and rupture to develop new therapies. In this review, we summarize animal TAA models including recent developments in porcine and zebrafish models: porcine models can assess new therapeutic devices or intervention strategies in a large mammal and zebrafish models can employ large-scale small-molecule suppressor screening in microwells. The second part of the review covers current views of TAA pathogenesis, derived from recent studies using these animal models, with a focus on the roles of the transforming growth factor-beta (TGFβ) pathway and the vascular smooth muscle cell (VSMC)-elastin-contractile unit. The last part discusses TAA treatment options as they emerge from recent preclinical studies.

The Fate of Conventional Elephant Trunk in the Frozen Elephant Trunk Era.

Conventional elephant trunk (cET) and frozen elephant trunk (FET) are two distinct approaches to the surgical treatment of thoracic aortic aneurysms and dissections. With the advent and growing uptake of endovascular technologies, FET is becoming increasingly popular for its potential to be performed as a single-stage operation with better aortic remodeling and less risk of graft kinking than the traditional two-stage cET procedure. However, FET has been associated with a higher risk of spinal cord ischemia and its use in patients with connective tissue disorder remains controversial. The current review aimed to reflect on recent evidence surrounding the application of cET and FET to different types of aortic pathology in both acute and elective settings. Another scope of this review was to compare the characteristics of the currently available FET commercial devices on the global market. Our findings highlight that when the pathology is confined to the proximal descending aorta, such as in Dsine, intervention is often single-staged and false lumen (FL) thrombosis is achieved with good effect. FET remains limited by spinal cord injury and applicability in patients with connective tissue disorder, although some groups have started to circumvent associated complications, likely due to growing surgical expertise. Many other aortic diseases do require second-stage intervention, and even in these cases, there appears to be lower in-hospital mortality when using FET over cET. This is possibly due to the higher rate of endovascular completion facilitated by the completed landing zones created during FET. FET is trending toward becoming the universal treatment modality for extending repair to the descending aorta.

Poor Survival in Women Referred for Treatment of Thoracic Aortic Aneurysms: Might Utilisation of the Aortic Size Index Improve Outcomes?

Poor Survival in Women Referred for Treatment of Thoracic Aortic Aneurysms: Might Utilisation of the Aortic Size Index Improve Outcomes?

"Big Data" Analyses Underlie Clinical Discoveries at the Aortic Institute.

This issue of the Yale Journal of Biology and Medicine (YJBM) focuses on Big Data and precision analytics in medical research. At the Aortic Institute at Yale New Haven Hospital, the vast majority of our investigations have emanated from our large, prospective clinical database of patients with thoracic aortic aneurysm (TAA), supplemented by ultra-large genetic sequencing files. Among the fundamental clinical and scientific discoveries enabled by application of advanced statistical and artificial intelligence techniques on these clinical and genetic databases are the following: From analysis of Traditional "Big Data" (Large data sets). 1. Ascending aortic aneurysms should be resected at 5 cm to prevent dissection and rupture. 2. Indexing aortic size to height improves aortic risk prognostication. 3. Aortic root dilatation is more malignant than mid-ascending aortic dilatation. 4. Ascending aortic aneurysm patients with bicuspid aortic valves do not carry the poorer prognosis previously postulated. 5. The descending and thoracoabdominal aorta are capable of rupture without dissection. 6. Female patients with TAA do more poorly than male patients. 7. Ascending aortic length is even better than aortic diameter at predicting dissection. 8. A "silver lining" of TAA disease is the profound, lifelong protection from atherosclerosis. From Modern "Big Data" Machine Learning/Artificial Intelligence analysis: 1. Machine learning models for TAA: outperforming traditional anatomic criteria. 2. Genetic testing for TAA and dissection and discovery of novel causative genes. 3. Phenotypic genetic characterization by Artificial Intelligence. 4. Panel of RNAs "detects" TAA. Such findings, based on (a) long-standing application of advanced conventional statistical analysis to large clinical data sets, and (b) recent application of advanced machine learning/artificial intelligence to large genetic data sets at the Yale Aortic Institute have advanced the diagnosis and medical and surgical treatment of TAA.

