Comparison of Early Efficacy of the Percutaneous Presuture Technique with the Femoral Artery Incision Technique in Endovascular Aortic Repair under Local Anesthesia for Uncomplicated Type B Aortic Dissection.

Objective: To compare the efficacy of the percutaneous presuture technique (PPST) and the femoral artery incision technique (FAIT) under local anesthesia in the treatment of endovascular aortic repair (EVAR) for patients with uncomplicated type B aortic dissection (uTBAD). Method: Two hundred and ninety-five patients diagnosed with uTBAD who underwent EVAR under local anesthesia from June 2017 to December 2021 were consecutively and randomly selected for retrospective analysis. The PPST was performed in 178 cases and the FAIT was performed in 117 cases. The clinical characteristics and surgical and postoperative data from the two groups were analyzed. Results: There were no significant differences in clinical characteristics between the two groups (p > 0.05). The operative time of the PPST group was significantly shorter than that of the FAIT group (46 (33, 58) versus 72 (67.5, 78.0) minutes, p < 0.001), as was the operative approach procedure time (6 (4.5, 9.0) versus 38 (36.5, 43.5) minutes, p < 0.001), and length of postoperative hospital stay (5.19 ± 2.26 versus 8.33 ± 3.76 days, p < 0.001). There were fewer postoperative approach-related procedural complications in the PPST group than in the FAIT group (2 versus 12, p < 0.001); similarly, the average frequency of postoperative wound disinfection was significantly lower in the PPST group (1.08 ± 0.39 versus 3.31 ± 0.91 times, p < 0.05). Obesity was identified as an independent risk factor for postoperative approach-related procedural complications (OR, 22.26; 95% CI, 4.74-104.49; p < 0.001). Conclusions: The PPST has comparable safety and efficacy to the FAIT in EVAR under local anesthesia. It can shorten the length of hospital stay, reduce operation time, lower the risk of wound-related complications, reduce the frequency of postoperative wound disinfection, and hasten postoperative recovery. It can therefore be used as a first-line surgical technique in EVAR of uTBAD under local anesthesia, especially in obese patients.

Risk factors for acute kidney injury after Stanford type A aortic dissection repair surgery: a systematic review and meta-analysis.

Background: Risk factors for acute kidney injury (AKI) after Stanford type A aortic dissection (TAAD) repair are inconsistent in different studies. This meta-analysis systematically analyzed the risk factors so as to early identify the therapeutic targets for preventing AKI.Methods: Studies exploring risk factors for AKI after TAAD repair were searched from four databases from inception to June 2022. The synthesized incidence and risk factors of AKI and its impact on mortality were calculated.Results: Twenty studies comprising 8223 patients were included. The synthesized incidence of postoperative AKI was 50.7%. Risk factors for AKI included cardiopulmonary bypass (CPB) time >180 min [odds ratio (OR), 4.89, 95% confidence interval (CI), 2.06-11.61, I2 = 0%], prolonged operative time (>7 h) (OR, 2.73, 95% CI, 1.95-3.82, I2 = 0), advanced age (per 10 years) (OR, 1.34, 95% CI, 1.21-1.49, I2 = 0], increased packed red blood cells (pRBCs) transfusion perioperatively (OR, 1.09, 95% CI, 1.07-1.11, I2 = 42%), elevated body mass index (per 5 kg/m2) (OR, 1.23, 95% CI, 1.18-1.28, I2 = 42%) and preoperative kidney injury (OR, 3.61, 95% CI, 2.48-5.28, I2 = 45%). All results were meta-analyzed using fixed-effects model finally (p < 0.01). The in-hospital or 30-day mortality was higher in patients with postoperative AKI than in that without AKI [risk ratio (RR), 3.12, 95% CI, 2.54-3.85, p < 0.01].Conclusions: AKI after TAAD repair increased the in-hospital or 30-day mortality. Reducing CPB time and pRBCs transfusion, especially in elderly or heavier weight patients, or patients with preoperative kidney injury were important to prevent AKI after TAAD repair surgery.

Clinical outcomes of mild versus moderate hypothermic circulatory arrest with antegrade cerebral perfusion in adult aortic arch surgery: A systematic review and meta-analysis.

