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1.
Medicine (Baltimore) ; 98(50): e18241, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852089

RESUMO

T helper 17 (Th17) cells are related to the progression of aortic dissection. This study aimed to determine whether circulating Th17 levels are associated with the prognosis of acute Stanford type B aortic dissection (STBAD) after thoracic endovascular aortic repair (TEVAR).A cohort study was performed and STBAD patients (n = 140) received TEVAR were enrolled, the circulating Th17 levels were measured and the patients were divided into low and high Th17 groups, and 36 months of follow-up was performed. The data for mortality, survival outcomes, heart structure and function changes, aortic regurgitation prevalence, and aortic remodeling outcomes were recorded.Lower mortality and fewer complications were observed in the low Th17 group than in the high Th17 group in the third year of follow-up. In addition, the low Th17 group exhibited better cardiac remodeling and cardiac function when compared with that in the high Th17 group in the second to third year after TEVAR. Aortic reflux was improved in both groups but was more pronounced in the low Th17 group. During follow-up, the true lumen of the proximal thoracic aorta at the level of the celiac trunk in both the low and high Th17 groups continuously enlarged and was more pronounced in the low Th17 group.Circulating Th17 cells were related to cardiac and aortic remodeling and prognosis during STBAD after TEVAR. Anti-inflammatory therapy may be useful for STBAD patients who have undergone TEVAR.


Assuntos
Aneurisma Dissecante/sangue , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/sangue , Procedimentos Endovasculares/métodos , Células Th17/patologia , Remodelação Vascular , Doença Aguda , Adulto , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Angiografia por Tomografia Computadorizada , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo
3.
Medicine (Baltimore) ; 98(38): e17173, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567956

RESUMO

BACKGROUND: Serum alkaline phosphatase (ALP) is related to vascular calcification and is known to have a prognostic impact in various cohorts. However, evidence in patients undergoing thoracic endovascular aortic repair (TEVAR) is lacking. Thus, we hypothesized that preoperative serum ALP level could be used for predicting adverse events after TEVAR. METHODS: We retrospectively reviewed 167 patients who underwent TEVAR between February 2013 and December 2016. Patients were classified into tertiles according to preoperative ALP level (<69, 69-92, and >92 IU/L). The composite of morbidity and mortality (composite MM) was defined as the presence of one or more of the following: myocardial infarction, cerebrovascular accident, dialysis requirement, pulmonary complication, infection, and mortality within 1 year after TEVAR. The incidence of composite MM was compared among the 3 tertiles, and stepwise logistic regression analysis was performed to evaluate the predictors for composite MM. RESULTS: The incidence of composite MM was 14.5% in the first tertile group, 17.9% in the second tertile group, and 35.7% in the third tertile group (P = .016). The third tertile of ALP level (odds ratio [OR] 1.766, 95% confidence interval [CI] 1.074-2.904, P = .025) and emergency TEVAR (OR 2.369, 95% CI 1.050-5.346, P = .038) remained as independent predictors of composite MM. CONCLUSIONS: Our data showed an independent relationship between high preoperative ALP levels and adverse outcomes in patients undergoing TEVAR. This finding might suggest a potential role of ALP level as a risk stratification marker.


Assuntos
Fosfatase Alcalina/sangue , Aorta Torácica/cirurgia , Procedimentos Endovasculares/efeitos adversos , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
4.
J Cardiothorac Surg ; 14(1): 144, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345241

RESUMO

BACKGROUND: Massive hemoptysis is a life-threatening condition and can arise as a complication of various conditions. It rarely occurs as a complication of a ruptured thoracic aortic aneurysm. Even rarer are conditions where pseudoanurysms of aorta result due to infection. CASE PRESENTATION: A 30 year-old female patient presented with left sided chest pain, intermittent fever, cough and massive hemoptysis. A pseudo-aneurysm of proximal descending thoracic aorta at the level of the left Subclavian artery was noted over CT scan. Upon performing a left posterolateral thoracotomy, the aneurysm was seen to have ruptured into the apical segment of left upper lobe, contained mainly by a thrombus. The anterior wall of the pseudoaneurysm was debrided and a bovine pericardial patch was used to repair the aortic defect. Cultures of the tissue obtained showed Enterobacter species, therefore the patient was prescribed 6 weeks of IV antibiotics following surgery. Post-operative CT scan revealed reduced diameter of the aorta. She was discharged in good health and remains well at follow up evaluation. CONCLUSIONS: We present a case of hemoptysis caused by a ruptured descending aorta aneurysm into left lung. The aneurysm was secondary to infection by Enterobacter. Surgical repair of the concerned region of aorta was effective, without any major sequelae. To the best of our knowledge, no such cases have been reported previously.


