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Acute aortic dissection

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https://www.readbyqxmd.com/read/28100966/total-arch-versus-hemiarch-replacement-for-type-a-acute-aortic-dissection-a-single-center-experience
#1
Antonio Lio, Francesca Nicolò, Emanuele Bovio, Andrea Serrao, Jacob Zeitani, Antonio Scafuri, Luigi Chiariello, Giovanni Ruvolo
We retrospectively evaluated early and intermediate outcomes of aortic arch surgery in patients with type A acute aortic dissection (AAD), investigating the effect of arch surgery extension on postoperative results. From January 2006 through July 2013, 201 patients with type A AAD underwent urgent corrective surgery at our institution. Of the 92 patients chosen for this study, 59 underwent hemiarch replacement (hemiarch group), and 33 underwent total arch replacement (total arch group) in conjunction with ascending aorta replacement...
December 2016: Texas Heart Institute Journal
https://www.readbyqxmd.com/read/28099082/therapeutics-targeting-drivers-of-thoracic-aortic-aneurysms-and-acute-aortic-dissections-insights-from-predisposing-genes-and-mouse-models
#2
Dianna M Milewicz, Siddharth K Prakash, Francesco Ramirez
Thoracic aortic diseases, including aneurysms and dissections of the thoracic aorta, are a major cause of morbidity and mortality. Risk factors for thoracic aortic disease include increased hemodynamic forces on the ascending aorta, typically due to poorly controlled hypertension, and heritable genetic variants. The altered genes predisposing to thoracic aortic disease either disrupt smooth muscle cell (SMC) contraction or adherence to an impaired extracellular matrix, or decrease canonical transforming growth factor beta (TGF-β) signaling...
January 14, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/28097197/early-coronary-thrombosis-without-st-segment-elevation-following-repair-of-acute-aortic-dissection
#3
Davide Carino, Francesco Nicolini, Giorgio Romano, Matteo Ricci, Tiziano Gherli
Acute coronary thrombosis after emergent surgery for acute Type A aortic dissection is a rare event that can remain undiagnosed in absence of typical electrocardiogram readings. We report a case of left anterior descending artery thrombosis without ST-segment elevation three days after surgical repair, which was successfully treated with angioplasty and stenting.
August 2016: Aorta (Stamford, Conn.)
https://www.readbyqxmd.com/read/28097193/axillary-versus-femoral-arterial-cannulation-during-repair-of-type-a-aortic-dissection-an-old-problem-seeking-new-solutions
#4
Sotiris C Stamou, Derek Gartner, Nicholas T Kouchoukos, Kevin W Lobdell, Kamal Khabbaz, Edward Murphy, Robert C Hagberg
BACKGROUND: The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute Type A aortic dissection with axillary or femoral artery cannulation. METHODS: A total of 305 patients from five academic medical centers underwent acute Type A aortic dissection repair via axillary (n = 107) or femoral (n = 198) artery cannulation between January 2000 and December 2010. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups...
August 2016: Aorta (Stamford, Conn.)
https://www.readbyqxmd.com/read/28093462/predictors-and-impact-of-massive-bleeding-in-acute-type-a-aortic-dissection
#5
Igor Zindovic, Johan Sjögren, Henrik Bjursten, Erik Björklund, Erik Herou, Richard Ingemansson, Shahab Nozohoor
OBJECTIVES: Bleeding complications associated with acute type A aortic dissection (aTAAD) are a well-known clinical problem. Here, we evaluated predictors of massive bleeding related to aTAAD and associated surgery and assessed the impact of massive bleeding on complications and survival. METHODS: This retrospective study of 256 patients used Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART) criteria to define massive bleeding, which was met by 66 individuals (Group I) who were compared to the remaining patients (Group II)...
