Aortic wrapping is life-saving in high-risk acute aortic dissection and intramural haematoma.

Aortic wrapping is a controversial repair in patients presenting with acute type A aortic dissection or intramural haematoma, but this method may be a potential alternative to medical treatment or conventional repair in patients aged >80 years and in those presenting with prohibitive co-morbidities such as stroke, circulatory collapse, full oral anticoagulation with the last generation drugs. We report on 5 high-risk and/or patients over 80 years who received external aortic wrapping with or without cardiopulmonary bypass during the last 18 months. All survived the procedure and could be extubated early postoperatively. No patient remained on the intensive care longer than 2 days and all were discharged without additional complications. Postoperative radiological control was acceptable and no patient had any new aortic event up to 18 months postoperatively.

Circumferential Fibrosis of the Ascending Aorta After COVID Infection.

After recovering from severe COVID-19 infection, 2 women presented with chest pain. Computed tomographic angiography suggested acute ascending aortic dissection. At operation in both patients, the ascending aorta was encased in dense fibrous tissue, within which were focal collections of mononuclear cells, including many plasma cells. There was no entry tear or dissection. Such findings we have not encountered previously, and PubMed search of "periaortic fibrosis and COVID-19" yielded no similar cases or possible relation.

A new “single” era of biomedicine: Applications in cardiovascular disease and COVID-19 (preprint)

With the development of cellular, chemical, and molecular biology, such as, single-cell, single-molecule, single-nucleus, single-chromosome and other related biotechnologies for analysis of chromatin regions, and under the help of single-nucleus and single-cell transcriptomics of human diseases in cardiovascular system, there are many novel breakthroughs in the field of life science and medicine. It can be said that a new “single” era of biomedicine comes. As transforming medical research tools at single-cell levels, single-cell technologies including single-cell RNA sequencing (scRNA-seq) provide high-resolutions insight into complex tissues covered cardiovascular and brain systems, they can help to understand molecular mechanisms of both COVID-19 and cardiovascular disease (CVD), such as atherosclerosis (AS), acute myocardial infarction (AMI), arrhythmogenic cardiomyopathy (ACM), inherited thoracic aortic aneurysm (iTAA) or ascending thoracic aortic aneurysm (ATAA), calcific aortic valve disease, heart failure, and others as well as develop novel therapeutic targets and approaches relevant for CVD and COVID-19.

Bovine Aortic Arch: A Result of Chance or Mandate of Inheritance?

Previous studies have shown that bovine arch incidence is higher in patients with thoracic aortic aneurysms than in patients without an aneurysm. Although thoracic aortic aneurysm disease is known to be familial in some cases, it remains unknown if bovine arch results from a genetic mutation, thus allowing it to be inherited. Our objective was to determine the heritability of bovine arch from phenotypic pedigrees. We identified 24 probands from an institutional database of 202 living patients with bovine arch who had previously been diagnosed with thoracic aortic aneurysm and who had family members with previous chest computed tomography or magnetic resonance imaging scans. Aortic arch configuration of all first-degree and second-degree relatives was determined from available scans. Heritability of bovine arch was estimated using maximum-likelihood-based variance decomposition methodology implemented by way of the SOLAR package (University of Maryland, Catonsville, Maryland). 43 relatives of 24 probands with bovine arch had preexisting imaging available for review. The prevalence of bovine arch in relatives with chest imaging was 53% (n = 23) and did not differ significantly by gender (male: 64.3%, female: 55.6%, p = 1). The bovine arch was shown to be highly heritable with a heritability estimate (h2) of 0.71 (p = 0.048). In conclusion, the high heritability of bovine arch in our sample population suggests a genetic basis.

Thoracoabdominal Aortic Aneursym Accompanied by Leriche Syndrome in a Patient with Coronary Artery Disease: Management Strategy in a Single Case Experience.

Aneurysms and occlusive pathologies of the aorta are frequently associated with atherosclerosis; however, thoracoabdominal aortic aneurysm accompanied by Leriche syndrome is an extremely rare condition with challenging treatment strategy and without established surgical treatment protocols. In this report, we present our treatment strategy in a 64-year-old male patient with ischemic heart disease and type 5 thoracoabdominal aortic aneurysm accompanied by Leriche syndrome.

Management of acute type A aortic dissection during COVID-19 outbreak: Experience from Anzhen.