OBJECTIVES: In adult aortic arch surgery, moderate hypothermic circulatory arrest (HCA) with selective antegrade cerebral perfusion (SACP) (MoHACP) is widely used, but the application of mild HCA with SACP (MiHACP) is still controversial. This meta-analysis aimed to compare clinical outcomes using MiHACP or MoHACP. METHODS: Studies comparing outcomes of MiHACP or MoHACP in adult aortic arch surgery were searched from four databases from inception through April 2022. Primary outcomes were postoperative permanent neurological deficit (PND), temporary neurological deficit (TND), and mortality. Secondary outcomes included other common complications. Meta-analysis was conducted using a random-effects model in all cases. RESULTS: Eleven comparative studies were included, with 1555 patients in MiHACP group and 1499 patients in MoHACP group, and the mean HCA temperature were 29.4°C and 24.8°C, respectively. Postoperative PND, TND, mortality, paraplegia, dialysis, tracheotomy, reexploration for bleeding, and chest tube drainage volume were comparable in the two groups (p > 0.05). Ventilator time, intensive care unit and in-hospital length of stay were shorter in MiHACP group (p < 0.05). Outcomes were also comparable or had some benefits in MiHACP group when subgroup analyses were conducted according to hemiarch or total arch replacement, unilateral or bilateral SACP, HCA time, emergency aortic dissection surgery, and concomitant procedure. CONCLUSION: The present meta-analysis showed acceptability of MiHACP in adult aortic arch surgery. Results need to be taken with caution as moderate risk of bias and very low quality of evidence were observed in this meta-analysis. Randomized controlled trials are needed for further analysis.

Establishment and effect evaluation of an aortic dissection model induced by different doses of ß-aminopropionitrile in rats.

INTRODUCTION: Given the controversy regarding the appropriate dose of ß-aminopropionitrile for induction of aortic dissection models in rats, the purpose of this study was to explore the most suitable concentration of ß-aminopropionitrile to establish a high-incidence and low-mortality aortic dissection model. METHODS: Eighty three-week-old male Sprague-Dawley rats were equally divided into four groups: a control group, a 0.06% ß-aminopropionitrile group, a 0.08% ß-aminopropionitrile group and a 0.1% ß-aminopropionitrile group. Initial experiments were performed on the control group, which was not treated with ß-aminopropionitrile (and drank water freely), and the other three groups, which were given different concentrations of ß-aminopropionitrile solution daily (0.06%, 0.08% and 0.1%). Subsequently, on the 40th day, osmotic minipumps administering 1 µg/kg per min angiotensin II (Ang II) were implanted subcutaneously into the ß-aminopropionitrile groups, while the control group was continuously pumped with normal saline. The rats were euthanized 48 h after implantation. All rats that died before the expected end time of the experiment were autopsied immediately, and the aortas were dissected. The rats surviving at the end of the experiment were sacrificed by an overdose of sodium pentobarbital, and tissue samples were harvested for further analyses. RESULTS: The mean survival days were significantly different among the groups, with 39.1 ± 6.04 days in the 0.08% ß-aminopropionitrile group and 32.7 ± 9.85 days in the 0.1% ß-aminopropionitrile group (P = 0.0178) at the end of the experiment. Compared with those in the 0.06% ß-aminopropionitrile group, the rates of aortic dissection were significantly higher in the 0.08% ß-aminopropionitrile group and the 0.1% ß-aminopropionitrile group (P = 0.0015 and P = 0.0005, respectively), while there was no significant difference between the 0.08% ß-aminopropionitrile group and the 0.1% ß-aminopropionitrile group (P = 0.723) at 70% and 75%, respectively. However, the rupture rates were significantly different between the 0.08% ß-aminopropionitrile group and the 0.1% ß-aminopropionitrile group (55% versus 20%, P = 0.022). Hematoxylin-eosin staining of the aortic tissue sections of the ß-aminopropionitrile group showed that red blood cells entered the pseudocavity in the vascular wall, while the vascular wall structure of the control group was intact. Compared with control rats, which were intact and free from fracture, ß-aminopropionitrile-treated rats had fewer collagen fibers and exhibited fracture. Magnetic resonance imaging showed that the aortic intimae of the aortic dissection rats showed double lumens and intimal tears. CONCLUSIONS: An aortic dissection model with a high incidence and low mortality was successfully and stably developed with 0.08% ß-aminopropionitrile. This model will enable further studies investigating aortic dissection pathogenesis and drug therapy. Magnetic resonance imaging may be a reliable technique for imaging the aorta in rats.