January 15, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28073667/enlargement-of-aortic-arch-vessels-after-surgical-repair-of-type-a-aortic-dissection
#6
Takashi Yamauchi, Suguru Kubota, Toshihiro Ohata, Kosei Hasegawa, Hideki Ueda
BACKGROUND: Information on the growth rate of the diameter of the residual dissected supra-aortic trunk after surgical repair of type A aortic dissection is limited. METHODS: We retrospectively reviewed 95 consecutive postsurgical patients with type A aortic dissection (acute, 91; chronic, 4) between 2005 and 2016 who were followed up with computed tomography. The diameter of the residual dissected supra-aortic trunk was measured by axial images and multiplanar reformatting, and the growth rate was calculated...
January 7, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28073571/early-clinical-outcomes-of-a-novel-self-expanding-transapical-transcatheter-aortic-valve-bioprosthesis
#7
Michael W A Chu, Rodrigo Bagur, Katie L Losenno, Philip M Jones, Pantelis Diamantouros, Patrick Teefy, Jill J Gelinas, Bob Kiaii
OBJECTIVE: Coronary obstruction remains a challenging complication of transcatheter aortic valve replacement; however, a new self-expanding transapical prosthesis may reduce this risk. The purpose of this study was to evaluate the early 1-year outcomes of patients with low coronary heights who received the Acurate TA bioprosthesis (Symetis, Ecublens, Switzerland). METHODS: Between May 2014 and April 2015, 30 consecutive patients (aged 85 ± 6 years, 63% were female, Society of Thoracic Surgeons score 8...
December 15, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28071727/plasma-amino-acid-profile-in-patients-with-aortic-dissection
#8
Linlin Wang, Sha Liu, Wengang Yang, Haitao Yu, Li Zhang, Ping Ma, Peng Wu, Xue Li, Kenka Cho, Song Xue, Baohong Jiang
Aortic dissection (AD), a severe cardiovascular disease with the characteristics of high mortality, is lack of specific clinical biomarkers. In order to facilitate the diagnosis of AD, we investigated plasma amino acid profile through metabolomics approach. Total 33 human subjects were enrolled in the study: 11 coronary heart disease (CHD) patients without aortic lesion and 11 acute AD and 11 chronic AD. Amino acids were identified in plasma using liquid chromatography and mass spectrometry (LC-MS/MS), and were further subjected to multiple logistic regression analysis...
January 10, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28070203/a-pilot-observational-study-on-magnesium-and-calcium-imbalance-in-elderly-patients-with-acute-aortic-dissection
#9
E Vianello, E Dozio, A Barassi, G Sammarco, L Tacchini, M M Marrocco-Trischitta, S Trimarchi, M M Corsi Romanelli
BACKGROUND: Magnesium (Mg) and calcium (Ca) are the principal essential elements involved in endothelial cell homeostasis. Extracellular changes in the levels of either alter endothelial contraction and dilatation. Consequently Mg and Ca imbalance is associated with a high risk of endothelial dysfunction, the main process observed during acute aortic dissection (AAD); in this clinical condition, which mainly affects elderly men, smooth muscle cell alterations lead to intimal tears, creating a false new lumen in the media of the aorta...
2017: Immunity & Ageing: I & A
https://www.readbyqxmd.com/read/28065489/chronobiology-of-acute-aortic-dissection-in-the-marfan-syndrome-from-the-national-registry-of-genetically-triggered-thoracic-aortic-aneurysms-and-cardiovascular-conditions-and-the-international-registry-of-acute-aortic-dissection
#10
Hasan K Siddiqi, Steven N Luminais, Dan Montgomery, Eduardo Bossone, Harry Dietz, Arturo Evangelista, Eric Isselbacher, Scott LeMaire, Roberto Manfredini, Dianna Milewicz, Christoph A Nienaber, Mary Roman, Udo Sechtem, Michael Silberbach, Kim A Eagle, Reed E Pyeritz
Marfan syndrome (MFS) is an autosomal dominant connective tissue disease associated with acute aortic dissection (AAD). We used 2 large registries that include patients with MFS to investigate possible trends in the chronobiology of AAD in MFS. We queried the International Registry of Acute Aortic Dissection (IRAD) and the Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC) registry to extract data on all patients with MFS who had suffered an AAD. The group included 257 patients with MFS who suffered an AAD from 1980 to 2012...
