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Acute aortic dissection

Masaomi Gohbara, Tsutomu Endo, Kazuo Kimura, Kouichi Tamura
In cases involving unstable hemodynamics in patients with Stanford type-A acute aortic dissection involving left main trunk (LMT) compression, LMT stenting without antiplatelet agents may be a good option as a bridge to surgery.
October 2017: Clinical Case Reports
José M de Miguel-Yanes, Rodrigo Jiménez-García, Valentín Hernández-Barrera, Manuel Méndez-Bailón, Javier de Miguel-Díez, Ana Lopez-de-Andrés
BACKGROUND: Diabetes mellitus has long been associated with cardiovascular events. Nevertheless, the higher burden of traditional cardiovascular risk factors reported in high-income countries is offset by a more widespread use of preventive measures and revascularization or other invasive procedures. The aim of this investigation is to describe trends in number of cases and outcomes, in-hospital mortality (IHM) and length of hospital stay (LHS), of hospital admissions for major cardiovascular events between type 2 diabetes (T2DM) and matched non-diabetes patients...
October 10, 2017: Cardiovascular Diabetology
Jian Dong, Junmin Bao, Rui Feng, Zhiqing Zhao, Qingsheng Lu, Guokun Wang, Haiyan Li, Dingfeng Su, Jian Zhou, Qing Jing, Zaiping Jing
Acute aortic dissection (AAD) is a catastrophic emergency with high mortality and misdiagnosis rate. We aimed to determine whether circulating microRNAs allow to distinguish AAD from healthy controls and chest pain patients without AAD (CP). Plasma microRNAs expression were determined in 103 participants, including 37 AAD patients, 26 chronic aortic dissection patients, 17 healthy volunteers, 23 patients without AAD. We selected 16 microRNAs from microarray screening as candidates for further testing via qRT-PCR...
October 6, 2017: Scientific Reports
Stefania Marconi, Ettore Lanzarone, Hector De Beaufort, Michele Conti, Santi Trimarchi, Ferdinando Auricchio
INTRODUCTION: Predicting aortic growth in acute type B dissection is fundamental in planning interventions. Several factors are considered to be growth predictors in the literature and, among them, size and location of entry tears have been recognized to particularly influence the false lumen pressure. In this study, we develop an in vitro setting to analyze the actual impact of size and location of the entry tears on false lumen pressure, in the absence of other confounding factors such as the deformability of the aortic wall...
September 28, 2017: International Journal of Artificial Organs
Magnus Larsen, Santi Trimarchi, Himanshu J Patel, Marco Di Eusanio, Kevin L Greason, Mark D Peterson, Rossella Fattori, Stuart Hutchison, Nimesh D Desai, Amit Korach, Daniel G Montgomery, Eric M Isselbacher, Christoph A Nienaber, Kim A Eagle, Kristian Bartnes, Truls Myrmel
OBJECTIVES: The recommended extent of surgical resection and reconstruction of the arch in acute DeBakey Type I aortic dissection is an ongoing controversy. However, several recent reports indicate a trend towards a more extensive arch operation in several institutions. We have analysed the recent data from the International Registry of Acute Aortic Dissection to assess the choice of procedure over time and to evaluate the surgical outcome in a 'real-world' database. Our aim was to compare short- and mid-term outcomes of limited repairs versus complete arch surgery...
July 12, 2017: European Journal of Cardio-thoracic Surgery
Kentaro Tamura, Genta Chikazawa, Arudo Hiraoka, Toshinori Totsugawa, Taichi Sakaguchi, Hidenori Yoshitaka
OBJECTIVES: Distal anastomotic new entry (DANE) is considered to be one of the causes of patent false lumen (PFL) after acute type I aortic dissection repair. However, there have been few articles with regard to this important issue. We assessed the influence of PFL caused by DANE on long-term outcomes. METHODS: One hundred twenty-two patients underwent emergency surgery for acute type I aortic dissection (2007-12). The in-hospital mortality was 8% (10 patients)...
July 17, 2017: European Journal of Cardio-thoracic Surgery
Maximilian Kreibich, Tim Berger, Julia Morlock, Stoyan Kondov, Johannes Scheumann, Fabian A Kari, Bartosz Rylski, Matthias Siepe, Friedhelm Beyersdorf, Martin Czerny
OBJECTIVES: Our goal was to report our preliminary results in patients with acute complicated Type B aortic dissection without a suitable landing zone for primary thoracic endovascular aortic repair who were treated with the frozen elephant trunk (FET) technique. METHODS: Within a 25-month period, 14 patients with acute complicated Type B aortic dissection underwent surgical repair using the FET technique. The reasons to perform the FET procedure were an ectatic ascending aorta/arch in 6 patients and the lack of an adequate landing zone in 8 patients...
