Smaller Hospital Size is Associated With Higher Mortality in Stanford Type A Aortic Dissection.

BACKGROUND: Stanford Type A Aortic Dissection (TAAD) is associated with high in-hospital mortality and the need for immediate surgical intervention. Larger hospital size may be associated with better patient care and surgical outcomes. This study aimed to examine the effect of hospital size on TAAD outcomes. METHOD: Patients who underwent TAAD repair were identified in National Inpatient Sample (NIS) from Q4 2015-2020. NIS stratifies hospital size into small, medium, and large based on the number of hospital beds, geographical location, and the teaching status of the hospitals. Patients admitted to small/medium and large hospitals were stratified into two cohorts. Multivariable logistic regressions were performed to compare in-hospital outcomes, adjusted for demographics, comorbidity, primary payer status, and hospital characteristics including procedural volume. RESULTS: There were 1106 and 3752 TAAD admitted to small/medium and large hospitals, respectively. Among patients admitted to small/medium hospitals, there was higher mortality (17.27% vs 14.37%, aOR = 1.32, P < 0.01), but shorter length of stay (P < 0.01) and lower cost (P = 0.03) compared to larger hospitals. There was no difference in morbidities. CONCLUSIONS: Marked higher mortality is associated with admission to smaller hospitals among patients with TAAD, which may in turn decrease the average hospital stay and cost. Given that a significant percentage of patients are already being transferred out of the initial hospital and small/medium hospital is associated with higher mortality, centralization of care in centers of excellence may decrease the high mortality associated with TAAD.

Risk factors for postoperative hepatic dysfunction in overweight patients with acute type A aortic dissection.

BACKGROUND: Acute hepatic dysfunction (AHD) is a common postoperative complication in patients with acute type A aortic dissection. The aim of this study was to identify risk factors for acute hepatic dysfunction after surgery for acute type A aortic dissection. METHODS: We performed a retrospective study from March 1, 2019, to February 28, 2021. The primary endpoints of this study were morbidity due to AHD and risk factors for incidence. Univariate analysis and multivariate logistic regression analysis were used to analyse the related factors, and receiver operating characteristic (ROC) curves were plotted to evaluate their predictive value. RESULTS: Among 147 patients, 29 (19.73%) developed postoperative acute hepatic dysfunction, and 9 (6.12%) died. Univariate analysis revealed that the ALT (P = 0.042), Cr (P < 0.001), and BUN (P = 0.008) levels were significantly different between the two groups. Multivariate logistic regression analysis revealed that Cr (OR = 1.013, 95% CI = 1.003-1.023, P = 0.008) was an independent risk factor for postoperative hepatic dysfunction in overweight (BMI > 24) patients with ATAAD. The area under the ROC curve (AUC) for Cr was 0.745 > 0.7, indicating good predictive value. CONCLUSION: A high Cr concentration is an independent risk factor for postoperative AHD in overweight (BMI > 24) patients with ATAAD.

Patients undergoing emergent surgery for type A intramural hematomas or type A aortic dissections have similar outcomes.

OBJECTIVE: Despite key differences in pathological processes, both Intramural Hematomas and Aortic Dissections are Acute Aortic Syndromes repaired with similar surgical technique. The objective of this study was to determine differences in surgical outcomes between patients with Intramural Hematoma versus Type A Aortic Dissection undergoing Ascending Aortic Arch repair. METHODS: This retrospective review of prospectively collected data included all patients with acute Intramural Hematoma or Type A Aortic Dissection who underwent emergent Ascending- or Arch Repair from January 2018 to May 2023 at a single academic institution. Primary outcomes included intraoperative mortality, 30-Day mortality, and postoperative stay. Secondary outcomes included postoperative complications. Outcomes were analyzed using Chi-squared, Fisher's Exact, and t-tests, with significance set at p < 0.05. RESULTS: A total of 107 patients were included, 27 of whom (25%) had Intramural Hematoma and 80 (75%) had Type A Aortic Dissection. There were no differences in preoperative characteristics such as age, gender, and comorbidities, and no differences in perioperative characteristics such as case length, cardiopulmonary bypass, aortic cross-clamp, and circulatory arrest times. When comparing postoperative outcomes, there was a higher rate of postoperative pericardial effusions requiring pericardial window in the Intramural Hematoma cohort compared to the Aortic Dissection cohort (15% [n = 4] vs. 3% [n = 2]; p = 0.02). There were no differences in other primary outcomes such as intraoperative mortality, 30-Day mortality, and postoperative length of stay. There were also no differences in the rates of postoperative complications such as bleeding requiring reoperation, cerebrovascular accident, atrial fibrillation, pleural effusion requiring thoracentesis, and surgery-related Emergency Department visits. CONCLUSIONS: Our analysis demonstrates similar outcomes for patients undergoing Ascending Aortic Arch repair between patients with Intramural Hematoma and Type A Aortic Dissection. Despite the higher rate of required postoperative pericardial windows in the Intramural Hematoma cohort, the overall primary outcomes remained comparable. These findings better elucidate the standard of care for patients with acute Intramural Hematoma undergoing Ascending Aortic Arch repair.

