(Tissue PET) Vascular metabolic imaging and peripheral plasma biomarkers in the evolution of chronic aortic dissections.

AIMS: Despite adequate medical management, dissection of the descending aorta (type B) may develop complications, including aneurysmal progression and eventually rupture. Partial false lumen thrombosis has been identified as a marker of adverse evolution in chronic dissection. The aim of this study was to test the ability of complementary information, provided by (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) and peripheral biomarkers, to add pathophysiological significance and a prognostic value to morphological data. METHODS AND RESULTS: We explored serial aortic (18)F-FDG uptake by PET/CT imaging and plasma biomarkers in a series of 23 patients with type B dissection to predict complications from initial data and to investigate potential associations with aneurysmal expansion during follow-up. Complications occurred in 17 patients. Acute initial characteristics associated with complications were male gender (P = 0.021), arterial hypertension (P = 0.040), aortic dissection diameter (P = 0.0086), partial thrombosis of the false channel (P = 0.0046), and enhanced focal (18)F-FDG uptake (P = 0.045). During follow-up (mean 16.7 ± 8.0 months), aneurysmal expansion was associated with false lumen morphology (P< 0.0001), quantitative (18)F-FDG uptake, (P = 0.0029), elevated plasma concentrations of biomarkers of platelets (P-selectin, P = 0.0009) and thrombin activation (TAT complexes, P = 0.0075), and fibrinolysis (PAP complexes, P < 0.0001; D-dimers, P = 0.0006). Plasma markers of coagulation and fibrinolysis were related to false channel morphology, suggesting that thrombus biological dynamics may drive progressive expansion of type B dissections. CONCLUSION: Enhanced FDG uptake may be considered as a complementary imaging marker associated with secondary complications in type B dissections. During follow-up, aneurysmal progression is related to PET/CT and biomarkers of thrombus renewal and lysis.

Comparison of inflammatory responses after off-pump and on-pump coronary surgery using surface modifying additives circuit.

BACKGROUND: Cardiac surgery is followed by various degrees of inflammation, which have harmful consequences. Because of the central role of extracorporeal circulation (EC), off-pump coronary bypass surgery is deemed preferable. Do different modalities of EC challenge this view? METHODS: Four groups of similar patients underwent coronary surgery: (group 1) on-pump, EC with closed surface modifying additives (SMA) circuit and no pump suckers (n = 20); (group 2) on-pump, EC with open SMA circuit and pump suckers (n = 20); (group 3) off-pump (beating heart) and heparin 3 mg/kg (n = 20); (group 4) off-pump (beating heart) and heparin 1 mg/kg (n = 20). Interleukins (IL)-6, IL-8, IL-10, myeloperoxidase, elastase, and terminal complex of the complement (TCC) were analyzed at various times: at induction (time I); after heparin (time II); after complete revascularization (time III); after protamine (time IV); and 24 hours later (time V). RESULTS: The TCC was significantly higher in groups 1 and 2 at time III. The pattern of IL-6 was the same for the four groups. No significant difference in myeloperoxydase content was noted; however, elastase was significantly higher in the two EC (on-pump) groups. CONCLUSIONS: Except for the complement system and elastase, on-pump surgery with SMA-coated circuits did not elicit any greater inflammatory response than off-pump surgery.