Clinical outcomes of the type II hybrid procedure for the repair of extensive aortic arch pathology.

Background: Type II hybrid arch repair (HAR) has been used for the repair of extensive aortic arch pathology. The aim of this study was to retrospectively analyze single-stage hybrid treatment involving replacement of the ascending aorta, arch debranching, and zone 0 stent graft deployment. Methods: We retrospectively analyzed clinical data from 41 patients with acute and chronic aortic disease who underwent a type II hybrid arch procedure at Beijing Anzhen Hospital and Beijing Chaoyang Hospital from January 2020 to August 2022. The femoral arteries and right axillary arteries were used as cannulation sites to decrease the risk of malperfusion. During surgery, the nasopharyngeal temperature was lowered to 30 ℃. Demographic, perioperative, and late results data were retrieved and analyzed. Results: The mean age of the patients was 54.9±11.1 years, and 31 patients (75.6%) were men. In all cases, zone 0 stent graft deployment was successful, with no in-hospital mortality. The median follow-up time was 10.5 [interquartile range (IQR), 4.8-17.6] months, and the survival rate was 94.9% during follow-up. Complications included cerebral infarction (3 patients, 7.3%) and renal failure requiring dialysis (3 patients, 7.3%). There were no occurrences of paraplegia, and no stent-related complications occurred during the follow-up period. Conclusions: The single-stage hybrid arch procedure achieved satisfactory early results and represents a less invasive approach for treating complex diffuse aortic disease that affects the arch. This strategy is an important technical advance in the treatment of high-risk patients with extensive aortic arch pathology.

Coronary sodium [18F]fluoride activity predicts outcomes post-CABG: a comparative evaluation with conventional metrics.

PURPOSE: The value of preoperative multidisciplinary approach remains inadequately delineated in forecasting postoperative outcomes of patients undergoing coronary artery bypass grafting (CABG). Herein, we aimed to ascertain the efficacy of multi-modality cardiac imaging in predicting post-CABG cardiovascular outcomes. METHODS: Patients with triple coronary artery disease underwent cardiac sodium [18F]fluoride ([18F]NaF) positron emission tomography/computed tomography (PET/CT), coronary angiography, and CT-based coronary artery calcium scoring before CABG. The maximum coronary [18F]NaF activity (target-to-blood ratio [TBR]max) and the global coronary [18F]NaF activity (TBRglobal) was determined. The primary endpoint was perioperative myocardial infarction (PMI) within 7-day post-CABG. Secondary endpoint included major adverse cardiac and cerebrovascular events (MACCEs) and recurrent angina. RESULTS: This prospective observational study examined 101 patients for a median of 40 months (interquartile range: 19-47 months). Both TBRmax (odds ratio [OR] = 1.445; p = 0.011) and TBRglobal (OR = 1.797; P = 0.018) were significant predictors of PMI. TBRmax>3.0 (area under the curve [AUC], 0.65; sensitivity, 75.0%; specificity, 56.8%; p = 0.036) increased PMI risk by 3.661-fold, independent of external confounders. Kaplan-Meier test revealed a decrease in MACCE survival rate concomitant with an escalating TBRmax. TBRmax>3.6 (AUC, 0.70; sensitivity, 76.9%; specificity, 73.9%; p = 0.017) increased MACCEs risk by 5.520-fold. Both TBRmax (hazard ratio [HR], 1.298; p = 0.004) and TBRglobal (HR = 1.335; p = 0.011) were significantly correlated with recurrent angina. No significant associations were found between CAC and SYNTAX scores and between PMI occurrence and long-term MACCEs. CONCLUSION: Quantification of coronary microcalcification activity via [18F]NaF PET displayed a strong ability to predict early and long-term post-CABG cardiovascular outcomes, thereby outperforming conventional metrics of coronary macrocalcification burden and stenosis severity. TRIAL REGISTRATION: The trial was registered with the Chinese Clinical Trial Committee (number: ChiCTR1900022527; URL: www.chictr.org.cn/showproj.html?proj=37933 ).

