AORTA最新文献

{"title":"Preoperative Risk-assessment Score for Elective Total Aortic Arch Repair: AAORTA Risk Tool.","authors":"Michael Tyler Guinn, Travis J Miles, Veronica A Glover, Susan Y Green, Lynna H Nguyen, Ginger M Etheridge, Lauren K Barron, Anna H Xue, Vicente Orozco-Sevilla, Subhasis Chatterjee, Marc R Moon, Joseph S Coselli","doi":"10.1055/a-2965-6246","DOIUrl":"10.1055/a-2965-6246","url":null,"abstract":"<p><strong>Objective: </strong>Total transverse aortic arch replacement is a complex operation performed to address aortic aneurysm with and without chronic aortic dissection. To predict 90-day survival after this procedure, we created a holistic tool for predicting postoperative mortality in patients who undergo total arch repair (TAR): the Aortic Arch Operation Risk Tool for Assessment (AAORTA) score.</p><p><strong>Methods: </strong>Univariate and multivariate analyses were performed on data from patients (<i>N</i>=470; 243 with nondissecting aneurysm, 227 with chronic Type A dissection) who underwent TAR at a high-volume practice between April 2006 and November 2024. Regression analysis identified variables to be used in the AAORTA score. The predictive performance of the score was assessed with the area under the receiver operating characteristic curve (AUROCC), Brier score, and linear fitting.</p><p><strong>Results: </strong>Of 470 patients who underwent TAR, 65 (13.8%) died within 90 days of repair. The AAORTA score relied on five preoperative variables: heritable thoracic aortic disease, prior coronary artery bypass grafting (CABG), kidney disease, pulmonary disease (restrictive or obstructive), and no history of smoking. Previous CABG was the strongest predictor of 90-day mortality. The AAORTA score had an AUROCC of 0.784, a Brier score of 0.105, and a goodness-of-fit <i>R</i> ² of 0.954.</p><p><strong>Conclusion: </strong>The AAORTA score can accurately stratify 90-day mortality risk in patients who undergo elective TAR, using only five variables easily acquired during standard preoperative evaluation. This score could be used to aid preoperative counseling with patients and families. Prospective multicenter validation will help establish its generalizability.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"14 CP","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186023","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":"Marfan Syndrome versus Loeys-Dietz Syndrome after Aortic Surgery: A Systematic Review and Meta-analysis of Reconstructed Time-to-Event Data.","authors":"Johannes Fischer, Steve Wehner, Ayodeji Arobo, Abdullah Almehandi, Felipe S Passos, Christian Eitel, Hristo Kirov, Xander Jacquemyn, Ibrahim Sultan, Torsten Doenst, Tulio Caldonazo","doi":"10.1055/a-2965-6400","DOIUrl":"10.1055/a-2965-6400","url":null,"abstract":"<p><strong>Objective: </strong>Marfan syndrome (MFS) and Loeys-Dietz syndrome (LDS) are hereditary connective tissue diseases, both characterized by aortic root and vessel involvement with an increased risk of aneurysms and dissections. Despite advances in surgical techniques and improved postoperative follow-up, the impact of surgery on long-term outcomes in these patient groups is still unknown.</p><p><strong>Methods: </strong>We performed a systematic review and a meta-analysis to compare the postoperative long-term events. The main outcome was long-term survival. Additional outcomes were freedom from dissection and reoperation. After reconstruction of time-to-event data for the individual survival analysis, pooled Kaplan-Meier curves for the endpoints were generated.</p><p><strong>Results: </strong>A total of 1,794 studies were identified, of which 5 were included in the analysis, encompassing 1,005 patients (MFS: 778; LDS: 227). With MFS as the reference group, there was no significant difference in long-term survival between both groups, based on age (hazard ratio [HR]: 0.919; 95% confidence interval [CI]: 0.58-1.45; <i>p</i>=0.717) or postoperative follow-up (HR: 0.997; 95% CI: 0.45-2.19; <i>p</i>=0.995). However, LDS was associated with higher risk of dissection (HR: 0.331; 95% CI: 0.21-0.53; <i>p</i><0.005) and reoperation (HR: 0.603; 95% CI: 0.40-0.90; <i>p</i>=0.014), reflecting unadjusted comparisons reconstructed from Kaplan-Meier curves.</p><p><strong>Conclusion: </strong>Although long-term survival is similar between MFS and LDS patients, those with LDS face a significantly higher risk of aortic dissection and reoperation. This elevated risk may be partly explained by the intrinsic genotypic heterogeneity of the LDS population. However, our pooled analysis could not fully adjust for this heterogeneity, underscoring the need for vigilant lifelong imaging surveillance and individualized surgical thresholds in LDS.