RESUMEN
OBJECTIVE: To investigate the presentation, aortic involvement, and surgical outcomes in patients with Takayasu arteritis undergoing aortic surgery. METHODS: We queried our surgical database for patients with Takayasu arteritis who underwent aortic surgery from 1994 to 2022. RESULTS: There were a total of 31 patients with Takayasu arteritis who underwent aortic surgery. Patients' median age at the time of diagnosis was 35.0 years (interquartile range, 25.0-42.0). The majority were female (n = 27, 87.0%). Most patients (n = 28, 90.3%) were diagnosed before surgery, and 3 patients (9.6%) were diagnosed perioperatively. The median time interval from diagnosis to surgery was 2.8 years (interquartile range, 0.5-13.9). The most common presentation was ascending aorta aneurysm (n = 22, 70.9%), and severe aortic regurgitation was the most common valve insufficiency (n = 17, 54.8%). The most common operation was ascending aorta replacement (n = 20, 64.5%), and aortic valve replacement was the most common valve intervention (n = 17, 54.8%). Active vasculitis was identified in 2 (11.7%) aortic valve specimens. Early mortality was 6.5% (n = 2). A total of 6 deaths occurred over a median follow-up of 13.1 years (interquartile range, 6.1-25.2). Survival at 10 years was 86.7% (95% CI, 75.4-99.7). A total of 5 patients (16.1%) required a subsequent operation in a median of 1.9 years (interquartile range, 0.2-7.4). Freedom from reoperation was 96.9% (95% CI, 90.1-100) at 1 year, 89.4% (95% CI, 78.7-100.0) at 5 years, and 77.5% (95% CI, 61.2-98.1) at 10 and 15 years. CONCLUSIONS: Ascending aorta aneurysm and aortic valve regurgitation are the most frequent presentations in patients with Takayasu arteritis requiring aortic surgery. Surgery in these individuals is safe, with acceptable short- and long-term results.
RESUMEN
With the advent of recorded lectures, face-to-face teaching in medical school large classroom settings is increasingly under pressure to incorporate engaging activities that encourage attendance and can translate to greater attainment and long-term retention for learners, especially of "Generation Z" learning styles. This places a greater onus on lecturers to convey key concepts in a manner that holds value beyond their recorded substitute. The present article details several on-stage Medical Gross Anatomy and Neurobiology demonstrations that involve the teaching of an intuitive understanding of brain fluidic mechanics, such as hematoma formation and the protective functions of an intact cerebral spinal fluid system (addressing concussion and lumbar punctures). These demonstrations can be presented relatively quickly on stage and are suitable for engaging large classroom sizes (n > 100), which can be used in conjunction with traditional lecture formats. Ideally, these in-class demonstrations, together with the continued contributions of other quantitatively assessed demonstrations from other institutions, will help to maintain a growing body of large class face-to-face teaching approaches and strategies to help influence decisions regarding what basic medical knowledge may best be taught in class live versus by recorded substitute or other non-traditional lecture methods.