Type a aortic dissection after aortic wrapping performed 26 years ago: a case report.

BACKGROUND: Aortic wrapping (AW) has been performed as a less invasive alternative to aortoplasty. However, AW can also cause long-term aortic complications. In this report, we present a rare case of a dissecting aortic aneurysm between the proximal side of the wrap and the sinotubular junction after AW. CASE PRESENTATION: A female patient had undergone urgent aortic valve replacement with a 19-mm mechanical valve to treat infective endocarditis and AW to treat an enlarged ascending aorta 26 years prior. At the age of 71 years, the patient was diagnosed with a dissecting aortic aneurysm between the proximal side of the wrap and the sinotubular junction. We performed graft replacement of the ascending aorta, including complete resection of the wrap. The patient was discharged on postoperative day 10, and there have been no cardiovascular events during her ongoing follow up. CONCLUSIONS: AW in younger patients can lead to late aortic complications. Careful consideration should be paid when performing AW in young patients, and patients who have previously undergone AW require strict life-long follow-up.

Long-term outcomes of frozen elephant trunk for aortic dissection: a single-center experience.

BACKGROUND: To date a number of papers analysing outcomes of the frozen elephant trunk (FET) in acute aortic dissection has been published. However, there are limited comparative studies on long-term outcomes of FET in acute and chronic aortic dissection. The objective of the study was to analyze the long-term outcomes after FET procedure for aortic dissection (AD). METHODS: Between March 2012 and December 2022, a total of 123 FET had been performed for thoracic aortic disease. Patients with aortic dissection (n = 97) were divided into 2 groups: acute (n = 32, 33%) and chronic aortic dissection (n = 65, 67%). Pre-, intra- and postoperative data were retrospectively collected from electronic patient's records, including follow-up data of the analyzed patients. RESULTS: The incidence of stroke was 3.1%. The delirium rate was up to 9.3% in both groups with a prevalence in chronic aortic dissection (CAD) group without significant differences (P = 0.494). Paraplegia was diagnosed only in CAD patients (n = 2). Respiratory failure and the rate of renal replacement therapy were similar in the studied groups. Re-sternotomy was required in one (3.1%) patient with acute AD and 5 (7.7%) patients with chronic AD (P = 0.416). Overall 30-day mortality in the entire cohort, acute and chronic AD was 13 (13.4%), 7 (21.9%) and 6 (9.2%), respectively (P = 0.097). The overall survival rate at 60 months for the entire cohort, acute and chronic AD was 64.1 ± 5.9%, 62.3 ± 9.1%, 66.5 ± 7%, respectively (P = 0.265). Freedom from unintended distal aortic re-intervention at 60 months for the entire cohort of patients, acute and chronic AD was 74.2 ± 1.5%, 100%, 65.3 ± 2%, respectively (P = 0.355). CONCLUSIONS: Our experience showed acceptable long-term outcomes after the FET procedure including mortality and re-intervention rate in patients with aortic dissection regardless of acuity of the dissection. TRIAL REGISTRATION: The study has been registered in Australian and New Zealand Clinical Trial Registry (ACTRN 12618001329257) on August 7, 2018.

Clinical effects of hybrid debranching technique for acute Stanford type A aortic dissection.