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"14 CP","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138282","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":"Early Single-Center Experience with the Ascyrus Medical Dissection Stent in Acute Type A Aortic Dissection Repair.","authors":"Raymond Shi, Mathew Doyle, Jada Ching, Bruce French","doi":"10.1055/a-2934-2828","DOIUrl":"https://doi.org/10.1055/a-2934-2828","url":null,"abstract":"<p><strong>Background: </strong>Acute Type A aortic dissection (ATAAD) is a cardiac surgical emergency associated with high rates of mortality and morbidity. The Ascyrus Medical Dissection Stent (AMDS) is a novel hybrid device that has demonstrated promise in stabilizing the aortic arch, eliminating distal anastomosis new reentry tears and improving malperfusion syndromes. This report examines early outcomes of ATAAD patients treated with the AMDS device compared with a sole hemiarch repair.</p><p><strong>Methods: </strong>This retrospective study included all patients who underwent emergency surgery for computed tomography confirmed ATAAD at our center from January 2024 to November 2025. Iatrogenic, subacute, and chronic dissections were excluded from the study as were patients who received any form of arch surgery.</p><p><strong>Results: </strong>Six patients received the AMDS device and hemiarch, whereas 18 patients received a hemiarch repair only. A 30-day mortality was 16.7 and 22.2% in the AMDS and hemiarch cohorts, respectively (<i>p</i>>0.99). The 30-day stroke rate was 50 and 27.8% in the AMDS and hemiarch cohorts, respectively (<i>p</i>=0.36). Mean intensive care unit length of stay was 11 days in both cohorts, whereas hospital length of stay was 20 and 18 days in the AMDS and hemiarch cohorts, respectively.</p><p><strong>Conclusion: </strong>This study has demonstrated the relative safety of the AMDS device when used as an adjunct to the standard hemiarch repair in the management of ATAAD patients. Long-term outcome data are required to determine the extent of the positive aortic remodeling effect of the AMDS device and its impact on aortic reintervention and survival.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"14 CP","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13494682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801502","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":"Successful Management of Acute Type A Aortic Dissection in a 305 kg Patient Using Two Oxygenators in Parallel.","authors":"Joseph C Sweeney, Andrew A Tully, Gabriel E Cambronero, Lorrie P Graf, Matthew D Lee, Steven C Eastlack, Adrian L Lata","doi":"10.1055/a-2926-8670","DOIUrl":"10.1055/a-2926-8670","url":null,"abstract":"<p><strong>Abstract: </strong>Patient factors can present formidable challenges in emergent aortic surgery. We report successful mechanical aortic root, ascending aorta, and Zone 2 arch replacement under hypothermic circulatory arrest in a 305 kg patient with acute type A aortic dissection. A dual-oxygenator bypass circuit, proactive metabolic management, bilateral fasciotomies, and early renal replacement therapy were critical to a favorable outcome.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"14 CP","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714615","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":"Circumferential False Lumen Exclusion: A Technique for Indirect Cannulation of a Dissected Innominate Artery in Acute Type A Aortic Syndromes.","authors":"Merih Yilmaz, Ahmet Baltalarli, Abdullah Gokhun Alpua","doi":"10.1055/a-2915-3215","DOIUrl":"10.1055/a-2915-3215","url":null,"abstract":"<p><strong>Abstract: </strong>Indirect innominate artery (IA) cannulation provides important advantages of central arterial inflow and antegrade cerebral perfusion in proximal aortic surgery but is often avoided when the artery is dissected. We describe a stepwise technique enabling indirect cannulation of a dissected IA through circumferential false lumen exclusion and adventitia-true lumen reapproximation. In nine patients with dissected IA undergoing this approach, cannulation was successfully achieved without in-hospital mortality or permanent neurological deficit.