AORTA最新文献

{"title":"Aorta Wall Stress during Exercise in Patients with an Ascending Thoracic Aortic Aneurysm: Insights from a Case Series.","authors":"Mark J Haykowsky, Rachel J Skow, Stephen J Foulkes, Justin Grenier, John A Elefteriades, Richard B Thompson, M Sean McMurtry","doi":"10.1055/a-2558-4266","DOIUrl":"https://doi.org/10.1055/a-2558-4266","url":null,"abstract":"<p><p>Individuals with ascending thoracic aortic aneurysm (ATAA) are recommended to avoid intense exercise for fear of marked increases in aortic wall stress (AWS). However, no study has measured AWS during exercise. The aim of this case series was to examine AWS during \"light-to-moderate\" aerobic exercise in individuals with ATAA and healthy control (CON) participants.Three clinically stable patients with ATAA (2 male, mean age: 74 ± 1 years) and 3 CON (2 male, mean age: 69 ± 7 years) were studied on 2 separate days. Day 1: a maximal cardiopulmonary exercise test was performed to measure peak aerobic power (VO₂peak), maximal heart rate, and blood pressure (BP). Day 2: cardiac and aortic magnetic resonance imaging were performed at rest and during submaximal (3-5 metabolic equivalents) \"stepper\" exercise during which cardiac output (Qc), aorta diameters, wall thickness, and BP were measured. Circumferential ascending and descending AWS were calculated in accord with LaPlace Law, whereas aorta mechanical efficiency was derived as the AWS/Qc slope.Patients with ATAA demonstrated lower median VO₂peak (18.2 vs. 24.1 mL/kg/min). During exercise, the absolute ascending (ATAA: 257 vs. CON: 269 kPa) and descending AWS increased (ATAA: 224 vs. CON: 207 kPa), and ∆AWS during exercise was similar between ATAA and CON (Ascending, ATAA: 79 vs. CON: 62 kPa; Descending, ATAA: 64 vs. CON: 55 kPa). During exercise, ascending and descending AWS were 76 to 83% below ATAA rupture thresholds (i.e., 800-1,200 kPa) in all patients. Finally, exercise Qc was 17% lower and the ascending AWS/Qc slope was 30% higher in ATAA (16 kPa/L/min) versus CON (12 kPa/L/min).Our findings demonstrate \"light-to-moderate\" aerobic exercise produces similar AWS responses between ATAA and CON and is well below aneurysmal rupture thresholds. The higher AWS/Qc slope in ATAA suggests decreased aortic mechanical efficiency and may be a useful measure for exercise prescription for these patients.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reoperative Aortic Root Replacement in Patients with Prior Aortic Valve, Root Replacement, or Arch Replacement Surgery: A Single-Center Experience.","authors":"Toyokazu Endo, Jaimin R Trivedi, Priyadarshini Chandrashekhar, Michele Gallo, Erin M Schumer, Biran Ganzel, Mark S Slaughter, Siddharth Pahwa","doi":"10.1055/a-2542-4443","DOIUrl":"https://doi.org/10.1055/a-2542-4443","url":null,"abstract":"<p><p>This case series evaluated the characteristics and outcomes of reoperative root replacement in patients with prior aortic valve replacement (AVR), aortic root replacement (ARR), or ascending or hemiarch replacement (AoR) from our single institution from 2014 to 2023. A total of 55 (prior surgery: 38 AVR, 5 ARR, and 12 AoR) patients were identified and indication for reoperation included valvular stenosis, endocarditis, aneurysm, and dissection. Perioperative mortality was 10.9% (6 patients) (inpatient complications: 2 stroke, 4 bleeding event, 2 renal failure, and 21 prolonged vent).</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed Paraplegia after Complex Repair of Thoracic Aortic Dissection.","authors":"Daniel Nguyen, Scott S Berman, Luis R Leon","doi":"10.1055/a-2524-4880","DOIUrl":"10.1055/a-2524-4880","url":null,"abstract":"<p><p>Spinal cord ischemia (SCI) is a well-known complication of both open and endovascular repair of the thoracoabdominal aorta. Perioperative maneuvers to increase spinal cord perfusion, including permissive hypertension and lumbar drain placement to control spinal pressure, are commonly used to reduce the risk of SCI. Additional perioperative measures to reduce the susceptibility of the spinal cord to ischemic insult include hypothermia, steroids, and naloxone infusion. Most cases manifest immediately or within days of surgery and improve with the aforementioned maneuvers. We describe a rare occurrence of delayed SCI 20 months after thoracic endovascular aortic aneurysm repair.