AORTA最新文献

Individuals with ascending thoracic aortic aneurysm (ATAA) are recommended to avoid intense exercise for fear of marked increases in aortic wall stress (AWS). However, no study has measured AWS during exercise. The aim of this case series was to examine AWS during "light-to-moderate" aerobic exercise in individuals with ATAA and healthy control (CON) participants.Three clinically stable patients with ATAA (2 male, mean age: 74 ± 1 years) and 3 CON (2 male, mean age: 69 ± 7 years) were studied on 2 separate days. Day 1: a maximal cardiopulmonary exercise test was performed to measure peak aerobic power (VO₂peak), maximal heart rate, and blood pressure (BP). Day 2: cardiac and aortic magnetic resonance imaging were performed at rest and during submaximal (3-5 metabolic equivalents) "stepper" exercise during which cardiac output (Qc), aorta diameters, wall thickness, and BP were measured. Circumferential ascending and descending AWS were calculated in accord with LaPlace Law, whereas aorta mechanical efficiency was derived as the AWS/Qc slope.Patients with ATAA demonstrated lower median VO₂peak (18.2 vs. 24.1 mL/kg/min). During exercise, the absolute ascending (ATAA: 257 vs. CON: 269 kPa) and descending AWS increased (ATAA: 224 vs. CON: 207 kPa), and ∆AWS during exercise was similar between ATAA and CON (Ascending, ATAA: 79 vs. CON: 62 kPa; Descending, ATAA: 64 vs. CON: 55 kPa). During exercise, ascending and descending AWS were 76 to 83% below ATAA rupture thresholds (i.e., 800-1,200 kPa) in all patients. Finally, exercise Qc was 17% lower and the ascending AWS/Qc slope was 30% higher in ATAA (16 kPa/L/min) versus CON (12 kPa/L/min).Our findings demonstrate "light-to-moderate" aerobic exercise produces similar AWS responses between ATAA and CON and is well below aneurysmal rupture thresholds. The higher AWS/Qc slope in ATAA suggests decreased aortic mechanical efficiency and may be a useful measure for exercise prescription for these patients.

This case series evaluated the characteristics and outcomes of reoperative root replacement in patients with prior aortic valve replacement (AVR), aortic root replacement (ARR), or ascending or hemiarch replacement (AoR) from our single institution from 2014 to 2023. A total of 55 (prior surgery: 38 AVR, 5 ARR, and 12 AoR) patients were identified and indication for reoperation included valvular stenosis, endocarditis, aneurysm, and dissection. Perioperative mortality was 10.9% (6 patients) (inpatient complications: 2 stroke, 4 bleeding event, 2 renal failure, and 21 prolonged vent).

The purpose of the study was to compare axial measurements of the ascending thoracic aorta on gated CT study studies with double oblique measurements and calculate the divergence between orthogonal axial and double oblique diameters of the tubular ascending aorta.Retrospective measurements of axial and double oblique diameters were obtained in 153 consecutive patients.On average, the axial dimension exceeded the double oblique measurement.Our study endorsed the subtraction of 0.58 mm from the axial diameter in order to obtain the double oblique measurement.

A mobile mass in the ascending aorta is a rare cause for stroke. Detection is usually accomplished by Computed tomography angiography and/or echocardiography. In suitable patients, urgent surgical removal remains the best approach.

Fenestrated endovascular aortic aneurysm repair is a minimally invasive technique used for the treatment of thoracoabdominal aortic aneurysms (TAAAs). We report an easy method for positioning the controlled-release fenestrated endoprosthesis, associated with a less invasive approach for positioning the endoprosthesis and catheterization of the target vessels through percutaneous access.

Spinal cord ischemia (SCI) is a well-known complication of both open and endovascular repair of the thoracoabdominal aorta. Perioperative maneuvers to increase spinal cord perfusion, including permissive hypertension and lumbar drain placement to control spinal pressure, are commonly used to reduce the risk of SCI. Additional perioperative measures to reduce the susceptibility of the spinal cord to ischemic insult include hypothermia, steroids, and naloxone infusion. Most cases manifest immediately or within days of surgery and improve with the aforementioned maneuvers. We describe a rare occurrence of delayed SCI 20 months after thoracic endovascular aortic aneurysm repair.

Type A aortic dissection as a highly lethal disease continues being a great challenge for cardiac surgeons worldwide. There are still unanswered questions regarding intraoperative decisions and their impact on the surgical outcomes. The aim of this study is to compare postoperative outcomes according to site of cannulation in patients with acute Type A aortic dissection (ATAAD).This was a retrospective cohort study. We included all ATAAD procedures from January 2002 to November 2023. We defined groups according to site of cannulation (aorta, axillary, femoral, innominate). Data from pre-, intra-, and postoperative variables were collected. Our main outcomes were spinal cord injury (SCI), stroke rate, and in-hospital mortality. Between-group comparisons were performed using standard statistical tests and post hoc tests adjusting for multiple comparisons were performed.We identified 127 ATAAD procedures. Reoperation for bleeding was significantly higher in the femoral cannulation group (75%, p = 0.0006). There were no statistically significant differences in acute kidney injury rate (p = 0.012), SCI rate (p = 0.78), or in-hospital mortality (p = 0.75). Our data suggest that there is a lower stroke rate in the axillary cannulation group (3.6%, p = 0.4), which did not reach statistical significance.Choosing an adequate cannulation site is a critical step in TAAD surgery. In our series, axillary and innominate cannulation were the preferred methods with relatively low complication rates.

The frozen elephant trunk (FET) has been a mainstay in the treatment of acute as well as chronic aortic dissections. Although various complications have been reported in the literature, rupture of the descending thoracic aorta by the endovascular graft has, to our knowledge, not been published. We report an FET procedure following previous valve-sparing root replacement for Type A aortic dissection leading to rupture of the descending thoracic aorta.

Acute Type A aortic dissection (ATAAD) is a life-threatening condition requiring timely surgical intervention. Despite successful surgery, postoperative outcomes are frequently suboptimal due to the high frequency of cardiovascular risk factors. This study examines baseline cardiovascular risk factors in a population of ATAAD patients in the Netherlands. Additionally, this study outlines the protocol for a randomized controlled trial, designed to improve postoperative management.Baseline data were collected from patients with ATAAD. Data were gained through the Stichting Aorta Dissectie Nederland, a Dutch association for aortic dissection patients. The data included information on cardiovascular risk factors and health-related quality of life. A survey was further conducted, to gain more insights into the ATAAD postoperative care experiences of cardiac and vascular surgeons.Among the 50 ATAAD patients in our study, we found significant cardiovascular risk factors, including smoking (36.7%), obesity (34.2%), and hypertension (51.3%). In the surgeon survey (N = 48), 84% of respondents highlighted the significance of lifestyle changes for patients, underscoring the need for individualized risk management. These findings underscore the need for tailored postoperative management programs aimed at improving patient outcomes.The results of our study highlight that ATAAD patients require comprehensive postoperative care management strategies. The ultimate goal is to enhance long-term patient outcomes and improve health-related quality of life. To address this need, the TRAIN (Targeted caRdiovAscular rIsk reductioN) Health Awareness platform seeks to implement personalized eHealth-based lifestyle interventions.

Aortic pseudoaneurysm occurs in 10 to 24% of patients after acute type A aortic dissection repair. We report the case of a 72-year-old female who developed an intraoperative iatrogenic ascending aortic dissection following mitral valve repair. A giant ascending aortic pseudoaneurysm was detected on follow-up imaging. This case emphasizes the importance of close radiological surveillance following acute aortic dissection repair.