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"14 CP","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13492304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714621","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":"Aortic Arch Pseudoaneurysm with Porcelain Aortic Arch and Triple-Vessel Coronary Artery Disease: Single-Stage Total Arch Replacement with Coronary Artery Bypass Grafting.","authors":"Harikrishnan Radhakrishnan, Amitabh Satsangi, Kanmaniyan Bala, Shruti Jobalia, Arindam Choudhury, Harsh Anand Singh","doi":"10.1055/a-2915-2888","DOIUrl":"10.1055/a-2915-2888","url":null,"abstract":"<p><strong>Abstract: </strong>Porcelain aortic arch with coronary artery disease poses a major surgical challenge. We report a 66-year-old man with a large arch pseudoaneurysm, circumferential arch calcification, left common carotid artery thrombosis, and triple-vessel coronary disease who underwent single-stage total arch replacement with coronary artery bypass grafting. Surgery utilized axillary and femoral cannulation, hypothermic circulatory arrest, and selective antegrade cerebral perfusion. Complete recovery followed a transient postoperative neurological deficit, demonstrating feasibility of tailored open repair.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"14 CP","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13492306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674651","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":"Frozen Elephant Trunk versus Ascyrus Medical Dissection Stent in Acute Type A Aortic Dissection: Choosing the Appropriate Arch Strategy.","authors":"Sunil Ohri, Amit Modi, Sanjay Asopa, Geoffrey Tsang","doi":"10.1055/a-2915-3346","DOIUrl":"10.1055/a-2915-3346","url":null,"abstract":"<p><strong>Abstract: </strong>Optimal management of the aortic arch during repair of acute type A aortic dissection remains debated. Hemiarch repair can achieve acceptable early survival, but persistent false lumen perfusion and residual distal dissection may contribute to later distal aortic enlargement or reintervention in a subset of patients. The frozen elephant trunk (FET) technique aims to improve distal aortic remodeling by covering intimal tears, expanding the true lumen, and promoting false lumen thrombosis, but it adds operative complexity because it requires more extensive arch reconstruction and supra-aortic vessel management. The Ascyrus Medical Dissection Stent (AMDS), an uncovered nitinol stent, has emerged as an adjunct to hemiarch repair. It is intended to reduce distal anastomotic new entry tears, support true lumen expansion, and facilitate distal aortic stabilization without formal total arch replacement. Contemporary evidence from the DARTS and PERSEVERE studies and observational series suggests that FET and AMDS may serve different operative goals in selected patients, although their roles are overlapping rather than mutually exclusive. FET may be more suitable when more extensive distal arch or proximal descending aortic pathology is present, whereas AMDS may be considered when a less extensive arch procedure is desired in the setting of arch instability or malperfusion. Neither approach should be viewed as universally superior. Instead, strategy should be individualized on the basis of patient age, intimal tear location, malperfusion status, operative risk, and institutional experience. AMDS may represent an additional option in selected high-risk patients.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"14 CP","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581066","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":"Acute Aortic Wall Stress Response to Handgrip Exercise in Aneurysmal versus Nondilated Ascending Thoracic Aortas.","authors":"Rachel J Skow, Stephen J Foulkes, Richard B Thompson, Devyn Walesiak, Christopher Weinkauf, David Niederseer, Michael Sean McMurtry, Mark J Haykowsky","doi":"10.1055/a-2875-3346","DOIUrl":"10.1055/a-2875-3346","url":null,"abstract":"","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"14 CP","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018837","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":"Surgical and Endovascular Management of Pseudoaneurysms of the Ascending Aorta and Aortic Root: Operative Strategies and Long-Term Outcomes.","authors":"Rafat Abu Ghannam, Gal Aviel, Noa Oren, David Planer, Gabby Elbaz-Greener, Ori Wald, Amit Korach","doi":"10.1055/a-2875-3047","DOIUrl":"10.1055/a-2875-3047","url":null,"abstract":"<p><strong>Background: </strong>Ascending aortic and aortic root pseudoaneurysms are rare but potentially life-threatening complications, most commonly occurring after prior cardiac or aortic interventions. Management remains challenging and may require complex surgery or, in selected cases, endovascular therapy. We reported the experience of a single cardiovascular center in the management of aortic pseudoaneurysms.</p><p><strong>Methods: </strong>We retrospectively reviewed 12 consecutive patients treated for thoracic aortic pseudoaneurysms between August 2008 and November 2025. Demographic, perioperative, and follow-up data were obtained from the institutional Society of Thoracic Surgeons (STS) database. Descriptive statistics were used for baseline characteristics and outcomes. Overall survival was estimated using Kaplan-Meier analysis.