Surgical Treatment for Type A Aortic Dissection after Endovascular Aortic Repair: A 12-year, Single-Center Study.

OBJECTIVE: This study aims to investigate the clinical manifestations, operative techniques, and outcomes of patients who undergo open repair after thoracic endovascular aortic repair (TEVAR). METHODS: From January 2010 to June 2022, 113 consecutive type A aortic dissection (TAAD) patients underwent secondary open operation after TEVAR at our institution, and the median interval from primary intervention to open surgery was 12 (1.9-48.0) months. We divided the patients into two groups (RTAD (retrograde type A dissection) group, N = 56; PNAD (proximal new aortic dissection) group, N = 57) according to their anatomical features. Survival analysis during the follow-up was evaluated using a Kaplan-Meier survival curve and a log-rank test. RESULTS: The 30-day mortality was 6.2% (7/113), the median follow-up period was 31.7 (IQR 14.7-65.6) months, and the overall survival at 1 year, 5 years, and 10 years was 88.5%, 88.5%, and 87.6%, respectively. Fourteen deaths occurred during the follow-up, but there were no late aorta-related deaths. Three patients underwent total thoracoabdominal aortic replacement 1 year after a second open operation. The RTAD group had a smaller ascending aorta size (42.5 ± 7.7 mm vs 48.4 ± 11.4 mm; P < .01) and a closer proximal landing zone (P < .01) compared to the PNAD group. However, there were no differences in survival between the two groups. CONCLUSIONS: TAAD can present as an early or a late complication after TEVAR due to stent-grafting-related issues or disease progression. Open operation can be performed to treat TAAD, and this has acceptable early and mid-term outcomes. Follow-up should become mandatory for patients after TEVAR because these patients are at increased risk for TAAD.

Mammalian sterile 20-like kinase 1 acts as a candidate biomarker of mortality of emergency surgical repair for acute type a aortic dissection.

BACKGROUND: Acute type A aortic dissection (ATAAD) is a life-threatening pathological change of the aorta. Patients who have undergone aortic surgery are usually at high risk of mortality. AIM: We investigated the predictive value of serum Mammalian sterile 20-like kinase 1 (MST1) as a biomarker for the risk of mortality of ATAAD patients. METHODS: In this retrospective cohort study, we analyzed 160 consecutive ATAAD patients who had undergone emergency surgery from July 2016 to April 2017. Medical records and blood samples were collected and analyzed. ELISA assays were performed to detect the concentrations of several proteins including MST1. The relationship between these potential biomarkers and the primary endpoint of death was evaluated using Cox proportional hazard regression analysis. RESULTS: Compared with a low level (< 1330.8 ng/L), high serum MST1 level (≥ 1330.8 ng/L) was positively associated with the 30-day mortality (OR = 5.233, 95%CI, 1.843-14.862, P < 0.01) and retained predictive after adjustment for sex, age, BMI, nasopharyngeal temperature and deep hypothermia circulatory arrest time (OR = 4.628 95% CI, 1.572-13.625, P < 0.01). A pre-existing basic clinical prediction model was improved with the inclusion of preoperative serum MST1. Specifically, the area under the ROC curve for base model (history of cerebrovascular disease, creatinine, time of operation) was 0.708 (95%CI, 0.546-0.836) and markedly increased to 0.823 when taking MST1 into consideration (95%CI, 0.700-0.912, P = 0.02). CONCLUSION: Our study suggests that high preoperative circulating MST1, with a concentration greater than 1330.8 ng/L, was correlated with the 30-day mortality of ATAAD patients who underwent emergency surgery.

Safety and Efficacy of Tirofiban Bridging Therapy During a Hybrid Carotid Artery Stenting and Off-pump Coronary Artery Bypass Grafting Surgery: A Single-center Study.