BACKGROUND: To investigate the clinical effects and safety of the hybrid debranching technique for patients with acute Stanford type A aortic dissection (AD). METHODS: One hundred nine patients with acute Stanford type a AD were selected and divided into observation group and control group according to the different surgical methods. Fifty-five patients in the observation group were treated with hybrid debranching, and 54 patients in the control group were treated with Sun's operation. The operation duration, clamp time, cardiopulmonary bypass duration, volume of blood transfusion, ventilator application duration, duration of stay in the intensive care unit, aortic rupture, second thoracotomy due to hemorrhage, gastrointestinal hemorrhage, stroke, paraplegia, renal failure, and all-cause mortality were recorded. Postoperative follow-up was conducted. The number of cases that underwent follow-up and the number of cases with complete thrombosis of the false aneurysm cavity detected by computed tomography angiography (CTA) was recorded. RESULTS: The surgical success rate was 100% in both groups, and there were no cases with unplanned secondary surgery. Compared with the control group, only the difference in the volume of blood transfusion was not significantly significant between the two groups (P = 0.052), while the rest of the observation indicators were significantly lower in the observation group than in the control group (P < 0.001 for all). The proportion of cases with complete thrombosis of the false aneurysm cavity was significantly higher in the observation group than in the control group at 3 and 6 months after surgery (P < 0.05). CONCLUSION: In patients with acute Stanford type A AD involving the arch, the hybrid debranching technique was safe and effective. It was recommended for patients with advanced age and a high risk of intolerance to deep hypothermic circulatory arrest.

Quantitative Electroencephalography Monitoring in Type A Aortic Dissection Surgery: A Clinical Case Review and Prospective Applications.

PURPOSE: This review explores advanced methods for assessing perioperative cerebral function in Type A aortic dissection (TAAD) patients, with a focus on quantitative electroencephalography (QEEG). It highlights the critical issue of cerebral malperfusion, which is associated with higher mortality and poor prognosis during the perioperative phase in TAAD patients. METHOD: The review centers on the utilization of QEEG as a pivotal tool for the extensive monitoring of brain function at various stages: preoperatively, intraoperatively, and postoperatively. It elaborates on the foundational principles of QEEG, including the mathematical and computational analysis of electroencephalographic signals, enriched with intuitive graphical representations of cerebral functional states. FINDING: QEEG is presented as an innovative approach for the real-time, noninvasive, and reliable assessment of cerebral function. The review details the application of QEEG in monitoring conditions such as preoperative cerebral malperfusion, intraoperative deep hypothermic circulatory arrest, and postoperative recovery of cerebral function in patients undergoing TAAD treatment. CONCLUSION: Although QEEG is still in an exploratory phase for TAAD patients, it has shown efficacy in other domains, suggesting its potential in multimodal brain function monitoring. However, its broader application requires further research and technological advancements.

Preoperative clinical characteristics and risk assessment in Sun's modified classification of Stanford type A acute aortic dissection.

OBJECTIVES: This study aims to retrospectively analyze the clinical features of Stanford type A acute aortic dissection (TAAAD) based on Sun's modified classification, and to investigate whether the Sun's modified classification can be used to assess the risk of preoperative rupture. METHODS: Clinical data was collected between January 2018 and June 2019. Data included patient demographics, history of disease, type of dissection according to the Sun's modified classification, time of onset, biochemical tests, and preoperative rupture. RESULTS: A total of 387 patients with TAAAD who met the inclusion criteria of Sun's modified classification were included. There were more complex types, with 75, 151 and 140 patients in the type A1C, A2C and A3C groups, respectively. The age of the entire group of patients was 51.46 ± 12.65 years and 283 (73.1%) were male. The time from onset to the emergency room was 25.37 ± 30.78 h. There were a few cases of TAAAD combined with stroke, pericardial effusion, pleural effusion, and lower extremity and organ ischemia in the complex type group. The white blood cell count (WBC), neutrophil count (NEC) and blood amylase differed significantly between the groups. Three independent risk factors for preoperative rupture were identified: neutrophil count, blood potassium ion level, and platelet count. Binary logistic regression analysis showed that the Sun's modified classification could not be used to assess the risk of preoperative rupture in TAAAD. CONCLUSION: TAAAD was classified as the complex type in most patients. WBC, NEC and blood amylase were significantly different between the groups. NEC and serum potassium ion level were independent risk factors for preoperative rupture of TAAAD, while platelet count was its protective factor. More samples are needed to determine whether Sun's modified classification can be used to evaluate the risk of preoperative rupture.