OBJECTIVES: We seek to report our management protocol and early outcomes of acute type A aortic dissection (ATAAD) repair during the early phase of coronavirus disease 2019 (COVID-19). METHODS: From January 23 to April 30, 2020, we performed ATAAD repair for 33 patients, including three with pregnancy-related TAADs. Confirmation of COVID-19 depended on the results of two nucleic acid tests and pulmonary computed tomography scan. Based on testing results and hemodynamic stability, patients were triaged to an isolated intensive care unit or negative pressure operating room for emergency surgery. RESULTS: Mean age 50.2 ± 13.3 years and 20 were male (60.1%) and 8 patients were febrile (>37.3°C; 24.2%) and 17 were lymphopenic (51.5%). No patient was excluded from COVID-19 infection preoperatively. Extensive aortic repair with total arch replacement (TAR) was performed in 24 (72.7%), and limited proximal repair in 9 patients (27.3%). Cardiopulmonary bypass and cross-clamp times averaged 177 ± 34 and 88 ± 20 min for TAR, and 150 ± 30 and 83 ± 18 min for hemiarch, respectively. The mean operation time was 410 ± 68.3 min. Operative mortality was 6.1% (2/33). Complications included reintubation in four (12.1%), acute kidney failure in two (6.1%), and cerebral infarction in one (3.0%). No paraplegia nor re-exploration for bleeding occurred. COVID-19 was excluded in 100% eventually. No nosocomial infection occurred. Nor did any patient/surgical staff develop fever or test positive during the study period. CONCLUSIONS: The results of this study show that our management protocol based on testing results and hemodynamic stability in patients with ATAAD during the COVID-19 pandemic was effective and achieved favorable early surgical outcomes.

Graft Retrieval for Liver Transplant in a Donor With Giant Thoracoabdominal Aortic Aneurysm.

Liver transplant is a lifesaving treatment option for end-stage liver disease in those with or without hepatocellular carcinoma. Organ shortage is currently the main limitation to liver transplant in many countries worldwide, with fewer donors than patients waiting for transplant. Different solutions have been proposed, including the use of marginal grafts, living donors, and machine perfusion. Potential organs are sometimes discarded due to technical difficulties that may hamper the success of their retrieval and eventual transplant. Here, we present the case of a 69-year-old man with a history of cardiac and pulmonary disease who was considered a potential organ donor after brain death. According to the patient's history, a computed tomography before acceptance was required. The scan revealed a giant thoracoabdominal aortic aneurysm. The donor had previous cardiac surgery with sternotomy and a talcage of the right pleural space. The 2 renal arteries were also unusable because of spread calcifications and involvement by the aneurism. We decided to cannulate the superior mesenteric vessels. Liver transplant was uneventful, and the recipient had no vascular complications, as shown by Doppler ultrasonography performed on days 1, 3, and 7. Length of hospitalization was 14 days. Organ shortages for transplant seemed to have worsened during the COVID-19 period. Nonetheless, the condition of oncology patients can worsen if surgical treatments are delayed. Rearrangements of resources require adaptations in clinical practice.

Acute type A aortic dissection in a patient with COVID-19.

The novel coronavirus spread all over the world in 2019 and became a serious international health concern of this century. Coronavirus disease 2019 (COVID-19) had a wide range of clinical manifestations; it can cause mild-to-severe multiorgan diseases, mostly affecting the respiratory system, but cardiovascular symptoms and complications are also frequently presented in COVID-19 patients. Herein, we report a type A aortic dissection in a confirmed case of COVID-19.

Contained aortic rupture in a term pregnant patient during the COVID-19 pandemic.

Aortic dissection and rupture is a rare occurrence in pregnant and postpartum patients. This case discusses the presentation and diagnosis of a patient with an acute contained thoracic aortic aneurysm rupture at 38 weeks of gestation, after presenting with throat pain and syncope during the COVID-19 pandemic. The patient underwent emergent caesarean delivery for non-reassuring fetal heart tracing, following which continued syncope workup revealed an aortic aneurysm and pericardial effusion. Diagnosis in this case was finalised with multimodality imaging, including transthoracic echocardiogram, and the patient underwent surgical aortic repair.

An infection-oriented approach for thoracic endovascular aortic repair in a SARS-CoV-2 positive patient. A case report.