PURPOSE: The optimal perioperative antithrombosis management for carotid artery stenting (CAS) and coronary artery bypass grafting (CABG) hybrid surgeries remains unclear; however, a more aggressive antithrombotic therapy might be required after a hybrid CAS + CABG duo stent-related intimal injury or the use of protamine-neutralizing heparin. This study evaluated the safety and efficacy of tirofiban as a bridging therapy after a hybrid CAS + CABG surgery. METHODS: Between June 2018 and February 2022, a total of 45 patients undergoing a hybrid CAS + off-pump CABG surgery were divided into either the control group (standard dual antiplatelet therapy postsurgery, n = 27) or the tirofiban group (tirofiban bridging + dual antiplatelet therapy, n = 18). The 30-day outcome was compared between the 2 groups, and the primary end points included stroke, postoperative myocardial infarction, and death. FINDINGS: Two patients (7.41%) from the control group experienced a stroke. There was a trend toward a lower rate of composite end points, including stroke, postoperative myocardial infarction, and death, within the tirofiban group that did not reach statistical significance (0% vs 11.1%; P = 0.264). The need for a transfusion was similar between the 2 groups (33.33% vs 29.63%; P = 0.793). There were no major bleeding events in the 2 groups. IMPLICATIONS: Tirofiban bridging therapy was safe, with a trend toward reducing the risk of ischemic events after a hybrid CAS + off-pump CABG surgery. Tirofiban might be a feasible periprocedural bridging protocol in high-risk patients.

Does intensive blood pressure control benefit type B aortic dissection patients who undergoing surgical repair?

OBJECTIVES: The aim of this research is to determine the optimum blood pressure (BP) control goal for hypertensive type B aortic dissection (TBAD) patients undergoing surgery. METHODS: Between January 2019 and April 2021, 259 hypertensive TBAD patients undergoing surgery were included in the research. 98 patients received intensive BP control with a target of systolic BP (SBP) < 120 mmHg, and 161 received standard BP control targeting SBP between 120 and 140 mmHg. Clinical data from two groups were compared. RESULTS: Patients who received intensive BP control experienced a significantly higher incidence of acute kidney injury (AKI) postoperatively (21/98, 21.4% vs 14/161, 8.7%, p = 0.004). The intensive group took more anti-hypertensive drugs per day compared with the standard group (1.9 vs 1.5, p < 0.001). Triple-drug combination treatment was more frequent in the intensive group (38.8% vs 14.3%, p < 0.001), as were angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB; 67.3% vs 44.7%, p 0.001), and thiazide-like diuretic (44.9% vs 18.0%, p < 0.001). CONCLUSIONS: Intensive BP control treatment increases the incidence of AKI and raises the utilization of the anti-hypertensive drug, but did not reduce the operative mortality and late mortality in TBAD patients undergoing surgical repair.

High-TSH Subclinical Hypothyroidism Is Associated With Postoperative Mortality in Acute Type A Aortic Dissection.

Background: Subclinical hypothyroidism can negatively affect the cardiovascular system and increase the risk of mortality, especially for individuals with thyroid-stimulating hormone (TSH) levels above 10 mU/L. We investigated the relationship between high-TSH subclinical hypothyroidism and postoperative mortality in acute type A aortic dissection (ATAAD) patients. Method: We enrolled 146 patients with ATAAD who underwent aortic surgery in Beijing Anzhen Hospital from July 2016 to November 2018. Thyroid hormone levels were obtained before surgery, and participants were divided into a ≥10mU/L TSH level group and a <10mU/L level group. Cox proportional hazard regression and subgroup analysis were conducted to examine the association of preoperative high-TSH subclinical hypothyroidism with postoperative mortality. Result: Participants with preoperative high-TSH (≥10mU/L) subclinical hypothyroidism tended to have longer hospitalization stays after surgery [16.0 (IQR 11.0-21.0) days vs 12.5 (IQR 8.0-16.0) days, P=0.001]. During the first 30 days after operation, 15 of 146 patients died (10.3%); during a median of 3.16 (IQR 1.76-4.56) years of follow-up, 24 patients died (16.4%). Cox proportional hazard regression showed that preoperative high-TSH subclinical hypothyroidism was independently associated with 30-day mortality (HR=6.2, 95% CI, 1.7-22.0, P=0.005) and postoperative mortality after adjusting for age, sex, BMI, hypertension, ejection fraction, diabetes and history of PCI (HR=3.4, 95% CI, 1.4-8.0, P=0.005). Conclusion: This study showed that preoperative high-TSH subclinical hypothyroidism was an independent predictor of postoperative mortality in ATAAD patients who underwent aortic surgery.