December 2, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/28065240/endovascular-repair-for-acute-type-b-aortic-dissection
#11
Wei Ye, Chang-Wei Liu, Xiao-Jun Song, Yong-Jun Li, Bao Liu, Yue-Hong Zheng, Rong Zeng
Objective To report experience and result of endovascular repair for acute type B aortic dissection (ATBD). Methods Totally 125 ATBD patients receiving endovascular repair with stent-graft were enrolled in this study. Demographic data,operation details,perioperative findings,and follow-up results were retrospectively analyzed. Results All the 125 patients were successfully implanted with 135 stent-grafts. Thirteen cases were covered left subclavian artery,16 cases underwent left subclavian artery revascularization,and 10 cases underwent visceral artery revascularization...
December 20, 2016: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
https://www.readbyqxmd.com/read/28062620/application-of-cardiac-troponin-in-cardiovascular-diseases-other-than-acute-coronary-syndrome
#12
REVIEW
Kai M Eggers, Bertil Lindahl
BACKGROUND: Increased cardiac troponin concentrations in acute coronary syndrome (ACS) identify patients with ongoing cardiomyocyte necrosis who are at increased risk. However, with the use of more precise assays, cardiac troponin increases are commonly noted in other cardiovascular conditions as well. This has generated interest in the use of cardiac troponin for prognostic assessment and clinical management of these patients. In this review, we have summarized the data from studies investigating the implications of cardiac troponin concentrations in various acute and chronic conditions beyond ACS, i...
January 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28062548/modified-frozen-elephant-trunk-for-acute-type-a-aortic-dissection-a-comparative-study-with-standard-repair-technique
#13
Peter Matt, Prerana Banerjee, Martin Grapow, Florian Rueter, Ulrich Schurr, Martin Siegemund, Jens Fassl, Oliver Reuthebuch, Friedrich Eckstein
OBJECTIVES: We hypothesized that antegrade open stent graft implantation in the descending aorta during acute type A aortic dissection surgery is safe and improves patient outcome compared with the standard repair technique. METHODS: Hundred and forty-one consecutive patients underwent surgery for acute type A aortic dissection at our institution from 2010 to 2016. Of those, 104 patients underwent ascending aorta and hemiarch repair under hypothermic circulatory arrest with antegrade cerebral perfusion (standard group)...
January 5, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28045241/evidence-for-and-risks-of-endovascular-treatment-of-asymptomatic-acute-type-b-aortic-dissection
#14
Rachel E Clough, Christoph A Nienaber
Acute aortic dissection is a challenging disease to manage. Type B aortic dissection has traditionally been divided temporally into acute and chronic cases but more recently this classification has been modified to include a sub-acute phase. Computed tomography is the imaging technique used most frequently in diagnosis and management. Active management of blood pressure is essential and should include beta-blockade unless contra-indicated. In-hospital outcomes are generally acceptable in patients with medically managed acute uncomplicated type B aortic dissection, with up to 90% of patients surviving to hospital discharge but by 5-years up to 50% of patients are dead with a significant proportion dying from aortic rupture...
January 3, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28040765/classification-and-outcomes-of-extended-arch-repair-for-acute-type-a-aortic-dissection-a-systematic-review-and-meta-analysis
#15
REVIEW
Holly N Smith, Munir Boodhwani, Maral Ouzounian, Richard Saczkowski, Alexander J Gregory, Eric J Herget, Jehangir J Appoo
OBJECTIVES: Distal extent of repair in patients undergoing surgery for acute Type A aortic dissection (ATAAD) is controversial. Emerging hybrid techniques involving open and endovascular surgery have been reported in small numbers by select individual centres. A systematic review and meta-analysis was performed to investigate the outcomes following extended arch repair for ATAAD. A classification system is proposed of the different techniques to facilitate discussion and further investigation...