Redo aortic arch repair using trifurcated hybrid prosthesis after failed Ascyrus medical dissection stent treatment.

BACKGROUND: The management of acute type A aortic dissection (ATAAD) using the Ascyrus Medical Dissection Stent (AMDS) can lead to complications due to the persistence of the false lumen (FL). This case report presents two instances of failed AMDS treatment for ATAAD, highlighting the novel use of a trifurcated hybrid prosthesis for redo aortic arch repair using a minimally invasive frozen elephant trunk (FET) technique. CASE PRESENTATION: Case 1: A 57-year-old male, previously treated with AMDS for ATAAD, presented with an enlarging aortic arch and persistent FL two years post-surgery caused by re-entry in the distal aortic arch. Redo surgery using the FET technique with an E-vita OPEN NEO Trifurcated hybrid prosthesis resulted in successful repair and partial FL thrombosis. Case 2: A 51-year-old male with prior AMDS treatment for ATAAD presented with severe aortic valve regurgitation and a maintained FL perfusion due to a residual re-entry in the proximal region of the descending aorta. Redo surgery using the FET technique with the same hybrid prosthesis led to successful repair and good recovery, confirmed by follow-up imaging. CONCLUSIONS: The use of the E-vita OPEN NEO Trifurcated hybrid prosthesis in the FET technique offers a promising solution for redo aortic arch repair in cases of failed AMDS treatment for ATAAD. This approach can improve patient outcomes by addressing complications associated with persistent FL and enhancing long-term survival.

INFLAMMATORY FACTORS IN DISSECTION OF THORACIC AORTIC ANEURYSM.

In recent years, the prevalence of thoracic aortic aneurysm has increased, and in most cases this pathological condition is diagnosed accidentally. The aim of the current study was to determine the relationship of clinical, laboratory and morphological data with the presence of aorta wall dissection in patients with thoracic aortic aneurysm to reveal factors associated with aorta dissection. MATERIALS AND METHODS: The following data of 109 patients mean aged of 53 years with thoracic aortic aneurysm (43 patients with aortic dissection) were analyzed: presence/absence of arterial hypertension, indicators of general blood analysis and blood biochemistry, immunomorphological characteristics of the expression of Von Willebrand factor. RESULTS: Statistically significant differences were found between the incidence of arterial hypertension with respect to the presence or absence of aortic dissection (p=0.002), the relationship between the content of lymphocytes (p=0.021), segmented neutrophils (p=0.001) and the presence of Von Willebrand factor in the medial layer of the aorta, i.e., the prevalence of vasa vasorum (p=0.018), with aortic dissection. The average expression area of Willebrand factor in the medial layer of the aorta during dissection was 3.6 (1.5)%, and in patients without aortic dissection - 0.8 (0.3)%. CONCLUSION: The results of the study indicate that aortic dissection in patients with thoracic aortic aneurysm is associated with high blood pressure and is accompanied by the development of an inflammatory reaction.

Monocytes perturbation implicated in the association of stress hyperglycemia with postoperative poor prognosis in non-diabetic patients with Stanford type-A acute aortic dissection.

OBJECTIVES: The study aimed to investigate the interaction of intraoperative stress hyperglycemia with monocyte functions and their impact on major adverse events (MAEs) in acute aortic dissection (AAD) patients who underwent open repair surgery. METHODS: A total of 321 adults who underwent open surgery for AAD at two tertiary medical centers in China were enrolled in the study. The primary endpoint was defined as the incidence and characteristics of perioperative stress hyperglycemia. The secondary endpoints included the incidence of postoperative MAEs, postoperative monocyte counts and inflammatory cytokine expression. Multi-logistic, linear regression and receiver operating characteristic (ROC) curve analyses were used to establish relationships between intraoperative time-weighted average glucose (TWAG), day-one postoperative monocyte counts, serum inflammatory cytokines and postoperative outcomes. In addition, in vitro experiments were conducted to evaluate changes in the inflammatory features of monocytes under high glucose conditions. RESULTS: Intraoperative hyperglycemia, as indicated by a TWAG level over 142 mg/dL, was associated with elevated postoperative monocyte counts and inflammatory cytokines, which correlated with extended intensive care unit (ICU) stays and worsened outcomes. In vitro, high glucose treatment induced mitochondrial impairment in monocytes, increased the release of inflammatory cytokines and the proportion of classical monocytes from AAD patients. CONCLUSIONS: Intraoperative stress hyperglycemia, in combination with day-one postoperative monocyte counts, were clinically significant for predicting adverse outcomes in AAD patients undergoing open repair surgery. Elevated glucose concentrations shaped the inflammatory features of monocytes in AAD by impairing mitochondrial functions.