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"94-97"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Cohort Study Comparing Different Cannulation Strategies in Type A Aortic Dissection Surgery: 20-year Single-Center Experience in a Referral Center.","authors":"Nicolas Nunez-Ordonez, Julian Senociain, Juan Pablo Umaña, Andres Felipe Amado-Olivares, Carlos Andrés Villa, Carlos Obando, Jaime Camacho","doi":"10.1055/s-0045-1802993","DOIUrl":"10.1055/s-0045-1802993","url":null,"abstract":"<p><p>Type A aortic dissection as a highly lethal disease continues being a great challenge for cardiac surgeons worldwide. There are still unanswered questions regarding intraoperative decisions and their impact on the surgical outcomes. The aim of this study is to compare postoperative outcomes according to site of cannulation in patients with acute Type A aortic dissection (ATAAD).This was a retrospective cohort study. We included all ATAAD procedures from January 2002 to November 2023. We defined groups according to site of cannulation (aorta, axillary, femoral, innominate). Data from pre-, intra-, and postoperative variables were collected. Our main outcomes were spinal cord injury (SCI), stroke rate, and in-hospital mortality. Between-group comparisons were performed using standard statistical tests and post hoc tests adjusting for multiple comparisons were performed.We identified 127 ATAAD procedures. Reoperation for bleeding was significantly higher in the femoral cannulation group (75%, <i>p</i> = 0.0006). There were no statistically significant differences in acute kidney injury rate (<i>p</i> = 0.012), SCI rate (<i>p</i> = 0.78), or in-hospital mortality (<i>p</i> = 0.75). Our data suggest that there is a lower stroke rate in the axillary cannulation group (3.6%, <i>p</i> = 0.4), which did not reach statistical significance.Choosing an adequate cannulation site is a critical step in TAAD surgery. In our series, axillary and innominate cannulation were the preferred methods with relatively low complication rates.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"80-85"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical Injury of Thoracic Aorta by Elephant Trunk Graft Limb following Frozen Elephant Trunk Procedure.","authors":"Jayakumar Thanathu Krishnan Nair, Dinesh Kumar Sathanantham, Nidheesh Chooraiyil, Vinitha V Nair, Jeevan J Jose","doi":"10.1055/a-2536-4098","DOIUrl":"10.1055/a-2536-4098","url":null,"abstract":"<p><p>The frozen elephant trunk (FET) has been a mainstay in the treatment of acute as well as chronic aortic dissections. Although various complications have been reported in the literature, rupture of the descending thoracic aorta by the endovascular graft has, to our knowledge, not been published. We report an FET procedure following previous valve-sparing root replacement for Type A aortic dissection leading to rupture of the descending thoracic aorta.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"98-101"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The TRAIN Health Awareness Clinical Trial: Baseline Findings and Cardiovascular Risk Management in Aortic Dissection Patients.","authors":"Nora Bacour, Simran Grewal, Aytug U Tirpan, Rutger Theijse, Olivia Van Erp, Robert J M Klautz, Natzi Sakalihasan, Rebecka Hultgren, Nimrat Grewal","doi":"10.1055/a-2524-4772","DOIUrl":"10.1055/a-2524-4772","url":null,"abstract":"<p><p>Acute Type A aortic dissection (ATAAD) is a life-threatening condition requiring timely surgical intervention. Despite successful surgery, postoperative outcomes are frequently suboptimal due to the high frequency of cardiovascular risk factors. This study examines baseline cardiovascular risk factors in a population of ATAAD patients in the Netherlands. Additionally, this study outlines the protocol for a randomized controlled trial, designed to improve postoperative