December 31, 2016: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28034631/emergency-endovascular-management-of-acute-thoracic-aortic-pathology-a-safe-and-feasible-option
#16
Z Ahmed, S M McHugh, A Elmallah, M P Colgan, A O'Callaghan, S M O'Neill, P Madhavan, Z Martin
Endovascular repair has revolutionised the emergency treatment of thoracic aortic disease. We report our 10 year experience using this treatment in emergency cases. A prospectively maintained vascular database was analysed. Patients' medical records and CT images stored on the hospital PACS system were also reviewed. Statistical analysis was done using IBM SPSS V21. There were a total of 59 thoracic aortic stenting procedures of which 33 (60% males with a mean age of 58 yrs) were performed for emergency thoracic pathologies: traumatic transection (n = 10), ruptured aneurysm (n = 6), non-traumatic dissection (n = 8) and penetrating aortic ulcer (n = 9)...
December 27, 2016: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
https://www.readbyqxmd.com/read/28018832/limited-distal-arch-open-stenting-for-type-b-aortic-dissection-with-an-enlarged-ulcer-like-projection-complicated-by-abdominal-aortic-occlusion
#17
Mitsumasa Hata, Kenji Akiyama, Yukihiko Orime
A 79-year-old man underwent bifurcated graft replacement for abdominal aortic aneurysm, but the graft was totally occluded owing to an acute type B aortic dissection. We could not have access to the root for performing endovascular stenting for dissecting aneurysm. Furthermore, it was difficult to remove the aneurysm via a left thoracotomy because it was impossible to perfuse the lower body with blood from the femoral artery and also a left axillary arterial cannulation was unusable. Herein, we report a patient who was successfully treated with open surgical aortic stenting for an enlarged ulcer-like projection complicated by a type B aortic dissection...
December 2016: Thoracic and Cardiovascular Surgeon Reports
https://www.readbyqxmd.com/read/28018831/endovascular-and-operative-treatment-of-the-aortic-arch-in-a-high-risk-marfan-patient
#18
Marwan Hamiko, Matthias Endlich, Wolfgang Schiller, Armin Welz, Georg Nickenig, Chris Probst
In this case, we describe a combined endovascular and operative management for aortic arch repair in a 57-year-old Marfan patient with complex aortic arch geometry previously treated with several open surgeries for acute type A dissection. The patient, who was presented to our department with dorsal pain, deemed to be at high operative risk for another open aortic surgery due to massive aortic calcification. It is an unusual method of placing a custom-made stent-graft system in the false aortic lumen with operative and endovascular treatment of the supra-aortic vessels...
December 2016: Thoracic and Cardiovascular Surgeon Reports
https://www.readbyqxmd.com/read/28017673/outcome-after-surgery-for-acute-aortic-dissection-influence-of-preoperative-antiplatelet-therapy-on-prognosis
#19
Raphaelle Avigael Chemtob, Hasse Moeller-Soerensen, Lene Holmvang, Peter Skov Olsen, Hanne Berg Ravn
OBJECTIVES: Outcome in patients with acute coronary syndrome (ACS) is improved with dual antiplatelet therapy (DAPT). Patients with acute aortic dissection type A (AAD) often present with similar symptoms and may therefore be prescribed DAPT before diagnosis. The aim of this study was to evaluate the use of antiplatelet therapy (APT) prior to AAD surgery and patient outcome, including indications according to the European Society of Cardiology's (ESC) recent guidelines. DESIGN: A retrospective, observational study...
October 11, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28017277/outcomes-after-surgery-for-acute-type-a-aortic-dissection-in-non-marfan-syndrome-patients-with-long-life-expectancy-a-24-year-follow-up
#20
Alessandro Piccardo, Tommaso Regesta, Alexandre Le Guyader, Nicola Di Lorenzo, François Bertin, Francis Pesteil, Elisabeth Cornu
BACKGROUND: Long-term survival and risk of reoperation in "non-Marfan syndrome" patients with a long life expectancy who undergo emergency surgery for acute type A aortic dissection (aTAAD) are not well known. AIM: To analyse survival, risk of reoperation and quality of life in this population. METHODS: From 1990 to 2010, all patients aged≤50 years and not affected by Marfan syndrome, who underwent emergency surgery for aTAAD at two institutions, were included in this analysis...
December 21, 2016: Archives of Cardiovascular Diseases
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