AORTA最新文献

{"title":"Evaluating Patient Outcomes and Access to Care in Aortic Surgery Based on Ethnicity and Social Vulnerability.","authors":"Ananya Shah, Adam M Carroll, Nicolas Chanes, Kyndall Hadley, Cenea Kemp, Bo Chang Brian Wu, Alejandro Suarez-Pierre, Jessica Rove, Catherine Velopulos, Muhammad Aftab, T Brett Reece","doi":"10.1055/a-2608-1346","DOIUrl":"https://doi.org/10.1055/a-2608-1346","url":null,"abstract":"<p><p>We previously demonstrated the impact of ethnicity on aortic surgery, with underrepresentation and greater acuity in minority patients, raising concerns regarding access to care. The Centers for Disease Control and Prevention's social vulnerability index (SVI) measure is increasingly used to quantify patient socioeconomic and demographic factors. This study expands on our prior work by incorporating SVI and ethnicity to analyze patient presentation and outcomes in aortic arch surgery.We utilized a single-institution database of patients who underwent total arch replacement or hemiarch repair between 2009 and 2022. A total of 837 patients were placed into five cohorts based on their self-reported race: African American, Asian, Caucasian, Hispanic, and Other, with further subdivision based on SVI (high social vulnerability, ≥75%, normal social vulnerability < 75%). Additional analyses were performed using SVI alone. We compared patient presentation, operative variables, and outcomes based on the above cohorts.African American and Hispanic patients were underrepresented compared with city demographics. High SVI and minority patients presented at younger ages (<i>p</i> = 0.007) with higher blood pressures (<i>p</i> = 0.002). These groups also had more urgent/emergent presentations (<i>p</i> < 0.001) with aortic dissections (<i>p</i> = 0.006). Operatively, high SVI groups had longer cardiopulmonary bypass (<i>p</i> = 0.018), cross-clamp (<i>p</i> = 0.020), and circulatory arrest times (<i>p</i> = 0.002) but fewer adjunctive procedures (<i>p</i> = 0.018). High SVI patients more often required total arch replacement (<i>p</i> = 0.048) and postoperative mechanical circulatory support (<i>p</i> = 0.025). After discharge, African Americans had more emergency department (ED) visits within a year (<i>p</i> < 0.001), although no significant differences were observed in readmission rates or cardiovascular follow-up.Underrepresented groups face barriers to care, as reflected in disparities in demographics, surgical acuity, and postdischarge ED usage. Analyses-based solely on ethnicity overlooked critical differences between normal and high SVI groups, emphasizing the need for care strategies that are both tailored to high SVI groups and racially sensitive applied across all levels of health care.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217493","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":"The Western Aortic Collaborative: Multi-institutional Aortic Surgery, Education, and Research.","authors":"Fenton H McCarthy, Christopher R Burke, Jason P Glotzbach, Michael P Fischbein, Anthony Caffarelli, Fernando Fleischman, T Brett Reece","doi":"10.1055/s-0045-1809344","DOIUrl":"https://doi.org/10.1055/s-0045-1809344","url":null,"abstract":"<p><p>The Western Aortic Collaborative (WAC) is a new, hybrid, multi-institutional academic model that seeks to perform aortic surgery research and education.The WAC has three fundamental thoracic aortic surgery goals: (1) advancing surgical techniques, (2) furthering education and development of aortic surgeons, and (3) performing multi-institutional clinical research. The WAC utilizes a hybrid model of annual in-person meetings at the Western Thoracic Surgical Association (WTSA) combined with videoconferencing platforms that regularly connect surgeons dispersed throughout the Western region. The structure of WAC is intentionally horizontal. The goal is to promote cross-pollination of ideas, techniques, and experiences between surgeons at different institutions.For its research goals, the WAC first identified the principal areas of aortic surgery with the greatest knowledge gaps and which of those knowledge gaps could best be addressed by institutional practice differences within WAC. Using this natural experiment design, five high-priority research topics from the aortic root to the left subclavian artery were created. In order to perform this subspecialized, multi-institutional research, the WAC created a novel, cloud-based database that piggybacks on the Society for Thoracic Surgeon database. The combined database also preserves the ability to generate subspecialized variables and to link with each institution's medical record system for semi-automated functionality.In its inaugural year, the WAC succeeded in its primary goals of utilizing remote technology platforms and the annual WTSA meeting to create a regional community of aortic surgeons with shared research and educational goals.