Plasma levels of receptor-interacting protein kinase 3 is associated with postoperative acute kidney injury in acute DeBakey type I aortic dissection.

BACKGROUND: Postoperative acute kidney injury (AKI) in acute DeBakey type I aortic dissection (ADIAD) is common but has unclear pathogeneses and limited treatments. Receptor-interacting protein kinase 3 (RIP3), a mediator of necroptosis, is associated with human sepsis-induced and posttraumatic AKI, but its role in human postoperative AKI in ADIAD remains unclear. We assumed that RIP3 levels is associated with postoperative AKI in ADIAD. METHODS: Plasma samples and the clinical data of continuous patients with ADIAD were collected prospectively. The patients were divided into three groups according to AKI stage postoperatively. The plasma RIP3 levels were compared among the groups, and the relationship between RIP3 and serum creatinine (sCr), inflammatory cytokines as well as clinical results were analyzed. RESULTS: Eighty patients were enrolled. The postoperative and elevated RIP3 levels among the three groups were significantly different (P < 0.0001), both with a positive trend across the AKI stage (P for trend < 0.001), and they were also independent risk factors for postoperative AKI in ADIAD (OR = 1.018 and 1.026, P < 0.05). The postoperative RIP3 levels were positively correlated with the aortic crossclamp time (R = 0.253, P < 0.05); the peak values of sCr, procalcitonin, interleukin-6 and lactate postoperatively; the mechanical ventilation time; and the ICU stay time (R = 0.66, 0.369, 0.409, 0.397, 0.474 and 0.435, respectively; all P < 0.001). Plasma RIP3 level and sCr were comparable in diagnosing postoperative AKI in ADIAD (P = 0.898), and higher postoperative RIP3 level was associated with lower survival rate. CONCLUSION: The plasma RIP3 levels are associated with postoperative AKI, inflammatory response and clinical outcomes in ADIAD.

Low vs standardized dose anticoagulation regimens for extracorporeal membrane oxygenation: A meta-analysis.

BACKGROUND: To compare the safety and efficacy of low-dose anticoagulation (LA) with that of standardized dose anticoagulation (SA) for patients supported with extracorporeal membrane oxygenation (ECMO). METHODS: PubMed, MEDLINE, the Cochrane Library, and Web of Science were screened for original articles. Screening was performed using predefined search terms to identify cohort studies reporting the comparison of LA with SA in patients supported with ECMO from Nov 1990 to Jun 2020. The effect size was determined by the odds ratio (OR) with the 95% confidence interval (CI). RESULTS: An analysis of 7 studies including a total of 553 patients was performed. LA (Low-heparin group) was administered to 255 patients, whereas the other 298 patients received SA (Full-heparin group). The incidence of gastrointestinal tract hemorrhage (OR 0.36, 95% CI 0.20-0.64) and surgical site hemorrhage (OR 0.43, 95% CI 0.20-0.94) were significantly lower in patients who underwent LA compared with that in those who underwent SA. The rates of hospital mortality (OR 0.81, 95% CI 0.42-1.56), successfully weaning off of ECMO (OR 0.80, 95% CI 0.30-2.14), pulmonary embolism (OR 0.79, 95% CI 0.24-2.65), intracardiac thrombus (OR 0.34, 95% CI 0.09-1.30), intracranial hemorrhage (OR 0.62, 95% CI 0.22-1.74), and pulmonary hemorrhage (OR 0.77, 95% CI 0.30-1.93) were similar between the two groups. CONCLUSIONS: This meta-analysis confirms that LA is a feasible and safe anticoagulation strategy in patients supported by ECMO. Future studies should focus on the long-term benefits of LA compared with SA.

Plasma interleukin-6 is a potential predictive biomarker for postoperative delirium among acute type a aortic dissection patients treated with open surgical repair.