Assuntos
Aneurisma Infectado/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Ruptura Aórtica/diagnóstico , Adulto , Aneurisma Infectado/complicações , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/complicações , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Dor no Peito/etiologia , Diagnóstico Diferencial , Feminino , Hemoptise/etiologia , Humanos , Toracotomia/efeitos adversos , Tomografia Computadorizada por Raios X
5.
Int Heart J ; 60(4): 845-848, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308322

RESUMO

The aim of this study was to summarize the clinical experience of postoperative extracorporeal membrane oxygenation (ECMO) support in Stanford type A aortic dissection (STAAD) patients.We retrospectively reviewed 246 consecutive acute STAAD patients undergoing operations at our institution from January 2012 to December 2016. Postoperative ECMO was used in 7 patients. There were 5 males and 2 females with a mean age of 43.1 ± 9.3 years. All 7 patients with acute STAAD underwent ascending aorta replacement and total arch repair with a self-designed stent graft (Micropart Corp, Shanghai, China). Concomitant procedures were aortic root replacement in 1 patient and coronary artery bypass grafting (CABG) in 2 patients. All patients received veno-arterial ECMO through the femoral artery and vein. Five patients were extubated before being removed from ECMO. The mean ECMO supporting time was 244.5 ± 57.8 hours. All 7 patients were successfully weaned from ECMO support, and 6 (85.7%) patients survived to discharge. The average hospital time was 26.3 ± 8.8 days. One patient died of cardiac arrest after being weaned from ECMO. Two patients underwent reoperation for bleeding and 1 patient showed transient delirium. The remaining patients all survived during a median follow-up of 19 months.ECMO provides a good temporary cardiopulmonary support in STAAD patients with refractory cardiogenic shock after surgery for aortic dissection. The early use of ECMO and preventing its complications actively can improve the patient survival rate.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Oxigenação por Membrana Extracorpórea/métodos , Adulto , Aneurisma Dissecante/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico , Angiografia por Tomografia Computadorizada , Ecocardiografia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
6.
Amyloid ; 26(3): 148-155, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31210552

RESUMO

Objective: To explore the relationship of aortic medial amyloid with biochemical and micromechanical properties of the aortic wall in aneurysm patients. Methods: Human aortic tissues removed during aneurysm surgery from tricuspid (idiopathic degenerative aneurysm, DA) and bicuspid valve (BAV) patients were subjected to oscillatory nanoindentation experiments to determine localised mechanical properties of the tissue (shear storage modulus, G´ and shear loss modulus, G˝). Collagen, elastin, matrix metalloproteinase 2 and glycosaminoglycans concentrations were determined, along with relative levels of aortic medial amyloid-related factors (medin, milk fat globule-EGF factor 8, oligomers and fibrils). Measurements were combined with clinical data and statistical analyses performed. Results: The DA cohort can be divided based on their phenotype. One group shared similar characteristics with BAV patients, termed bicuspid like phenotype-tricuspid valve. The second group had high amyloid oligomer species present with a significantly lower G´ (p = .01), indicative of reduced elastic response of the tissue, termed amyloid-rich. Conclusions: We identified a group of DA patients with high amyloid oligomers and altered micromechanical and structural properties of the vessel wall. We propose these findings as a cause for aneurysm formation in these patients. Amyloid is not found in BAV patients, suggesting at least two distinct mechanisms for pathogenesis.