Effect of left ventricular ejection fraction (LVEF) on mortality of total arch replacement in subacute/chronic type A aortic dissection.

Background: Preoperative reduced left ventricular ejection fraction (LVEF) is a prognostic factor for postoperative mortality following cardiovascular surgery. We investigated the relationship between the LVEF and the outcome of total arch replacement (TAR) in patients with subacute/chronic type A aortic dissection (TAAD). Methods: A total of 136 patients with subacute/chronic TAAD who received a TAR at Beijing Anzhen hospital from January 2015 to January 2018 were included in the analysis. Univariable and multivariable Cox proportional hazards regression analyses were performed to assess the relationship between the LVEF and the surgical outcome in this subset of patients. Results: The in-hospital mortality rate 4.4%, and 6.6% of patients experienced neurologic complications. During the median follow-up period of 3.97 years [interquartile range (IQR) 3.20-4.67 years], the all-cause mortality was 10.3% (14/136). The multivariable Cox proportional hazards analysis demonstrated that reduced LVEF was an independent predictor of mid-term mortality (hazards ratio =0.93, 95% CI: 0.86-0.99, P=0.03). The Kaplan-Meier survival analysis showed that patients with a LVEF <55% had a significantly worse prognosis than those with a LVEF ≥55%. Conclusions: During the mid-term follow-up period, subacute/chronic TAAD patients had a satisfactory surgical survival rate following TAR. Patients with a reduced LVEF had higher postoperative mortality following TAR. Thus, subacute/chronic TAAD patients with LVEF <55% should be carefully evaluated to determine their suitability for elective repair with TAR.

Deep-Red to Near-Infrared Thermally Activated Delayed Fluorescence in Organic Solid Films and Electroluminescent Devices.

The design and synthesis of highly efficient deep red (DR) and near-infrared (NIR) organic emitting materials with characteristic of thermally activated delayed fluorescence (TADF) still remains a great challenge. A strategy was developed to construct TADF organic solid films with strong DR or NIR emission feature. The triphenylamine (TPA) and quinoxaline-6,7-dicarbonitrile (QCN) were employed as electron donor (D) and acceptor (A), respectively, to synthesize a TADF compound, TPA-QCN. The TPA-QCN molecule with orange-red emission in solution was employed as a dopant to prepare DR and NIR luminescent solid thin films. The high doped concentration and neat films exhibited efficient DR and NIR emissions, respectively. The highly efficient DR and NIR organic light-emitting devices (OLEDs) were fabricated by regulating TPA-QCN dopant concentration in the emitting layers.

Highly Efficient Long-Wavelength Thermally Activated Delayed Fluorescence OLEDs Based on Dicyanopyrazino Phenanthrene Derivatives.

Highly efficient long-wavelength thermally activated delayed fluorescence (TADF) materials are developed using 2,3-dicyanopyrazino phenanthrene (DCPP) as the electron acceptor (A), and carbazole (Cz), diphenylamine (DPA), or 9,9-dimethyl-9,10-dihydroacridine (DMAC) as the electron donor (D). Because of the large, rigid π-conjugated structure and strong electron-withdrawing capability of DCPP, TADF molecules with emitting colors ranging from yellow to deep-red are realized with different electron-donating groups and π-conjugation length. The connecting modes between donor and acceptor, that is, with or without the phenyl ring as π-bridge, are also investigated to study the π-bridge effect on the thermal, photophysical, electrochemical, and electroluminescent properties. Yellow, orange, red, and deep-red organic light-emitting diodes (OLEDs) based on DCPP derivatives exhibit high efficiencies of 47.6 cd A-1 (14.8%), 34.5 cd A-1 (16.9%), 12.8 cd A-1 (10.1%), and 13.2 cd A-1 (15.1%), with Commission Internationale de L'Eclairage (CIE) coordinates of (0.44, 0.54), (0.53, 0.46), (0.60, 0.40), and (0.64, 0.36), respectively, which are among the best values for long-wavelength TADF OLEDs.