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183613","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":"Intraoperative Autologous Blood Transfusion in Aortic Surgery.","authors":"Shao Feng Zhou, Akiko Tanaka, Anthony Estrera","doi":"10.1055/s-0045-1809172","DOIUrl":"https://doi.org/10.1055/s-0045-1809172","url":null,"abstract":"<p><p>Aortic surgeries are associated with intraoperative blood loss, often requiring allogeneic blood transfusion. Therefore, blood must be viewed as a scarce resource that carries risks and benefits. Many preoperative and perioperative interventions are likely to reduce bleeding and blood transfusion. Perioperative blood conservation strategies in cardiovascular surgery are highly recommended and often necessary. In 2019, nearly 11 million units of whole blood and red blood cell units and more than 2.2 million apheresis and whole blood-derived platelet units were transfused in the United States. Intraoperative autologous blood transfusion techniques include saving red blood cells with cell saver, sparing whole blood through the acute, normovolemic hemodilution techniques, reducing hemodilution with retrograde autologous priming on cardiopulmonary bypass, and protection and reservation of coagulation factors and platelets through autologous platelet-rich plasma techniques. More than 80% of blood transfusions occur within the first 24 hours after surgical incision-with most intraoperative blood transfusions occurring between postcardiopulmonary bypass and reversed heparin before surgical closing. Intraoperative autologous blood transfusion techniques remain an important method in blood conservation strategies in aortic surgeries. Intraoperative cell savers are considered a cost-effective tool for most cardiovascular procedures or other surgeries in which substantial blood loss is expected (>500 mL).</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112401","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":"Outcomes of a Standardized Protocol on the Management of Acute Type A Aortic Dissection: A Retrospective Cohort Study.","authors":"Supitchaya Philippoz, Dionysios Adamopoulos, Tornike Sologashvili, Mathieu van Steenberghe, Jalal Jolou, Christoph Huber, Mustafa Cikirikcioglu","doi":"10.1055/s-0045-1809170","DOIUrl":"https://doi.org/10.1055/s-0045-1809170","url":null,"abstract":"<p><p>Acute Type A aortic dissection (AAAD) is a life-threatening condition, with surgery being the recommended treatment. However, there is ongoing debate regarding the optimal surgical procedure. This study aimed to evaluate the impact of implementing a standardized protocol, introduced in our institution in 2016, on AAAD management.A retrospective cohort study was conducted involving patients treated surgically for AAAD between 2010 and 2021 in our department. Patients were divided into two groups: those who underwent surgery before 2016 using operator-dependent techniques, and those who underwent surgery starting in 2016 using a standardized protocol.A total of 104 patients were included in this study. The mean age was 66.5 ± 11.4 years and 55.8% were male. Demographics and preoperative data were similar in both groups. Arterial and venous cannulation site of both groups were different (<i>p</i> < 0.001): femoral artery and vein cannulation for group 1 versus subclavian artery and central venous canulation for group 2. Alone ascending aorta replacement versus ascending aorta plus hemiarch replacement were the preferred techniques in groups 1 and 2, respectively (<i>p</i> < 0.001). Hypothermic circulatory arrest and cerebral perfusion were largely performed in group 2 compared with group 1 (<i>p</i> < 0.001). The total time of surgery, the cardiopulmonary bypass, and aortic cross-clamping times were longer in group 2 (<i>p</i> < 0.05). Both groups had similar rates of postoperative complications, except for late reoperation and aortic dilatation rates, which were less frequent in group 2 (<i>p</i> < 0.05).The implementation of a standardized institutional protocol can transform AAAD surgery from a \"surgeon-tailored\" to a \" patient-tailored\" approach. The use of a standardized protocol in our institution resulted in a significant reduction of aortic reoperation and aortic dilation rates, suggesting that the introduction of standardized protocols in low-volume centers may improve AAAD management.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008107","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":"Management of Direct Oral Anticoagulants in Acute Type A Aortic Dissection.","authors":"Robert Semco, Thais Faggion Vinholo, Jake Awtry, Asishana Osho, Kim de la Cruz, Ashraf A Sabe","doi":"10.1055/a-2542-4290","DOIUrl":"https://doi.org/10.1055/a-2542-4290","url":null,"abstract":"<p><strong>Background: </strong>Direct oral anticoagulants (DOACs) are a commonly used class of anti-coagulants that may complicate surgical management of acute Type A aortic dissection (ATAAD).</p><p><strong>Methods: </strong> Surgical management and clinical courses were described for patients who presented to our institution with ATAAD while taking DOACs, after FDA approval of the two currently available reversal agents. A thorough literature review was completed for cases of administration of DOAC reversal agents in ATAAD.</p><p><strong>Results: </strong> The only patient treated with andexanet-alfa had heparin insensitivity while on cardiopulmonary bypass. Four other patients were successfully managed with a combination of surgical delay and factor repletion.</p><p><strong>Conclusion: </strong> This case series demonstrates that preoperative management of DOACs in patients with ATAAD may employ factor repletion with success. Literature review demonstrated a safety signal for heparin insensitivity or pump thrombosis when andexanet-alfa was administered before or while on cardiopulmonary bypass or extracorporeal membrane oxygenation. Our institutional clinical practice guidelines recommend against administration of andexanet-alfa within 4 to 6 hours before heparinization for surgery in ATAAD but recommend considering andexanet-alfa administration when there is life-threatening bleeding after heparin reversal that is thought to be due to Xa-inhibition with laboratory evidence of elevated anti-Xa activity.