management.Baseline data were collected from patients with ATAAD. Data were gained through the Stichting Aorta Dissectie Nederland, a Dutch association for aortic dissection patients. The data included information on cardiovascular risk factors and health-related quality of life. A survey was further conducted, to gain more insights into the ATAAD postoperative care experiences of cardiac and vascular surgeons.Among the 50 ATAAD patients in our study, we found significant cardiovascular risk factors, including smoking (36.7%), obesity (34.2%), and hypertension (51.3%). In the surgeon survey (<i>N</i> = 48), 84% of respondents highlighted the significance of lifestyle changes for patients, underscoring the need for individualized risk management. These findings underscore the need for tailored postoperative management programs aimed at improving patient outcomes.The results of our study highlight that ATAAD patients require comprehensive postoperative care management strategies. The ultimate goal is to enhance long-term patient outcomes and improve health-related quality of life. To address this need, the TRAIN (Targeted caRdiovAscular rIsk reductioN) Health Awareness platform seeks to implement personalized eHealth-based lifestyle interventions.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"86-93"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late Giant Aortic Pseudoaneurysm Following Iatrogenic Aortic Dissection.","authors":"Amritanshu Sinha, Metesh Nalin Acharya, Giovanni Mariscalco","doi":"10.1055/s-0045-1802990","DOIUrl":"10.1055/s-0045-1802990","url":null,"abstract":"<p><p>Aortic pseudoaneurysm occurs in 10 to 24% of patients after acute type A aortic dissection repair. We report the case of a 72-year-old female who developed an intraoperative iatrogenic ascending aortic dissection following mitral valve repair. A giant ascending aortic pseudoaneurysm was detected on follow-up imaging. This case emphasizes the importance of close radiological surveillance following acute aortic dissection repair.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"102-104"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innominate Artery Translocation with Hemiarch Replacement Strategy for Acute Type A Aortic Dissection: a Single-Center Study.","authors":"Amarit Phothikun, Nutthayuth Kanokkavinvong, Weerachai Nawarawong, Noppon Taksaudom, Surin Woragidpoonpol","doi":"10.1055/s-0044-1795129","DOIUrl":"10.1055/s-0044-1795129","url":null,"abstract":"<p><strong>Background: </strong> Aggressive surgical methods for acute type A aortic dissection (ATAD) can cause extended operating times and postoperative complications. less extensive techniques may increase the risk of needing further aortic reintervention. To prevent the need for extensive aortic arch surgery and subsequent re-sternotomy, hemiarch replacement (HAR) with innominate artery (a.) translocation is performed to create a suitable proximal landing zone for future endovascular repair.</p><p><strong>Methods: </strong> Retrospective study of 112 patients with ATAD who underwent aortic surgery from January 2009 to December 2020. Forty-one patients underwent HAR with innominate artery translocation, 16 underwent total arch replacement (TAR), and 55 underwent only HAR. Multivariable Cox regression and logistic regression analyses were used to study the outcomes and risk factors.</p><p><strong>Results: </strong> The TAR group had a higher incidence of postoperative acute kidney injury. The overall mortality rate of the TAR group was 25%, compared with 20% in the HAR group and 14.6% in the translocation group. The 5-year overall survival rates for the groups were 81.9%, 75.0%, and 77.7%, respectively. False lumen thrombosis at the aortic arch and descending aorta level were factors associated with reduced mortality in both univariable and multivariable analyses. The translocation group had a significantly higher reintervention rate of 41.5% compared with the TAR and HAR groups, with rates of 31.3% and 16.4%, respectively. The median reintervention time for the translocation group was 4.72 years.