Machine learning and artificial intelligence in the prediction, diagnosis and treatment of thoracic aortic diseases (literature review). Part 1

Despite their relatively low prevalence compared to cardiac valve lesions and coronary heart disease, thoracic aortic aneurysm and dissection are potentially fatal and represent serious public health problems. The indications for surgical treatment in most thoracic aortic diseases are predominantly based on the maximum aortic diameter in a particular area. Congenital connective tissue disorder, thoracic aortic anomalies (e.g., coarctation), family history of aneurysms, aortic dissections, and sudden deaths are considered as additional risk factors of aortic-related complications influencing the “stricter” indications and lowering the “threshold” aortic diameter. At the same time, a certain proportion of patients with aortic diseases develop aortic dissection and rupture in normal or near-normal thoracic aortic diameter in certain section. Many factors influence the development of aortic diseases and complications, and assessing the contribution to the aetiology and pathogenesis of each factor is difficult. Machine learning and mathematical modeling using artificial intelligence is an actively developing area of computer science, which also finds application in medicine, in particular in the study, diagnosis, and treatment of thoracic aortic aneurysms and dissections. This article discusses modern methods of data analysis, prediction of thoracic aortic aneurysms and dissections, treatment planning in thoracic aortic diseases, and prediction of complications using machine learning and artificial intelligence.

Machine learning and artificial intelligence in the prediction, diagnosis and treatment of thoracic aortic diseases (literature review). Part 2

Despite their relatively low prevalence compared to cardiac valve lesions and coronary heart disease, thoracic aortic aneurysm and dissection are potentially fatal and represent serious public health problems. The indications for surgical treatment in most thoracic aortic diseases are predominantly based on the maximum aortic diameter in a particular area. Congenital connective tissue disorder, thoracic aortic anomalies (e.g., coarctation), family history of aneurysms, aortic dissections, and sudden deaths are considered as additional risk factors of aortic-related complications influencing the “stricter” indications and lowering the “threshold” aortic diameter. At the same time, a certain proportion of patients with aortic diseases develop aortic dissection and rupture in normal or near-normal thoracic aortic diameter in certain section. Many factors influence the development of aortic diseases and complications, and assessing the contribution to the aetiology and pathogenesis of each factor is difficult. Machine learning and mathematical modeling using artificial intelligence is an actively developing area of computer science, which also finds application in medicine, in particular in the study, diagnosis, and treatment of thoracic aortic aneurysms and dissections. This article discusses modern methods of data analysis, prediction of thoracic aortic aneurysms and dissections, treatment planning in thoracic aortic diseases, and prediction of complications using machine learning and artificial intelligence.

Race-based outcomes of thoracic aortic aneurysms and dissections in the Global Registry for Endovascular Aortic Treatment

ObjectiveThis study characterizes racial differences in presentation, as well as short- and long-term outcomes after endovascular treatment of thoracic aortic aneurysm (TAA) and type B aortic dissection (TBAD). MethodsWe queried the Gore Global Registry for Endovascular Aortic Treatment for thoracic endovascular aortic repairs (TEVARs) performed between 2010 and 2016 and followed through 2022. Pathologies represented were descending TAA, complicated TBAD, and uncomplicated TBAD. Using standard statistical tests, we compared overall and pathology-specific demographics, procedural factors, and outcomes among Black and White patients undergoing TEVAR. ResultsWe identified 438 TEVAR cases, including 236 descending TAA, 121 complicated TBAD, and 74 uncomplicated TBAD. Overall, Black patients were younger and had a higher incidence of renal insufficiency (P = .001), whereas White patients had more chronic obstructive pulmonary disease (P = .003) and cardiac arrhythmias (P = .037). In patients treated for descending TAA, Black patients had increased device- and procedure-related complications (34.3% vs 17.4%; P = .014), conversion to open repair (2.9% vs 0%; P = .011) and type II endoleak (5.7% vs 1.0%; P = .040), but no differences in mortality, length of hospital stay, or major adverse cardiovascular events. Whereas outcomes of TEVAR for uncomplicated TBAD were comparable, Black patients more frequently presented with complicated TBAD than White patients (Black, 40.5% vs White, 24.8%; P = .008) and had subsequently greater reintervention rates (28.1% vs 12.4%; P = .012), all-cause mortality (hazard ratio, 4.28; 95% confidence interval, 1.74-10.5; P = .002) and aortic-related mortality (hazard ratio, 16.7; 95% confidence interval, 1.49-186; P = .022). ConclusionsDespite increased device- and procedure-related complications, similar short- and long-term outcomes are achieved in Black and White patients undergoing TEVAR for descending TAA and uncomplicated TBAD. However, Black patients are more likely to present with, require reintervention for, and suffer mortality from complicated TBAD.