August 2, 2017: European Journal of Cardio-thoracic Surgery
Arnar Geirsson, Anders Ahlsson, Anders Franco-Cereceda, Simon Fuglsang, Jarmo Gunn, Emma C Hansson, Vibeke Hjortdal, Kati Jarvela, Anders Jeppsson, Ari Mennander, Shahab Nozohoor, Christian Olsson, Emily Pan, Anders Wickbom, Igor Zindovic, Tomas Gudbjartsson
OBJECTIVES: Acute Type A aortic dissection remains a life-threatening disease, but there are indications that its surgical mortality is decreasing. The aim of this report was to study how surgical mortality has changed and what influences those changes. METHODS: Nordic Consortium for Acute Type A Aortic Dissection is a retrospective database comprising 1159 patients (mean age 61.6 ± 12.2 years, 68% male) treated for acute Type A aortic dissection at 8 centres in Denmark, Finland, Iceland and Sweden from 2005 to 2014...
July 25, 2017: European Journal of Cardio-thoracic Surgery
Malakh Shrestha, Andreas Martens, Tim Kaufeld, Erik Beckmann, Sebastian Bertele, Heike Krueger, Julia Neuser, Felix Fleissner, Fabio Ius, Firas Abd Alhadi, Jasmin Hanke, Jan D Schmitto, Serghei Cebotari, Matthias Karck, Axel Haverich, Ajay Chavan
OBJECTIVES: Our goal was to present our 15-year experience (2001-2015) with the frozen elephant trunk (FET) technique. METHODS: A total of 251 patients (82 with aortic aneurysms, 96 with acute aortic dissection type A, 4 with acute type B dissections, 52 with chronic aortic dissection type A, 17 with chronic type B dissection and 67 redo cases) underwent FET implantation with either the custom-made Chavan-Haverich ( n  = 66), the Jotec E-vita ( n  = 31) or the Vascutek Thoraflex hybrid ( n  = 154) prosthesis...
August 1, 2017: European Journal of Cardio-thoracic Surgery
Hanghang Wang, Matthew Wagner, Ehsan Benrashid, Jeffrey Keenan, Alice Wang, David Ranney, Babatunde Yerokun, Jeffrey G Gaca, Richard L McCann, G Chad Hughes
BACKGROUND: The optimal surgical approach for management of acute type A aortic dissection remains controversial. This study aimed to assess outcomes of reoperation after acute type A dissection repair to help guide decision making around index operative strategy. METHODS AND RESULTS: All aortic reoperations (n=129) at a single referral institution from August 2005 to April 2016 after prior acute type A dissection repair were reviewed. The primary outcome was 30-day or in-hospital mortality...
October 3, 2017: Journal of the American Heart Association
Qian Zhang, Xiaochun Ma, Wenlong Zhang, Zhengjun Wang, Haizhou Zhang, Xiaofeng Zhang, Jian Song, Chengwei Zou
BACKGROUND: Aortic dissection (AD) represents a clinically uncommon aortic pathology which predicts a dismal prognosis if not promptly treated. In acute Debakey type I AD (ADIAD), aortic lesion extends from aortic root to even distal abdominal aorta among which aortic arch and its three main branches still remain a great surgical challenge for repair and reconstruction. Several decades have witnessed the painstaking efforts of cardiovascular surgeons across the globe for optimizing the surgical procedures, from total or hemi-arch replacement, "elephant trunk" technique to branched stent graft...
October 3, 2017: Journal of Cardiothoracic Surgery
Igor Zindovic, Johan Sjögren, Anders Ahlsson, Henrik Bjursten, Simon Fuglsang, Arnar Geirsson, Richard Ingemansson, Emma C Hansson, Ari Mennander, Christian Olsson, Emily Pan, Susann Ullén, Tomas Gudbjartsson, Shahab Nozohoor
BACKGROUND: Surgery for acute type A aortic dissection (ATAAD) is often complicated by excessive bleeding. Recombinant factor VIIa (rFVIIa) effectively treats refractory bleeding associated with ATAAD surgery; however, adverse effects of rFVIIa in these patients have not been fully assessed. Here we evaluated rFVIIa treatment in ATAAD surgery using the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database. METHODS: This was a multicenter, propensity score-matched, retrospective study...
August 24, 2017: Journal of Thoracic and Cardiovascular Surgery
Qiang Ji, Hao Lai, YongXin Sun, Zhe Luo, Lan Liu, Chen Liu, JiaWei Gu, YuLin Wang, WenJun Ding, ChunSheng Wang
To evaluate the impact of presurgical mild acute respiratory distress syndrome (ARDS) on surgical mortality in patients undergoing surgical repair of acute type A aortic dissection by means of deep hypothermic circulatory arrest (DHCA) in a single-center, retrospective study.From January 2011 to December 2015, 333 eligible patients were divided into either a mild-ARDS group (n = 136) or a no-ARDS group (n = 197). The definition of mild ARDS referred to the recent revision of ARDS definition (Berlin criteria)...