Two-Dimensional Organic Single Crystals with Scale Regulated, Phase-Switchable, Polymorphism-Dependent, and Amplified Spontaneous Emission Properties.

The successful preparation of two-dimensional (2D) single crystals can promote the development of organic optoelectronic devices with excellent performance. A Schiff base compound salicylidene(4-dimethylamino)aniline with aggregation induced emission (AIE) property was employed as the building block to fabricate 2D thin single crystal plates with scales from around 50 µm to 1.5 cm. Yellow and red emissive polymorphs were concomitantly obtained during crystallization. The single-crystal-to-single-crystal (SC-to-SC) transformation from yellow polymorph to red one was demonstrated. Furthermore, both polymorphs exhibited amplified spontaneous emission (ASE) properties. Interestingly, the red polymorph displayed size-dependent ASE characteristics. The larger red polymorph showed near-infrared ASE with maximum at 706 nm, whereas the smaller one presented red ASE with maximum at 610 nm. These results suggest that the different scale single crystalline thin films with perfect optoelectronic properties may be fabricated by using the organic molecules with 2D assembly feature.

Highly Efficient Near-Infrared Delayed Fluorescence Organic Light Emitting Diodes Using a Phenanthrene-Based Charge-Transfer Compound.

Significant efforts have been made to develop high-efficiency organic light-emitting diodes (OLEDs) employing thermally activated delayed fluorescence (TADF) emitters with blue, green, yellow, and orange-red colors. However, efficient TADF materials with colors ranging from red, to deep-red, to near-infrared (NIR) have been rarely reported owing to the difficulty in molecular design. Herein, we report the first NIR TADF molecule TPA-DCPP (TPA=triphenylamine; DCPP=2,3-dicyanopyrazino phenanthrene) which has a small singlet-triplet splitting (ΔEST ) of 0.13 eV. Its nondoped OLED device exhibits a maximum external quantum efficiency (EQE) of 2.1 % with a Commission International de L'Éclairage (CIE) coordinate of (0.70, 0.29). Moreover, an extremely high EQE of nearly 10 % with an emission band at λ=668 nm has been achieved in the doped device, which is comparable to the most-efficient deep-red/NIR phosphorescent OLEDs with similar electroluminescent spectra.

Achieving high power efficiency and low roll-off OLEDs based on energy transfer from thermally activated delayed excitons to fluorescent dopants.

Achieving high power efficiencies at high-brightness levels is still an important issue for organic light-emitting diodes (OLEDs) based on the thermally activated delayed fluorescence (TADF) mechanism. Herein, enhanced electroluminescence efficiencies were achieved in fluorescent OLEDs using a TADF molecule, (4s,6s)-2,4,5,6-tetra(9H-carbazol-9-yl)isophthalonitrile (4CzIPN), as a host and quinacridone derivatives (QA) as fluorescent dopants.

High performance full color OLEDs based on a class of molecules with dual carrier transport channels and small singlet-triplet splitting.

Two deep blue emitting materials PPI-PPITPA and PPI-PPIPCz with dual carrier transport properties and small singlet-triplet splitting features are designed and synthesized. PPI-PPITPA and PPI-PPIPCz were used not only as non-doped emitting layers to fabricate highly efficient deep blue OLEDs, but also as hosts to construct high performance green, yellow and red phosphorescent OLEDs.