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065038","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":"High Flow, High-Pressure Retrograde Cerebral Perfusion at 28°C is Safe and Effective for Hemiarch Replacement of the Ascending Aorta.","authors":"R Wilson King, Adam M Carroll, Michal Schäfer, Zihan Feng, Jintong W Liu, George A Justison, Joseph C Cleveland, Jessica Y Rove, Muhammad Aftab, T Brett Reece","doi":"10.1055/a-2564-0323","DOIUrl":"https://doi.org/10.1055/a-2564-0323","url":null,"abstract":"<p><p>Traditional retrograde cerebral perfusion (RCP) parameters may be suboptimal for washout of debris during hemiarch replacement of the ascending aorta, so we have designed a protocol of increased RCP pressure and flow at moderate hypothermia. We hypothesize that higher RCP pressure is safe in neurological outcomes in cases utilizing circulatory arrest at 28°C in elective hemiarch replacement.A retrospective review of a single-institution prospective database was used to search for all patients with elective hemiarch surgery from 2015 to 2022. Two cohorts were created-patients who received RCP only during circulatory arrest at 28°C and patients who received selective antegrade cerebral perfusion (SACP) during circulatory arrest. Neurological and postoperative outcomes were compared. Arterial blood gas measurements during RCP were taken from the left carotid of 34 patients, which were compared with the arterial blood gas from the bypass circuit to ensure adequate oxygen extraction. Propensity score matching was used to adjust for perioperative indices and patient characteristics.A total of 248 patients were in the SACP cohort and 79 patients in the RCP cohort. The two groups were similar based on patient demographics and relevant comorbidities. The cohorts differed in nadir bladder temperature, circulatory arrest time, and cardiopulmonary bypass time. After propensity matching, nadir bladder temperature, circulatory arrest, and cardiopulmonary bypass times were similar. Neurological postoperative outcomes were similar in the unmatched and matched analysis. The median pressure in the RCP group during circulatory arrest was 40 mm Hg. The median change in oxygen from bypass circuit to the carotids is 398 mm Hg with a mean oxygen extraction of 93.3%.These data demonstrate that a more aggressive approach to RCP beyond traditional constraints at 28°C is safe for short periods of circulatory arrest. Even with the new RCP parameters and after adjusting for standard patient and perioperative characteristics, there is no difference between SACP and RCP in neurological outcomes. Further, adequate oxygen extraction is achieved during RCP.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056805","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":"A Rare Encounter: Incidental Ectopic Origin of the Right Pulmonary Artery in an Adult.","authors":"Rupali Jain, Maruti Kumaran, Achala Donuru","doi":"10.1055/a-2572-4238","DOIUrl":"https://doi.org/10.1055/a-2572-4238","url":null,"abstract":"<p><p>Ectopic origin of the right pulmonary artery (RPA) from the aorta is a rare congenital anomaly typically found in infants. We report an adult female presenting with shortness of breath diagnosed incidentally with ectopic RPA via computed tomography angiography. This case underscores the need to consider rare congenital anomalies in adults presenting with unexplained pulmonary symptoms.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991793","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":"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":"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":"108-116"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812931","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":"Evaluation of the Differences between Axial and Double Oblique Measurements of the Ascending Aorta on Gated, Contrast-Enhanced Thoracic Computed Tomography Scans: A Technical Note.","authors":"Paul Stark, Eric Y Chang","doi":"10.1055/a-2537-5390","DOIUrl":"https://doi.org/10.1055/a-2537-5390","url":null,"abstract":"<p><p>The purpose of the study was to compare axial measurements of the ascending thoracic aorta on gated CT study studies with double oblique measurements and calculate the divergence between orthogonal axial and double oblique diameters of the tubular ascending aorta.Retrospective measurements of axial and double oblique diameters were obtained in 153 consecutive patients.On average, the axial dimension exceeded the double oblique measurement.Our study endorsed the subtraction of 0.58 mm from the axial diameter in order to obtain the double oblique measurement.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"12 5","pages":"105-107"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058043","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":"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":"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":"122-125"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813018","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}