September 30, 2017: International Heart Journal
Jonathan M Hemli, Allan Mattia, Eden Payabyab, Yuriy Dudiy, S Jacob Scheinerman, Derek R Brinster
Arterial cannulation in acute DeBakey type I dissection can be difficult. Moreover, the residual dissected aorta is susceptible to further adverse events in the future. Implanting a stent-graft into the descending aorta during the initial dissection repair ('frozen elephant trunk') has been demonstrated to promote favourable aortic remodelling, mitigating some of these longer-term complications. We describe a technique for cannulation of the ascending aorta in acute dissection that facilitates expeditious antegrade deployment of a frozen elephant trunk...
September 15, 2017: Heart, Lung & Circulation
Carlos Ferrera, Isidre Vilacosta, Juan Carlos Gómez-Polo, Sara Villanueva-Medina, Beatriz Cabeza, Luis Ortega, Victoria Cañadas, Manuel Carnero-Alcázar, Isaac Martínez-López, Luis Maroto-Castellanos, Francisco Javier Serrano-Hernando
BACKGROUND: Although several hypotheses have been proposed, the true origin and pathogenesis of aortic intramural hematoma (IMH) remain unclear. Evolution of patients with aortic IMH is highly variable. Progression to classic aortic dissection, aneurysm or to complete resolution have been described. Our purpose was to assess in-hospital and mid-term evolution of patients with aortic IMH. METHODS: From 2000 to 2015, 40 patients with aortic IMH were prospectively and consecutively recruited in a tertiary care referral center...
September 20, 2017: International Journal of Cardiology
Bartosz Rylski
No abstract text is available yet for this article.
October 1, 2017: Interactive Cardiovascular and Thoracic Surgery
Eric E Roselli, Saad M Hasan, Jay J Idrees, Muhammad Aftab, Matthew J Eagleton, Venu Menon, Lars G Svensson
OBJECTIVES: The objectives are to (i) report characteristics and outcomes of patients with inoperable acute type A aortic dissection, (ii) describe proximal aortic morphology and (iii) identify potential for endovascular treatment of the entry tear. METHODS: Fifty-three (7.7%) of 686 patients with acute type A dissection between 2005 and 2015 were deemed inoperable. Chart review and active follow-up were performed for clinical characteristics and outcomes. Specific attention was directed at determining the reasons for inoperability...
October 1, 2017: Interactive Cardiovascular and Thoracic Surgery
Zhiyong Wu, Jinxing Chang, Wei Ren, Zhipeng Hu, Bowen Li, Huagang Liu
The pathogenesis of acute aortic dissection (AAD) complicated acute lung injury (ALI) is not currently well defined. At present, no effective animal model has been established for AAD complicated ALI, which hinders research and development of an appropriate treatment regimen for the concurrent conditions. The aim of the present study was to evaluate the therapeutic effects of bindarit (Bnd), an indazolic derivative, on the production of monocyte chemoattractant protein (MCP)-1 in angiotensin II (AngII)-induced complicated ALI in rats...
September 2017: Experimental and Therapeutic Medicine
Athanasios Antoniou, Ioannis Ntalas, Amit Gupta, Rizwan Attia
Iatrogenic acute aortic dissection during percutaneous coronary intervention is an extremely rare but critical complication. Although sealing the entry point with a coronary stent is an option to treat localized dissections, more extensive cases may require surgical intervention. We present a case of Type A aortic dissection that occurred during an angioplasty of a chronically occluded right coronary artery. Despite the extent of the dissection, a 'watch-and-wait' strategy was chosen, and repeated imaging a few days later revealed that the aorta had been remodelled to its normal anatomy...
September 12, 2017: European Journal of Cardio-thoracic Surgery
Bartosz Rylski, Camila Muñoz, Friedhelm Beyersdorf, Matthias Siepe, Diana Reser, Thierry Carrel, Florian Schoenhoff, Christian Schlensak, Mario Lescan, Hans-Henning Eckstein, Benedikt Reutersberg, Raimund Erbel, Rolf Alexander Janosi, Martin Czerny
OBJECTIVES: Thoracic endovascular aortic repair is the treatment of choice in complicated acute type B aortic dissection. How to infer predissection aortic diameter is not well understood. Our aim was to delineate changes in descending aortic geometry due to dissection. METHODS: Five tertiary centres reviewed their acute aortic dissection type B databases containing 802 patients. All patients who had undergone computed tomography angiography less than 2 years before and immediately after aortic dissection onset were included...
August 31, 2017: European Journal of Cardio-thoracic Surgery
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