OBJECTIVES: The relationship between inflammatory cytokines and postoperative delirium (POD) remains to be further investigated, especially in patients undergoing acute type A aortic dissection (AAD). Interleukin-6 (IL-6) is involved in the inflammatory process and has recently been identified as a biomarker of cerebral dysfunction. We explored the hypothesis that IL-6 was one of the critical causes of POD after surgical repair of AAD. METHODS: Plasma IL-6 was measured using electrochemiluminescence technology in patients preoperatively and 24 h, 48 h, and 72 h after surgical repair of acute type A aortic dissection. After the first three postoperative days, delirium was evaluated twice daily using the Confusion Assessment Method. ROC curves were used to evaluate the ability of IL-6 measurements to distinguish POD. RESULTS: The incidence of POD was 14.03% (31 of 221 patients). The patients in the POD group were significantly older than the patients in the non-POD group (56.48 ± 11.68 years vs 52.22 ± 10.50 years, P = 0.040). Plasma IL-6 concentrations were significantly higher in the POD group than in the non-POD group at three time points: preoperatively, after 24 h, and after 48 h. The AUC values corresponding to IL-6 preoperatively and 24 h after surgery were 0.73 and 0.72, respectively. CONCLUSIONS: Cerebral dysfunction after the surgical repair of AAD shows elevated stress levels and inflammatory responses. Plasma IL-6 is a potential biomarker to predict the onset of POD in acute type A aortic dissection patients following surgical repair.

Seizure-induced 5-HT release and chronic impairment of serotonergic function in rats.

We analyzed the dynamic concentration change of serotonin (5-HT) and its main metabolite 5-hydroxyindoleacetic acid (5-HIAA) within the epileptic hippocampus in rats. Seizure was induced by systemic injection of pilocarpine (320mg/kg, i.p.). Using electroencephalography (EEG) recordings, we found that primary seizure discharge was induced 30min after pilocarpine administration and that recurrent discharge peaked 14d after the onset of status epilepticus (SE). The extracellular fluid in the hippocampus was sampled by microdialysis from conscious animals at various time points before and after SE. The concentrations of 5-HT and 5-HIAA in the samples were measured by high-performance liquid chromatography and electrochemical detection (HPLC-ECD). Interestingly, 5-HT levels in the hippocampus were dramatically increased within the 30min following SE. This reversed to basal level by 4d after SE and continued to drop to 48% at 7d and 28% of basal level 14d after SE. Accordingly, a marked increase of 5-HIAA in the hippocampus appeared at 2d after SE, then gradually declined to levels below baseline. To identify serotonergic neurons in the raphe nuclei (a major source of 5-HT release in the brain), brain sections were immunostained for tryptophan hydroxylase (TPH). The number of TPH positive neurons and the intensity of TPH staining significantly decreased at 28d after SE. These data suggest that pilocarpine induces depletion of 5-HT in the hippocampus and significantly compromise serotonergic neurons in the raphe nuclei. The loss of serotonergic function may play a significant role in the pathophysiology of epilepsy.

[Effect of serotonin depletion on seizures learning-memory in pilocarpine-induced epileptic rats].

OBJECTIVE: To investigate the relationship between serotonin (5-HT) and epilepsy and the mechanism of learning-memory in pilocarpine (PILO)-induced epileptic rats after 5,7-dihydroxytryptamine (5,7-DHT) microinjection in median raphe nucleus. METHODS: Adult S D rats were randomly divided into 3 groups: PILO group, PILO+ 5,7-DHT group, vehicle control group; PILO group was divided into two groups by status epilepticus (SE): PILO + SE group and PILO - SE group. The rats' seizures and cortex electroencephalography (EEG) were observed by video EEG. The rats' spatial learning-memory was evaluated by Morris water maze. Finally, serotonergic neuron in raphe nuclei was observed by immunohistochemistry. RESULTS: After treatment of 5,7-DHT (PILO + 5,7-DHT group), the success rate, the mortality and the frequency of chronic spontaneous seizures in pilocarpine-induced epilepsy model were all improved. Compared with the control group, the number of serotonergic neuron in raphe nuclei was decrease in PILO + SE group (P < 0.05). Moreover, it's extremely decrease in PILO + 5,7-DHT group (P < 0.01). Compared with control group, the mean escape latency was prolonged, the times of crossing target was decreased and the retention time in target zone was shortened in PILO + SE group (P < 0.05), but there was no significant difference between PILO + SE group and PILO + 5,7-DHT group. CONCLUSION: Depletion of serotonin may facility the rats' epileptic seizures, but we could not interpret which may cause epileptic rats' cognitive deficit.