Assuntos
Aorta/metabolismo , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/metabolismo , Valva Mitral/metabolismo , Valva Tricúspide/metabolismo , Idoso , Antígenos de Superfície/genética , Antígenos de Superfície/metabolismo , Aorta/patologia , Aorta/cirurgia , Aneurisma da Aorta Torácica/patologia , Aneurisma da Aorta Torácica/cirurgia , Biomarcadores/metabolismo , Fenômenos Biomecânicos , Estudos de Coortes , Colágeno/genética , Colágeno/metabolismo , Elastina/genética , Elastina/metabolismo , Feminino , Expressão Gênica , Glicosaminoglicanos/metabolismo , Humanos , Masculino , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 2 da Matriz/metabolismo , Pessoa de Meia-Idade , Proteínas do Leite/genética , Proteínas do Leite/metabolismo , Valva Mitral/patologia , Valva Mitral/cirurgia , Fenótipo , Resistência ao Cisalhamento , Valva Tricúspide/patologia , Valva Tricúspide/cirurgia
7.
Cardiol Young ; 29(6): 768-776, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31198121

RESUMO

BACKGROUND: Transcatheter stent implantation has been employed to treat re-coarctation of the aorta in adolescents and young adults. The aim of this work is to use computational fluid dynamics to characterise haemodynamics associated with re-coarctation involving an aneurysmal ductal ampulla and aortic isthmus narrowing, which created minimal pressure drop, and to incorporate computational fluid dynamics's findings into decision-making concerning catheter-directed treatment. METHODS: Computational fluid dynamics permits numerically solving the Navier-Stokes equations governing pulsatile flow in the aorta, based on patient-specific data. We determined flow-velocity fields, wall shear stresses, oscillatory shear indices, and particle stream traces, which cannot be ascertained from catheterisation data or magnetic resonance imaging. RESULTS: Computational fluid dynamics showed that, as flow entered the isthmus, it separated from the aortic wall, and created vortices leading to re-circulating low-velocity flow that induced low and multidirectional wall shear stress, which could sustain platelet-mediated thrombus formation in the ampulla. In contrast, as flow exited the isthmus, it created a jet leading to high-velocity flow that induced high and unidirectional wall shear stress, which could eventually undermine the wall of the descending aorta. SUMMARY: We used computational fluid dynamics to study re-coarctation involving an aneurysmal ductal ampulla and aortic isthmus narrowing. Despite minimal pressure drop, computational fluid dynamics identified flow patterns that would place the patient at risk for: thromboembolic events, rupture of the ampulla, and impaired descending aortic wall integrity. Thus, catheter-directed stenting was undertaken and proved successful. Computational fluid dynamics yielded important information, not only about the case presented, but about the complementary role it can serve in the management of patients with complex aortic arch obstruction.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Coartação Aórtica/cirurgia , Velocidade do Fluxo Sanguíneo/fisiologia , Cateterismo Cardíaco/métodos , Simulação por Computador , Procedimentos Endovasculares/métodos , Stents , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/fisiopatologia , Coartação Aórtica/diagnóstico , Coartação Aórtica/fisiopatologia , Feminino , Humanos , Angiografia por Ressonância Magnética , Recidiva , Adulto Jovem
8.
Tex Heart Inst J ; 46(2): 120-123, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236076

RESUMO

Ascending thoracic aortic aneurysm (ATAA) is typically treated surgically. No commercially available device has been specifically designed for endovascular ATAA repair, and currently, multiple anatomic and technical challenges affect its feasibility. Previously, such repairs have been performed with the patients under general anesthesia. We describe a novel, minimally invasive approach to endovascular repair of ATAA, involving local anesthesia, conscious sedation, and 24-hour hospitalization. Two consecutive male patients (ages, 79 and 54 yr) who had comorbidities underwent percutaneous transfemoral endovascular ATAA repair with use of commercially available endografts. Patient 1 had a saccular aneurysm, and Patient 2 had a pseudoaneurysm consequent to recent surgical ATAA repair. The patients were discharged from the hospital 24 hours after technically successful, uncomplicated procedures. At 2 months, computed tomograms showed no endoleak or stent-graft migration. Our experience shows that minimally invasive endovascular ATAA repair is feasible for selected high-risk patients. We describe the procedure, access and closure devices, and challenges associated with this approach.


