AORTA最新文献

{"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":"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":"131-137"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065038","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":"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":"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}

{"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":"Urgent Removal of a Mobile Mass in the Ascending Aorta under Hypothermic Circulatory Arrest in a Patient with Acute Stroke: A Case Report.","authors":"Jenna E Aziz, Jesica Zvara, Cathy Burger, Shawn Sarin, Salim Aziz","doi":"10.1055/a-2536-4259","DOIUrl":"https://doi.org/10.1055/a-2536-4259","url":null,"abstract":"<p><p>A mobile mass in the ascending aorta is a rare cause for stroke. Detection is usually accomplished by Computed tomography angiography and/or echocardiography. In suitable patients, urgent surgical removal remains the best approach.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"12 5","pages":"117-121"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057753","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":"Sliding Rail Technique (Mandelli's), a Better Method to Repair Thoracoabdominal Aortic Aneurysms Controlled Release Fenestrated Endoprosthesis.","authors":"Nilo César Barbosa Mandelli, Felipe Figueiró Teixeira, Felipe do Couto Soares de Paula Barros, Laura Vicentini Correa Brunstein","doi":"10.1055/a-2541-8455","DOIUrl":"https://doi.org/10.1055/a-2541-8455","url":null,"abstract":"<p><p>Fenestrated endovascular aortic aneurysm repair is a minimally invasive technique used for the treatment of thoracoabdominal aortic aneurysms (TAAAs). We report an easy method for positioning the controlled-release fenestrated endoprosthesis, associated with a less invasive approach for positioning the endoprosthesis and catheterization of the target vessels through percutaneous access.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":"12 5","pages":"126-130"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039755","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":"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}