CASE REPORT: A 64-year-old woman presented to our emergency department during the outbreak of the covid-19 emergency in Italy with syncope, anosmia, mild dyspnoea and atypical chest and dorsal pain. A chest CT scan showed an acute type B aortic dissection (ATBAD) and bilateral lung involvement with ground-glass opacity, compatible with interstitial pneumonia. Nasopharyngeal swabs resulted positive for SARS-CoV-2. For the persistence of chest pain, despite the analgesic therapy, we decided to treat her with a TEVAR. Patient's chest and back pain resolved during the first few days after the procedure. No surgical or respiratory complications occurred and the patient was discharged 14 days after surgery. DISCUSSION: By performing the operation under local anesthesia, it was possible to limit both the staff inside the operatory room and droplet/aerosol release. Since we had to perform the operation in a hemodynamics room, thanks to the limited extension of the endoprosthesis and the good caliber of the right vertebral artery we were able to reduce the risk of spinal cord ischemia despite the lack of a revascularization of the left subclavian artery. CONCLUSIONS: A minimally invasive total endovascular approach allows, through local anesthesia and percutaneous access, to avoid surgical cut down and orotracheal intubation. This, combined with a defined management protocol for infected patients, seems to be a reasonable way to perform endovascular aortic procedures in urgent setting, even in a SARSCoV- 2 positive patient. KEY WORDS: COVID-19, Dissection, TEVAR.

International study on impact of COVID-19 on cardiac and thoracic aortic aneurysm surgery.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic gripped every nation's health care system and provisions on all levels. In cardiac and aortic surgery, as it is with most specialities, elective surgeries were halted. AIMS OF THE STUDY: We captured reflections, contingencies, and current practices across of high-volume centers in cardiac and aortic surgery globally. We also aimed this study to assess decision on prioritization of the surgical patients, the need for personal protection equipment, and the choice of preoperative investigations in current dynamic and fluid climate. METHODS: A validated web-based questionnaire was constructed and was circulated to the international surgeons amongst high volume cardiac and aortic surgery centers. Their intrinsic feedback on decision making, the impact of the lockdown, and perspectives for the future ahead of us all were noted. A mixed-method approach was constructed. Qualitative data analysis was introduced to signify the impact globally. RESULTS: Overall, 23 centers from 18 countries participated in this international study. About 91.7% of the respondents stopped operating on elective patients during the pandemic. The majority of the surgeons agreed that acute aortic dissection (87.1%) should be operated as an emergency procedure and stable triple vessel disease (87.1%) to be considered as an elective procedure. Three-fifth (60%) of the respondents relied on computerized tomography chest as a preoperative screening modality. CONCLUSION: In the present climate where there is a paucity of evidence, this will give an interim consensus for the cardiac surgeons. With the increase in the cumulative number of patients with COVID-19, careful utilization of the resources regarding hospital beds and manpower is of paramount importance.

Surgical management of thoracic aortic emergency with pre- and postoperative COVID-19 disease.

The nuance of operative decision making for those in need of emergent operation during coronavirus disease 2019 (COVID-19) pandemic is increasingly complex in the absence of robust data or guidelines. We present two cases of thoracic aortic emergencies with COVID-19 disease who survived high-risk operations to highlight the potential for successful outcomes even in situations compounding patient disease, morbid operation, and the added risk associated with virulent disease in the pandemic time.

Acute Aortic Dissection Surgery in a Patient With COVID-19.

Acute aortic dissection is one of the most common life-threatening diseases that affects the aortic vessel. We present a case of acute Stanford type A aortic dissection in a patient with coronavirus disease 2019 (COVID-19) under treatment with angiotensin-converting enzyme inhibitors. A 68-year-old woman complaining of acute chest pain and dyspnea was admitted to the emergency clinic of our hospital on May 6, 2020. She had history of diabetes and hypertension. This is one of the first acute aortic surgery cases among patients with COVID-19.

Acute complicated type B aortic dissection during the New York City COVID-19 surge.

The impact of the coronavirus disease 2019 (COVID-19) pandemic in New York City (NYC) is dramatic. COVID-19 cases surged, hospitals expanded to meet capacity, and NYC remains the global epicenter of this pandemic. During this unprecedented time, a young woman with known Marfan syndrome presented with an acute complicated type B aortic dissection to our Aortic Center. Using the provisional extension to induce a complete attachment technique, we treated this patient and quickly discharged her the next day to decrease the risk of COVID-19 infection. Her progress was monitored using frequent phone calls and one office visit at two weeks.