Assuntos
Anestesia Local/métodos , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Sedação Consciente/métodos , Procedimentos Endovasculares/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Idoso , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade
9.
Tex Heart Inst J ; 46(2): 130-132, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236079

RESUMO

Acute aortic dissection can be complicated by malperfusion syndromes, including ischemia of the lower limbs. In some cases, delayed correction of leg ischemia leads to reperfusion injury, potentially resulting in renal failure. We describe the case of a 64-year-old woman who presented with acute aortic dissection manifesting itself as lower-limb ischemia. During and after aortic surgery with cardiopulmonary bypass, the patient developed myonephropathic metabolic syndrome. Hyperkalemia was corrected and acute kidney injury was prevented by infusing large volumes of intravenous fluids and administering human atrial natriuretic peptide. Peripheral bypass surgery was unnecessary. This case suggests that restoring blood flow to an ischemic leg by means of adjunctive perfusion during aortic repair with cardiopulmonary bypass is a viable way to overcome the biochemical instability associated with prolonged ischemia, especially hyperkalemia in the early phase of reperfusion.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Ponte Cardiopulmonar/métodos , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Perfusão/métodos , Traumatismo por Reperfusão/prevenção & controle , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Isquemia/diagnóstico , Isquemia/etiologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
10.
Tex Heart Inst J ; 46(2): 143-146, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236083

RESUMO

A 63-year-old woman was incidentally found to have a thoracic aortic aneurysm. We performed hybrid repair involving aortic arch debranching and endovascular stent-graft placement. Four months later, an asymptomatic pseudoaneurysm had formed at the aortic conduit-brachiocephalic artery anastomosis. To exclude the pseudoaneurysm, we deployed a Covered CP Stent across the anastomosis through a surgically created right axillary artery conduit. We discuss the patient's case and our choice of treatment.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Tronco Braquiocefálico/cirurgia , Materiais Revestidos Biocompatíveis , Procedimentos Endovasculares/métodos , Stents , Falso Aneurisma/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Aortografia , Tronco Braquiocefálico/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Pessoa de Meia-Idade , Desenho de Prótese
12.
Gen Thorac Cardiovasc Surg ; 67(10): 855-860, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30963397

RESUMO

OBJECTIVE: Whether mild to moderate and moderate aortic regurgitation should be corrected surgically during other cardiovascular surgeries remains controversial. We evaluated the effectiveness of external suture annuloplasty in such cases. METHODS: Among 95 patients undergoing aortic valve repair between December 2013 and March 2018, five patients with mild to moderate and moderate aortic regurgitation due to aortic annulus dilatation (type Ic lesion) underwent surgery for mitral regurgitation and/or thoracic aortic aneurysm. Aortic valves were repaired with external suture annuloplasty alone with a mean Hegar dilator size of 20.4 ± 0.8 (20.0-22.0) mm at the same time and were followed up echocardiographically. RESULTS: There were no cases of mortality or major morbidity. Intraoperative direct measurement revealed ventriculoaortic junction size of 25.0 ± 0.8 (24.0-27.0) mm. The average cardiopulmonary bypass time and aortic cross-clamping time were 139 ± 46 (76-205) min and 105 ± 38 (58-172) min, respectively. Postoperative transthoracic echocardiogram during hospitalization showed trivial aortic regurgitation in all cases, with average ventriculoaortic junction size, aortic valve area, and peak and mean transvalvular gradient of 19.1 ± 0.7 (18.0-20.3) mm, 2.24 ± 0.48 (1.60-3.00) cm2, 6.4 ± 1.9 (4.0-9.2) mmHg, and 3.5 ± 1.1 (2.1-5.2) mmHg, respectively. Ventriculoaortic junction size was significantly decreased (P < 0.05). There have been no changes in ventriculoaortic junction size (P = 0.32) or other echocardiographic findings for 24 ± 6 (17-36) months after surgery. CONCLUSIONS: Although concomitant with other cardiac surgeries, mild to moderate and moderate aortic regurgitation could be repaired without clinically relevant additional surgical duration. External suture annuloplasty is a useful, safe, and secure treatment choice for type Ic lesion-induced aortic regurgitation.