Construction of a high-throughput aorta smooth muscle-on-a-chip for thoracic aortic aneurysm drug screening

Thoracic aortic aneurysm (TAA), in which arteries enlarge asymptomatically over time until dissection or rupture occurs, is a serious health risk. The mainstay of TAA treatment remains surgical repair due to the lack of effective drugs. The complex etiology and pathogenesis of TAA, including hemodynamic alterations and genetic factors, lead to inaccuracies in preclinical models for drug screening. Previously, our group designed an aorta smooth muscle-on-a-chip to emulate human aorta physiology and pathophysiology and screened three promising therapeutic drugs targeting mitochondrial dynamics in TAA. On this foundation, we updated the one-channel chip to an eighteen-well chip platform with four polydimethylsiloxane layers. Benefiting from this high-throughput chip, we rapidly screened multiple drugs simultaneously using distinct cell lines in vitro. In addition, we observed the abnormal activation of hypoxia-inducible factor 1-alpha (HIF-1alpha) in aortas from TAA patients by Western blot and bioinformatics analyses. Intriguingly, this phenomenon was replicated only when smooth muscle cells (SMCs) were strained on the chip. We then screened seven specific HIF-1alpha inhibitors and selected the two most effective drugs (2-methoxyestradiol and digoxin) by quantitative PCR and colorimetric methods. The results demonstrated that these two drugs can improve respiratory chain function and rescue the SMC contractile phenotype, showing applicability for the clinical treatment of TAA. This high-throughput aorta smooth muscle-on-a-chip will become a potential preclinical model for TAA drug screening.

ProvinLong non-coding RNA XIST negatively regulates thoracic aortic aneurysm cell proliferation by targeting the miR-193a-5p/KLF7 axis

Non-coding RNAs (ncRNAs) are important molecular modulators in diverse pathological processes, influencing the occurrence and progression of carcinomas. Thoracic aortic aneurysm (TAA) is an infrequent disease among aneurysmal diseases and accounts for nearly 3% of diagnosed aneurysms. The functional roles of long ncRNA (lncRNA) XIST and miR-193a-5p and the associated molecular mechanisms are yet to be investigated. In the current study, we discovered that miR-193a-5p was expressed at low levels in the blood of TAA patients. Further, loss-of-function and gain-of-function assays disclosed that miR-195-3p impacted the proliferation ability of TAA cells. XIST was found to be the most overexpressed lncRNA among predicted lncRNAs binding to miR-193a-5p. The promotive function of XIST in TAA was also explored. Subsequently, KLF7 was proved to be the downstream factor of the XIST/miR-193a-5p axis. Rescue assays testified the whole regulation mechanism of the XIST/miR-193a-5p/KLF7 axis in TAA. MiR-193a-5p was absorbed by XIST for the improvement of KLF7 in TAA. These results concluded that XIST might be engaged in TAA pathogenesis via regulation of the miR-193a-5p/KLF7 axis, supplementing more therapeutic options for TAA treatment.

Risk Factors Associated With Type II Endoleak After TEVAR for Thoracic Aortic Aneurysm

Thoracic endovascular aortic repair (TEVAR) has become a mainstay of treatment for thoracic aortic aneurysms. Endoleaks can occur in patients following TEVAR, potentiating aneurysm sac growth and the subsequent need for repeat intervention. The goal of this study was to determine the risk factors for type II endoleak following TEVAR for thoracic aortic aneurysms.

Artificial Intelligence Uncovers Natural MMP Inhibitor Crocin as a Potential Treatment of Thoracic Aortic Aneurysm and Dissection

Thoracic aortic aneurysm and dissection (TAAD) is a lethal cardiovascular condition without effective pharmaceutical therapy. Identifying novel drugs that target the key pathogenetic components is an urgent need. Bioinformatics analysis of pathological studies indicated “extracellular matrix organization” as the most significant functional pathway related to TAAD, in which matrix metallopeptidase (MMP) 2 and MMP9 ranked above other proteases. MMP1-14 were designated as the prototype molecules for docking against PubChem Compound Database using Surflex-Dock, and nine natural compounds were identified. Using a generic MMP activity assay and an aminopropionitrile (BAPN)-induced TAAD mouse model, we identified crocin as an effective MMP inhibitor, suppressing the occurrence and rupture of TAAD. Biolayer interferometry and AI/bioinformatics analyses indicated that crocin may inhibit MMP2 activity by direct binding. Possible binding sites were investigated. Overall, the integration of artificial intelligence and functional experiments identified crocin as an MMP inhibitor with strong therapeutic potential.