</p><p><strong>Results: </strong>Mean patient age was 56 ± 14 years, and 83.3% were male. All patients had prior cardiac interventions. Five patients (41.6%) had infected pseudoaneurysms. Median pseudoaneurysm size was 6.55 cm. Ten patients underwent open surgical repair, and two underwent percutaneous treatment. Hospital mortality was 8.3%. Postoperative stroke occurred in 16.7%, acute kidney injury in 16.7%, and atrial fibrillation in 25%. Median follow-up was 28 months with overall mortality of 16.7%. Estimated survival at the end of follow-up was 85%. One late death occurred in a patient with candidemia and recurrent infection.</p><p><strong>Conclusion: </strong>Surgical repair of ascending aortic pseudoaneurysms can be performed with acceptable morbidity and mortality and is effective in most patients. Infected pseudoaneurysms remain particularly challenging. In carefully selected high-risk patients, endovascular approaches provide a feasible less-invasive alternative with reasonable mid-term outcomes.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"14 CP","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13307301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018814","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":"Clinical and Radiological Features of Type A Aortic Dissection: A Retrospective Observational Study-An Indian Perspective.","authors":"Amitabh Satsangi, Surabhi Puri, Sumanth Raghuprakash, V Devagourou","doi":"10.1055/a-2839-9907","DOIUrl":"10.1055/a-2839-9907","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Acute aortic dissection remains a hazardous and unpredictable condition. Although it is the most common acute aortic disease requiring surgical intervention, still up to 35% of patients are misdiagnosed on the initial presentation. Presentation of aortic dissection is protean, contributing to confusion in diagnosis and a delay in appropriate, timely intervention. Early and accurate diagnosis and treatment are crucial for survival. The clinical diagnosis of aortic dissection depends on awareness of the entity, keen clinical suspicion, and an understanding of its varied manifestations. Unfortunately, many patients die before they can receive hospital treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A total number of 208 patients diagnosed with Type A aortic dissection (TAAD) and operated on in our center from June 2014 to June 2019 were included in the study. After review of the medical records of 178 patients, data were available for 162 patients. The aim was to delineate presentation patterns, various clinical manifestations, and radiological features of Stanford TAAD. Univariate analysis was used to provide frequency distribution and percentage distribution of qualitative demographic and comorbidity variables. Mean ± standard deviation was reported, whereas for non-normally distributed quantitative variables, median ± (min-max) was reported. Data analysis was performed using the Statistical Package for Social Sciences, version 18.0 (SPSS, Chicago, IL).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 162 patient records were reviewed; 131 (80.8%) patients were male, and 31 (19.2%) were female. The mean age of all patients was 43.3 years (± 13.49). A total of 146 patients (90.1%) had TAAD, and 16 patients (9.8%) had chronic TAAD. Severe pain was the most common presenting symptom, and 88.9% of patients reported chest pain. Four patients (2.7%) had renal malperfusion, and 23 (14%) had lower limb ischemia, with three having bilateral lower limb ischemia. Five patients had cerebrovascular accidents of new onset on presentation. Chest radiography showed mediastinal widening in 143 patients (88.8%). Two-dimensional (2D) echocardiography patients (87%) had dilated ascending aortas, with dissection flaps seen in 131 (81.4%) patients. Computed tomography (CT) dimensions-aortic valve annulus mean diameter was 31.5 mm (± 7.1), with the maximum diameter being 50 mm and minimum diameter being 16 mm.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The clinical characteristics and radiological features of TAAD in the past 10 years in our center were analyzed. We also compared our data with those reported by International Registry for Aortic Dissection, Japan Registry of Aortic Dissection, and German Registry for Acute Aortic Dissection Type A. Acute chest pain was the most common presenting complaint. CT angiography was the investigation of choice, with TTE being a helpful supportive tool. The majority of our patients had TAAD despite ao","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"14 CP","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13334202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629108","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}