Assuntos
Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca/métodos , Técnicas de Sutura , Idoso , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do Tratamento
13.
Interact Cardiovasc Thorac Surg ; 29(1): 130-136, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30977797

RESUMO

OBJECTIVES: The goal was to investigate the prevalence of acute kidney injury (AKI) after total arch replacement with frozen elephant trunk procedure, which was achieved by antegrade cerebral perfusion and moderate hypothermic circulatory arrest (MHCA) or deep hypothermic circulatory arrest (DHCA) among patients with type A aortic dissection. METHODS: Overall, 627 adult type A aortic dissection patients who underwent total arch replacement with frozen elephant trunk from January 2013 until December 2016 at Fuwai Hospital were divided into the DHCA (14.1-20.0°C) and MHCA (20.1-28.0°C) groups. Postoperative AKI as the primary outcome was compared using propensity-matched scoring. RESULTS: Overall, 340 (54.2%) and 287 (45.8%) patients underwent DHCA and MHCA, respectively. The overall incidence of AKI was 75.4%. Age [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.00-1.04; P = 0.022], body mass index (OR 1.06, 95% CI 1.01-1.12; P = 0.016), cardiopulmonary bypass duration (OR 1.01, 95% CI 1.00-1.01; P = 0.003) and hypertension history (OR 1.76, 95% CI 1.14-2.70; P = 0.010) were identified as independent risk factors for AKI onset with multivariable analysis. Postoperative AKI was not significantly different between the DHCA and MHCA groups regardless of the overall or propensity-matched cohort (overall data: P = 0.17; propensity score data: P = 0.88). Patients with MHCA experienced higher rates of postoperative stroke after propensity score analysis (DHCA 0.9% vs MHCA 3.7%; P = 0.034). CONCLUSIONS: MHCA was not superior to DHCA in decreasing postoperative AKI. Thus, MHCA should not definitively replace DHCA.


Assuntos
Lesão Renal Aguda/prevenção & controle , Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Parada Circulatória Induzida por Hipotermia Profunda/métodos , Pontuação de Propensão , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Aneurisma Dissecante/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico , Ponte Cardiopulmonar/efeitos adversos , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
16.
Ann Thorac Surg ; 108(2): 481-490, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30914284

RESUMO

BACKGROUND: A successful endovascular treatment for acute type A dissection has been recently reported. However, there has been no consensus regarding the appropriate stent graft size based on the estimated predissected aortic diameter for this pathology. METHODS: We developed new equations for estimating the predissected ascending aorta and aortic arch by investigating computed tomography images that had been scanned less than 3 years before dissection. From 684 patients with type A AAD, 28 were matched for the study. We measured the predissected whole circumference length (pre-wCL), postdissected whole circumference length (post-wCL), postdissected true lumen circumference length (post-tCL), postdissected major diameter (post-Dma), and postdissected minor diameter (post-Dmi) of the acutely dissected aorta. This was followed by the calculation of (post-tCL + post-wCL)/2 and (post-Dma + post-Dmi)/2. Six equations (linear function) and modified equations were derived from each of the abovementioned parameters. RESULTS: Four equations (post-wCL, post-Dma, [post-tCL + post-wCL]/2, and [post-Dma + post-Dmi]/2) had nearly the same bias and accuracy (<9.42 mm). For clinical use, we also developed one modified equation using the post-wCL (y = 0.9x) among four parameters because of its simplicity and decreased the possibility of measurement error. The biases of circumference length and accuracy were 5.5 ± 4.9 mm and 84.6%, respectively, and they improved to 4.4 ± 3.3 mm and 93.4% in cases with a ratio of post-tCL/post-wCL of 0.66 or more. CONCLUSIONS: Our newly developed equation can be used to calculate the predissected ascending aortic diameter and aortic arch diameter in cases of acute type A dissection.


Assuntos
Algoritmos , Aneurisma Dissecante/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico , Procedimentos Endovasculares/métodos , Stents , Doença Aguda , Idoso , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Angiografia por Tomografia Computadorizada , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Ann Thorac Surg ; 108(2): 491-498, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30898563