Urgent hybrid repair of a symptomatic dissection-related type II thoracoabdominal aortic aneurysm.

Emergency repair of type II thoracoabdominal aortic aneurysms is burdened by high perioperative morbidity and mortality. We report the case of a symptomatic type II post-dissection thoracoabdominal aortic aneurysm that was treated using a hybrid technique. The repair was carried out in 2 stages. In the first stage, we deployed 2 imbricated stent grafts in the descending thoracic aorta. A left carotid-to-left subclavian artery bypass was pre-emptively performed to obtain a proper proximal landing zone and as part of the manoeuvres to protect the spinal cord. The endovascular first stage was effective in obtaining proximal sealing but, as expected, it did not prevent distal reperfusion of the aneurysmatic false lumen. A few hours later, we moved on to the second stage in which we repaired the aneurysmal distal thoracic and abdominal aortic segment by means of a multibranched synthetic graft. The repair was carried out through a left thoracophreno-laparotomy in the seventh intercostal space. A left passive arterial bypass and selective cold renal and warm visceral perfusion were adopted to provide organ protection. Technical success was achieved and confirmed radiologically. The patient experienced mild postoperative paraplegia, which almost completely regressed after a neuromotor rehabilitation program.

[Prognostic scale for early detection of various postoperative complications after thoracic aortic surgery: post-hoc analysis of biomarkers]. / Prognosticheskaya shkala dlya rannego vyyavleniya oslozhnennogo techeniya posleoperatsionnogo perioda u patsientov, operirovannykh na grudnom otdele aorty: post-hoc analiz dinamiki biomarkerov.

OBJECTIVE: To create the prognostic scale based on some biomarkers after thoracic and thoracoabdominal aortic repair. MATERIAL AND METHODS: We analyzed 114 patients with aortic aneurysm/dissection. The following biomarkers were studied: proadrenomedullin, NT-proBNP, procalcitonin, interleukins 6, 8, 10, tumor necrosis factor, presepsin, highly sensitive troponin I. Stages of the study: before induction of anesthesia, at the end of surgery and 6 hours later. RESULTS: The most informative predictors of postoperative complications were identified using comparative and ROC analyses: baseline presepsin≥204 pg/ml and interleukin 6 ≥4.3 pg/ml. The scale based on assessment of presepsin and troponin I at the end of surgery and preoperative risk allows analysis of the risk of complicated postoperative period. If all three predictors are present, the risk of complicated postoperative period increases by 1.96 times. The equation based on serum presepsin, interleukin-8 and interleukin-6/interleukin-10 ratio in 6 hours after surgery is characterized by acceptable characteristics (AUC 0.785, 95% CI 0.700-0.870). CONCLUSION: An algorithm based on risk stratification consisting of 3 prognostic scales at various stages of perioperative period determines the probability of postoperative complications with sensitivity 67.2% and specificity 94.6%. The total share of correct predictions in this sample was 80.7±3.7%.

Sex-related differences in clinical characteristics and in-hospital outcomes of patients in acute type A aortic dissection.

