Targeted Proteomic Analysis of Patients with Ascending Thoracic Aortic Aneurysm.

BACKGROUND: There is a need for clinical markers to aid in the detection of individuals at risk of harboring an ascending thoracic aneurysm (ATAA) or developing one in the future. OBJECTIVES: To our knowledge, ATAA remains without a specific biomarker. This study aims to identify potential biomarkers for ATAA using targeted proteomic analysis. METHODS: In this study, 52 patients were divided into three groups depending on their ascending aorta diameter: 4.0-4.5 cm (N = 23), 4.6-5.0 cm (N = 20), and >5.0 cm (N = 9). A total of 30 controls were in-house populations ethnically matched to cases without known or visible ATAA-related symptoms and with no ATAA familial history. Before the debut of our study, all patients provided medical history and underwent physical examination. Diagnosis was confirmed by echocardiography and angio-computed tomography (CT) scans. Targeted-proteomic analysis was conducted to identify possible biomarkers for the diagnosis of ATAA. RESULTS: A Kruskal-Wallis test revealed that C-C motif chemokine ligand 5 (CCL5), defensin beta 1 (HBD1), intracellular adhesion molecule-1 (ICAM1), interleukin-8 (IL8), tumor necrosis factor alpha (TNFα) and transforming growth factor-beta 1 (TGFB1) expressions are significantly increased in ATAA patients in comparison to control subjects with physiological aorta diameter (p < 0.0001). The receiver-operating characteristic analysis showed that the area under the curve values for CCL5 (0.84), HBD1 (0.83) and ICAM1 (0.83) were superior to that of the other analyzed proteins. CONCLUSIONS: CCL5, HBD1 and ICAM1 are very promising biomarkers with satisfying sensitivity and specificity that could be helpful in stratifying risk for the development of ATAA. These biomarkers may assist in the diagnosis and follow-up of patients at risk of developing ATAA. This retrospective study is very encouraging; however, further in-depth studies may be worthwhile to investigate the role of these biomarkers in the pathogenesis of ATAA.

Totally Percutaneous Repair of an Aortic Arch Dissection: A Case Report.

Although the endovascular repair of descending thoracic aorta diseases is an already consolidated procedure, this approach is not well-established for ascending aorta and arch pathologies. A 71-year-old male patient who had undergone an open ascending aorta replacement ten years ago presented with a huge dissected aortic arch aneurysm. Vascular accesses were obtained with ultrasound-guided punctures, followed by aortic arch exclusion using aortic endoprostheses and the chimney-graft technique for preserving supra-aortic branches flow. This case demonstrates the feasibility of a totally percutaneous aortic arch repair provided that careful preprocedural planning and a dedicated team are available for such a challenging intervention.

Aortic thoracic neuromodulation in heart failure with preserved ejection fraction.

The inadequacy of medical therapies for heart failure with preserved ejection fraction (HFpEF) is driving the development of device-based solutions targeting underlying pathophysiologic abnormalities. The maladaptive autonomic imbalance with a reduction in vagal parasympathetic activity and increased sympathetic signalling contributes to the deterioration of cardiac performance, patient fitness, and the increased overall morbidity and mortality. Thoracic aortic vagal afferents mediate parasympathetic signalling, and their stimulation has been postulated to restore autonomic balance. In this first-in-man experience with chronic stimulation of aortic vagal afferents (Harmony™ System, Enopace, Israel), we demonstrate improved left atrial remodelling and function parallel with improved left ventricular performance. The observed favourable structural and functional cardiac changes remained stable throughout the 1 year follow-up and were associated with improved symptoms and physical fitness. The current experience warrants further validation of the endovascular stimulation of aortic thoracic afferents as a new interventional approach for device-based treatment in HFpEF.

Totally Percutaneous Repair of an Aortic Arch Dissection: A Case Report

ABSTRACT Although the endovascular repair of descending thoracic aorta diseases is an already consolidated procedure, this approach is not well-established for ascending aorta and arch pathologies. A 71-year-old male patient who had undergone an open ascending aorta replacement ten years ago presented with a huge dissected aortic arch aneurysm. Vascular accesses were obtained with ultrasound-guided punctures, followed by aortic arch exclusion using aortic endoprostheses and the chimney-graft technique for preserving supra-aortic branches flow. This case demonstrates the feasibility of a totally percutaneous aortic arch repair provided that careful preprocedural planning and a dedicated team are available for such a challenging intervention.

Hybrid Repair versus Conventional Open Repair Approaches for Aortic Arch Disease: a Comprehensive Review

Abstract Objective: To investigate whether hybrid repair has supremacy over conventional open repair in aortic arch diseases. Methods: A comprehensive search was undertaken in two major databases (PubMed and MEDLINE) to identify all studies comparing the two surgical techniques in five years, up to December 2018, that met the established criteria in this study. The search returned 310 papers, and 305 were selected after removing duplicates. The abstracts of the remaining articles were assessed, resulting in 15 studies that went to full-text analysis. After application of the inclusion and exclusion criteria, 8 papers remained for the final revision. Results: Eight studies met the criteria, with the inclusion of 1,837 patients. From a short-term perspective, hybrid repair and conventional open repair had similar outcomes in terms of postoperative mortality and acute neurological events. Hybrid repair was associated with less respiratory complications and risk of new intervention, as well as reduced hospital length of stay. Conventional open repair showed better mid- and long-term outcomes. Conclusion: Hybrid repair should be used in selected patients, with a high risk or very high-risk profile for conventional surgery. Finally, since most of the current data were obtained from limited to large samples, with narrow follow-up and had great heterogeneity, the best approach to the aortic arch is still variable. Therefore, the decision of the approach should be individualized and evaluated by the whole Heart Team, considering the expertise of the surgical team.