RESUMO

BACKGROUND: This study evaluated the outcome of physician-modified thoracic stent grafts for the treatment of dissecting aortic arch aneurysms after surgical treatment of acute type A dissection. METHODS: From August 2016 through February 2018, 13 patients (8 men and 5 women) underwent thoracic endovascular aortic repair in which physician-modified thoracic stent grafts were used to treat dissecting aortic arch aneurysms after surgical treatment of acute type A dissection. Patients were a mean age of 70.7 ± 10 years (range, 43 to 82 years). Four patients were treated in an emergent setting for a symptomatic aortic arch aneurysm. The aneurysmal disease involved zone 0 in 10 patients and zone 2 in 3. Seven patients (48%) were treated using an aortic arch stent graft with a single fenestration, combined with cervical debranching in 4 patients. Six patients underwent total endovascular aortic arch repair using a double-fenestrated stent graft. Additional planned endovascular procedures were performed in 3 patients. RESULTS: Median time for stent graft modifications was 18 minutes (range, 14 to 21 minutes). All the proximal entry tears in the arch were successfully excluded. The 30-day mortality rate was 0%. One patient (7.6%) had a stroke without permanent sequelae. The median length of stay was 5 days (range, 1 to 17 days). During follow up of 8 ± 6 months, there were no conversions to open repair, aortic rupture, paraplegia, or retrograde dissection. CONCLUSIONS: The use of physician-modified thoracic stent grafts for the treatment of dissecting aortic arch aneurysm after surgical treatment of acute type A dissection is feasible and effective. Durability concerns will need to be assessed in future studies.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Procedimentos Endovasculares/métodos , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico , Aortografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Interact Cardiovasc Thorac Surg ; 29(1): 124-129, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30824933

RESUMO

OBJECTIVES: Large aortic diameter is considered the most frequent cause of aortic dissection. However, this assumption relies on postdissection imaging of the aorta. We recently showed that acute dissection leads to a 23% increase in the descending aortic diameter. Our aim was to model the diameter of the aorta before the acute descending aortic dissection occurred. METHODS: Between 2003 and 2017, a total of 190 patients developed acute descending aortic dissection. In total, 165 non-Marfan patients were included, whose computed tomography angiography scans were available and taken within 6 h after the occurrence of acute descending aortic dissection [67 (first quartile 58-third quartile 75) years, 69% males]. The maximum postdissection aortic diameter was measured at the level of the mid-descending aorta. Modelling was performed by dividing the postdissection aortic diameter by the factor 1.23. RESULTS: The median modelled predissection descending diameter measured in the mid-descending aorta was 30.5 (27.3-35.4) mm. The median predissection descending diameter was higher in men (P = 0.021) and associated with age (P < 0.001) but not with body surface area. The modelled diameter of the predissected descending aorta revealed that 98.8% (163/165) of patients had an aortic diameter measuring <55 mm and 84.8% (140/165) <40 mm. In other words, 50% of these patients had a non-dilated descending aorta prior to dissection onset. CONCLUSIONS: Modelling indicated that more than 80% of patients who suffered an acute descending aortic dissection had a descending aorta <40 mm before dissection onset. Only 1% of them would have met the guideline criteria (aortic diameter ≥55 mm) for elective descending aortic repair. The role of an excessively large aortic diameter as a predictor of descending aortic dissection might be overrated.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Doença Aguda , Idoso , Aneurisma Dissecante/diagnóstico , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Tex Heart Inst J ; 46(1): 7-13, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30833831

RESUMO

To determine whether body mass index ≥30 kg/m2 affects morbidity and mortality rates in patients undergoing surgery for type A acute aortic dissection, we conducted a retrospective study of 201 patients with type A dissection. Patients were divided into 2 groups according to body mass index (BMI): nonobese (BMI, <30 kg/m2; 158 patients) and obese (BMI, ≥30 kg/m2; 43 patients). Propensity score matching was used to reduce selection bias. The overall mortality rate was 19% (38/201 patients). The perioperative mortality rate was higher in the obese group, both in the overall cohort (33% vs 15%; P=0.01) and in the propensity-matched cohort (32% vs 12%; P=0.039). In the propensity-matched cohort, patients with obesity had higher rates of low cardiac output syndrome (26% vs 6%; P=0.045) and pulmonary complications (32% vs 9%; P=0.033) than those without obesity. The overall 5-year survival rates were 52.5% ± 7.8% in the obese group and 70.3% ± 4.4% in the nonobese group (P=0.036). In the propensity-matched cohort, the 5-year survival rates were 54.3% ± 8.9% in the obese group and 81.6% ± 6.8% in the nonobese group (P=0.018). Patients with obesity (BMI, ≥30 kg/m2) who underwent surgery for type A acute aortic dissection had higher operative mortality rates and an increased risk of low cardiac output syndrome, pulmonary complications, and other postoperative morbidities than did patients without obesity. Additional extensive studies are needed to confirm our findings.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Índice de Massa Corporal , Obesidade/complicações , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Procedimentos Cirúrgicos Vasculares , Doença Aguda , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
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