OBJECTIVE: The aim of this study was to investigate sex-related differences in the clinical characteristics and hospital outcomes of patients undergoing surgery for acute type A aortic dissection (AAAD). METHODS: This study was a retrospective study. Patients who underwent surgery for AAAD at the Department of Cardiac Surgery, Fujian Medical University Union Hospital, from January 2014 to March 2023 were consecutively included. Data was extracted from electronic medical records. The primary outcome measure was in-hospital mortality, and secondary outcome measures included new-onset postoperative arrhythmia (POA), acute kidney injury (AKI), hepatic dysfunction, neurological complications, gastrointestinal hemorrhage, ICU length of stay, and hospital length of stay. Patients were divided into two groups based on sex, and data analysis was performed using SPSS 25.0 software. RESULTS: A total of 1137 subjects were included, with 863 males (75.9%) and 274 females (24.1%). There were statistically significant differences in age and BMI between the two groups (P < 0.05). There was no statistically significant difference in the incidence of pain at the onset between the two groups, but chest tightness in females was higher than in males (22.6% vs. 13.8%). Regarding primary outcomes, the in-hospital mortality rate was 11.1% for males and 10.6% for females (P = 0.803). There were no statistically significant differences between the groups in ICU days, length of hospitalization, neurological complications, or liver dysfunction (P > 0.05). The rate of POA in females was 4.7%, higher than in males (2.2%), but AKI and gastrointestinal hemorrhage were both higher in males than in females (P < 0.05). Multivariate analysis showed that age, white blood cell (WBC) counts, lactic acid, operation duration and prolonged mechanical ventilation (PMV) increased the risk of in-hospital mortality in male patients. Hypertension, WBC counts, lactic acid, and PMV increased the risk of in-hospital mortality in female patients. CONCLUSION: Despite significant baseline characteristic differences between male and female AAAD patients, there were no significant differences in onset symptoms. The in-hospital mortality rates were similar between male and female patients, but the risk factors for in-hospital mortality differed.

Preliminary experience of the isolate left subclavian artery in-situ fenestration during 'zone 2' thoracic endovascular aortic repair.

OBJECTIVES: To evaluate the results of isolated left subclavian artery in-situ fenestration (ISF) during 'zone 2' thoracic endovascular aortic repair (TEVAR) using a new adjustable needle puncturing device system. METHODS: It is a multicentre, retrospective, physician-initiated cohort study of patients treated from 28 July 2021 to 3 April 2024. Inclusion criteria were isolate left subclavian artery revascularization for elective or urgent/emergent 'zone 2' TEVAR. The primary outcome was technical success and freedom from ISF TEVAR-related reintervention or endoleak. RESULTS: We treated 50 patients: 28 (56.0%) atherosclerotic thoracic aneurysms, 12 (24.0%) type B aortic dissection and 10 (20.0%) penetrating aortic ulcers. Elective intervention was carried out in 46 (92.0%) cases. ISF was successful in all cases, with a procedural primary technical success in 47 (94.0%) cases. The median time of intervention was 184 min (interquartile range 135-220) with a median fenestration time of 20 min (interquartile range 13-35). Operative mortality did not occur. We observed 1 case of spinal cord ischaemia and 2 cases of bilateral posterior non-disabling stroke. Mortality at 30 days occurred in 1 (2.0%) patient (not aorta-related). The median follow-up was 4 months (interquartile range 1-12.25). Bridging stent graft patency was 100% with no ISF-related endoleak. ISF-related reintervention was never required. CONCLUSIONS: ISF TEVAR using the Ankura™-II device with the self-centring adjustable needle system showed high technical success, promising stability and stable aortic-related outcomes. Owing to these results, it represents a safe and effective alternative for standard 'zone 2' TEVAR.

Application of Antithrombotic Drugs in Patients with Acute Type B Aortic Dissection Underwent Thoracic Endovascular Aortic Repair.

This study aimed to evaluate the safety and necessity of antithrombotic drugs for acute type B aortic dissection (TBAD) treated with thoracic endovascular aortic repair (TEVAR).The patients of acute TBAD treated with TEVAR were retrospectively enrolled from January 2007 to October 2022 in General Hospital of Northern Theater Command. The primary outcomes such as mortality and aortic adverse events [stroke, paraplegia, limb ischemia, organ failure (renal and intestinal tract), endoleak, redissection, aortic rupture, reintervention, and mortality] were recorded and evaluated at 1 month (early term) and 18 months (late term).The 697 patients of TBAD treated with TEVAR were divided into the antithrombotic (AT) group (n = 208) and nonantithrombotic (NAT) group (n = 489). The incidence of early mortality, early aortic adverse events, and the 18 months of cumulative freedom from all-cause mortality and aortic adverse events were not significantly different between the AT and NAT groups (2.4% versus 1.4%, 2.9% versus 4.5%, 94.7% versus 96.5% and 88.4% versus 89.9%, respectively). Log-rank tests also indicated that there were no significant differences. In multivariate Cox regression models, only pleural effusion, partially thrombosed of false lumen, maximum diameter of false lumen, and branch involvement were independent predictors of mortality, whereas the systolic blood pressure (SBP), pleural effusion, partially thrombosed of false lumen, true lumen compression, maximum diameter of false lumen, branch involvement were independent predictors of adverse aortic events.The antithrombotic drug for acute TBAD treated with TEVAR does not influence the mortality and aortic events in the early and late terms.