</p><p><strong>Conclusion: </strong> Despite the innominate translocation technique having a higher reintervention rate, it had similar mortality outcomes to HAR and TAR. Thus, it could be a more convenient option for reintervention, including creating a proximal landing zone, which could benefit patients needing endovascular repair.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"60-69"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Early and Late Malperfusion Syndrome in Acute Type B Aortic Dissection with Retrograde Extension Using Hybrid Zone 2 Arch Repair and Thoracic Endovascular Aortic Repair: A Case Report.","authors":"Daniela Votano, Hector W L de Beaufort, Rob H W van de Mortel, Uday Sonker, Robin H Heijmen, Hans G Smeenk","doi":"10.1055/s-0045-1802992","DOIUrl":"10.1055/s-0045-1802992","url":null,"abstract":"<p><p>The distal extent of aortic repair in acute aortic dissection and the management of malperfusion in terms of timing and strategy are still debated topics. We present a case of acute type B dissection with retrograde extension to the ascending aorta, with the most proximal intimal tear in the descending thoracic aorta, associated with both early lower extremity and delayed mesenteric malperfusion syndrome, treated effectively by femoral artery open fenestration and hybrid zone 2 arch repair.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"74-76"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Life after Type A Aortic Dissection Surgery in the United Kingdom: The QUADS Study.","authors":"Brianda Ripoll, Adeyemi Olayiwola, Sanjeev Kalra, Aidil Syed, Massimo Capoccia, Shaheen Ahmed, Marinos Koulouroudias, Ioan Mocanu, Stephen Clark, Indu Deglurkar, Walid Elmahdy, Jonathan Hyde, Niki Nicou, Nawar Al Attar, Alexander Cale, Mahmoud Loubani, Aung Ye Oo, Ana Lopez-Marco","doi":"10.1055/s-0045-1802991","DOIUrl":"10.1055/s-0045-1802991","url":null,"abstract":"<p><strong>Background: </strong> Acute Type A aortic dissection (TAAD) is a life-threatening condition that carries significant mortality and morbidity; a proportion of the survivors might require further aortic procedures in the mid-/long-term follow-up. Quality of life (QoL) after TAAD is not well studied. Quality of life after Type A Aortic Dissection Surgery (QUADS) is the first multicentre study to assess QoL in survivors of surgically treated TAAD.</p><p><strong>Methods: </strong> A tailored questionnaire for survivors of TAAD was designed with patient and public involvement. Patients who underwent surgery from 2018 to 2022 in eight United Kingdom centres were invited to participate. Preoperative, intraoperative, and postoperative prospectively collected data were collated and analyzed retrospectively. The data were analyzed with SPSS v29. Patient's questionnaire was validated with a Cronbach's alpha analysis, exploratory factor analysis, and AMOS confirmatory factor analysis. Three groups were created according to QoL (Good, Fair, Poor).</p><p><strong>Results: </strong> A total of 162 patients were recruited. Majority were male with a mean age of 63 years (24-92). Surgical procedures for TAAD were root and ascending aorta replacement (<i>n</i> = 61, 38%), ascending (<i>n</i> = 81, 50%), and/or arch replacement (<i>n</i> = 20, 12%). Eleven patients (7%) required later intervention. Patient's answers regarding overall QoL were good (<i>n</i> = 67, 41%), fair (<i>n</i> = 89, 55%), and poor (<i>n</i> = 6, 4%). Neurological complications, circulatory arrest duration, reoperation for bleeding, postoperative myocardial infraction, arrhythmias, wound infection, and patient destination at discharge have been identified as main variables impacting on QoL after TAAD surgery across different domains of this questionnaire.</p><p><strong>Conclusion: </strong> QUADS questionnaire is the first tailored and validated questionnaire for TAAD survivors. Results in the United Kingdom population suggest that it is a useful tool to assess QoL after TAAD surgery.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":"50-59"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}