The Results of the Use of the Technique of Switching the Vessels of the Aortic Arch in the Formation of the Avascular Zone of Stent-Graft Fixation in the Hybrid Treatment of Thoracic Aortic Aneurysms

Thoracic and aortic aneurysms, including Stanford type B and neither A nor B aneurysms, are a complex problem for cardiac surgery. For a long time, the treatment of this pathology was carried out through the open method, which was associated with high hospital mortality. Hybrid and endovascular treatment have significantly reduced the number of complications and improved in-hospital mortality, although such methods are associated with specific difficulties, the study and elimination of which is an urgent issue at the present stage of cardiac surgery.&#x0D; The aim. To analyze the immediate and first long-term results of treatment of type B and non-A non-B aortic dissection through the hybrid method with the formation of avascular zone of proximal fixation of the stent-graft in the aortic arch, i.e. “landing zone”.&#x0D; Materials and methods. For the period from January 1, 2016 to December 31, 2019 at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine 122 patients underwent surgical treatment for type B and non-A nonB aortic dissection, of whom 57 (46.7%) patients underwent hybrid intervention involving the formation of a “landing zone”, i.e. an avascular section of the aortic arch to fix the stent-graft. Stent-graft was implanted in Z0 in 5 (8.8%) cases, in Z1 in 24 (42.1%) cases, and in Z2 in 28 (49.1%) cases. The stent-grafts used were Lifetech Ankura (41 cases), Relay (12 cases), and Medtronic Valiant (4 cases). The main causes of pathology were type B acute aortic aneurysm (11 [19%]), type B subacute aortic aneurysm (4 [7%]), type B chronic aortic aneurysm (30 [53%]), penetrating aortic ulcer (1 [2%]), primary parietal thrombosis of the aortic lumen (1 [2%]), postcoarctation aortic aneurysm (8 [14%]), thoracic aortic aneurysm (3 [5%]).&#x0D; Results. The total number of complications was 11 (19% of cases). Among the types of operations, the number of complications was evenly distributed, 5/28 (18%) were observed in partial debranching, 5/27 (19%) in subtotal debranching and 1/2 (50%) in total debranching. Hospital mortality was 3/122 (5.3%).&#x0D; Conclusions. The described methods of treatment of aneurysms of the arch and descending aorta have real prospects for development due to minimal invasiveness, reduction of the duration of surgery and time spent in the clinic, and significantly lower in-hospital mortality compared to traditional “open” surgery.

Endovascular (TEVAR) Versus Open Surgical Repair For The Management Of Unruptured Thoracic Aortic Aneurysms In Patients With Marfan's Syndrome

<h3>INTRODUCTION AND OBJECTIVES</h3> Treatment of thoracic aortic aneurysms (TAA) in patients with Marfan's syndrome has classically involved open repair; however, emerging data suggest similar efficacy between endovascular (TEVAR) approaches and conventional surgery. As there are limited data regarding this population, we compare 5-year morbidity and mortality rates after TEVAR versus open repair for unruptured TAA in Marfan's patients. <h3>METHODS</h3> Study timeframe was 1 January, 2010-31 December 2020. We used the TriNetX database to identify patients with Marfan's syndrome who had undergone TEVAR, as well as a propensity score-matched cohort of patients who had undergone open repair for first instance unruptured TAA. We compared postoperative mortality, reintervention, and complication rates using Kaplan-Meier estimates and Cox models over a 5-year follow up period. <h3>RESULTS</h3> Before matching, outcomes of 58 TEVAR patients were compared with 297 open repair patients. At 5 years, total reintervention rate, reintervention via endovascular technique, and paraplegia were more common in the TEVAR group. After matching for age, sex, and past cardiovascular surgery, only total reintervention rate and endovascular reintervention remained higher in the TEVAR group; <b>Tables 1</b> and <b>2</b>. Incidence of mortality, aortic dissection, limb ischemia, and renal failure was similar between groups. <h3>CONCLUSIONS</h3> Complications were common in patients undergoing TEVAR and open repair. Although reintervention via endovascular technique was more frequent in patients treated initially with TEVAR, incidence of mortality and other adverse outcomes were similar between groups. As endovascular approaches advance, further research is needed to better elucidate the role of TEVAR in treating TAAs in patients with Marfan's syndrome.