Successful TAVR for a Patient with Bicuspid Aortic Valve Stenosis and Previous Type A Aortic Dissection.

Whether transfemoral transcatheter aortic valve replacement (TAVR) can be accomplished in patients with a bicuspid aortic valve (AV) and previous type A aortic dissection remains rarely addressed. We report such a case in whom transfemoral TAVR was smoothly performed employing an extraordinary long sheath to bypass the dissected aortic segment, yet at the cost of perioperative left temporoparietal infarction owing to no suitable cerebral embolic protection device available in the presence of a remaining dissection in the aortic arch. Thus, for such patients, transfemoral TAVR is still feasible but novel embolic protection devices of distinct designs should be developed to avoid perioperative cerebral embolism.

Quantitative Electroencephalography for Predication of Neurological Dysfunction in Type A Aortic Dissection: A Prospective Observational Study.

BACKGROUND: Type A aortic dissection presents challenges with postoperative cerebral complications, and this study evaluates the predictive value of quantitative electroencephalography for perioperative brain function prognosis. METHODS AND RESULTS: Amplitude-integrated electroencephalography (aEEG) processes raw signals through filtering, amplitude integration, and time compression, displaying the data in a semilogarithmic format. Using this method, postoperative relative band power (post-RBP) α% and dynamic aEEG (ΔaEEG) grade were significantly associated with neurological dysfunction in univariate and multivariable analyses, with area under the receiver operating characteristic curve of 0.876 (95% CI, 0.825-0.926) for the combined model. Postoperative relative band power α% and ΔaEEG were significantly associated with adverse outcomes, with area under the receiver operating characteristic curve of 0.903 (95% CI, 0.835-0.971) for the combined model. Postoperative relative band power α% and ΔaEEG were significantly associated with transient neurological dysfunction and stroke, with areas under the receiver operating characteristic curve of 0.818 (95% CI, 0.760-0.876) and 0.868 (95% CI, 0.810-0.926) for transient neurological dysfunction, and 0.815 (95% CI, 0.743-0.886) and 0.831 (95% CI, 0.746-0.916) for stroke. Among 56 patients, the Alberta Stroke Program Early Computed Tomography score was superior to ΔaEEG in predicting neurological outcomes (area under the receiver operating characteristic curve of 0.872 versus 0.708 [95% CI, 0.633-0.783]; P<0.05). CONCLUSIONS: Perioperative quantitative electroencephalography monitoring offers valuable insights into brain function changes in patients with type A aortic dissection. ∆aEEG grades can aid in early detection of adverse outcomes, while postoperative relative band power and ∆aEEG grades predict transient neurological dysfunction. Quantitative electroencephalography can assist cardiac surgeons in assessing brain function and improving outcomes in patients with type A aortic dissection. REGISTRATION: URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2200055980.

Thoracoabdominal aortic replacement in a 6-year-old boy with Loeys-Dietz syndrome.

Connective tissue disorders such as Marfan- and Loeys-Dietz syndrome (LDS) can lead to aortic aneurysms and aortic dissections in children. Patients with LDS often necessitating multiple aortic surgeries throughout their lives to extend their lifespan. A boy with LDS underwent Bentall procedure at the age of three for aortic aneurysm. At the age of six, this boy was referred to the hospital again due to severe abdominal pain. Computed tomographic angiography (CTA)indicates aortic dissection (DeBakey Type III, Stanford Type B). After a multidisciplinary team discussion, a successful thoracoabdominal aortic replacement was performed.