Blunt traumatic thoracic aortic injuries: a retrospective cohort analysis of 2 decades of experience.

OBJECTIVES: The aim of this study was to analyse and report the changes in the management of blunt traumatic aortic injuries (BTAIs) in a single centre during the last 2 decades. METHODS: A retrospective analysis of all patients diagnosed with BTAI from January 1999 to January 2020 was performed. Data were collected from electronic/digitalized medical history records. RESULTS: Forty-six patients were included [median age 42.4 years (16-84 years), 71.7% males]. The predominant cause of BTAI was car accidents (54.5%, n = 24) and all patients presented with concomitant injuries (93% bone fractures, 77.8% abdominal and 62.2% pelvic injuries). Over 70% presented grade III or IV BTAI. Urgent repair was performed in 73.8% of patients (n = 31), with a median of 2.75 h between admission and repair. Thoracic endovascular repair (TEVAR) was performed in 87% (n = 49), open surgery (OS) in 10.9% (n = 5) and conservative management in 2.1% (n = 1). Technical success was 82.6% (92.1% TEVAR, 79% OS). In-hospital mortality was 19.5% (17.5% TEVAR, 40% OS). Of these, 3 died from aortic-related causes. Seven (15.2%) required an early vascular reintervention. The median follow-up was 34 months (1-220 months), with 19% of early survivors having a follow-up of >10 years. Only 1 vascular reintervention was necessary during follow-up: secondary TEVAR due to acute graft thrombosis. Of the patients who survived the initial event, 6.7% died during follow-up, none from aortic-related causes. CONCLUSIONS: Even with all the described shortcomings, in our experience TEVAR for BTAI proved to be feasible and effective, with few complications and stable aortic reconstruction at mid-term follow-up. With the current technical expertise and wide availability of a variety of devices, it should be pursued as a first-line therapy in these challenging scenarios.

Hybrid Repair versus Conventional Open Repair Approaches for Aortic Arch Disease: a Comprehensive Review.

OBJECTIVE: To investigate whether hybrid repair has supremacy over conventional open repair in aortic arch diseases. METHODS: A comprehensive search was undertaken in two major databases (PubMed and MEDLINE) to identify all studies comparing the two surgical techniques in five years, up to December 2018, that met the established criteria in this study. The search returned 310 papers, and 305 were selected after removing duplicates. The abstracts of the remaining articles were assessed, resulting in 15 studies that went to full-text analysis. After application of the inclusion and exclusion criteria, 8 papers remained for the final revision. RESULTS: Eight studies met the criteria, with the inclusion of 1,837 patients. From a short-term perspective, hybrid repair and conventional open repair had similar outcomes in terms of postoperative mortality and acute neurological events. Hybrid repair was associated with less respiratory complications and risk of new intervention, as well as reduced hospital length of stay. Conventional open repair showed better mid- and long-term outcomes. CONCLUSION: Hybrid repair should be used in selected patients, with a high risk or very high-risk profile for conventional surgery. Finally, since most of the current data were obtained from limited to large samples, with narrow follow-up and had great heterogeneity, the best approach to the aortic arch is still variable. Therefore, the decision of the approach should be individualized and evaluated by the whole Heart Team, considering the expertise of the surgical team.

Intramural haematoma of the thoracic aorta: A case series.

We reported four cases of intramural haematoma of the descending thoracic aorta. Four patients, aged 55-82 years, hypertensive, were transferred from the emergency room of other hospitals due to the appearance of epigastric pain and left thorax pain. All patients underwent computed tomography angiography reporting the presence of intramural haematoma. Three patients underwent a drug therapy to maintain a controlled hypotension. A computed tomography revaluation was performed documenting (1) an increase in the thickness of the intramural haematoma, (2) the appearance of a penetrating ulcer within the haematoma and (3) the appearance of several penetrating lesions throughout the thoracic aorta. Patients required the placement of one or two thoracic aorta endoprosthesis. For the fourth patient, the hyperdense appearance of the intramural haematoma and the presence of pleural effusion suggested an urgent treatment intervention. All patients underwent a placement of cerebrospinal fluid catheter and drainage before treatment. All patients were treated with endovascular intervention with 100% technical success and absence of migration or retrograde type A dissection. There were no complications related to femoral surgical access or access routes. Perioperative mortality was null; no patient had paraplegia. No strokes, transient ischemic attack or perioperative myocardial infarction were observed. The average hospitalization was 5 days. After 3 months, angio-computed tomography reported for all patients a complete reabsorption of the intramural haematoma and a complete exclusion of the penetrating ulcer of the aortic wall present at the time of the intervention. There have been no cases of distant thoracic aortic tears. Endovascular treatment must be considered the preeminent treatment for thoracic aortic haematoma. Best timing to perform the endovascular procedure depends on the patient clinical picture and on stability of hemodynamic parameters.

Aortoplasty with pulmonary autograft patch for coarctation of the aorta combined with hypoplastic aortic arch in infant / 中华胸心血管外科杂志

ObjectiveTo discuss the operative techniques and results of coarctation resection plus aortoplasty with pulmonary autograft patch for coarctation of the aorta combined with hypoplastic aortic arch in infant.MethodsBetween May 2007 and Dec 2009,14 cases including 9 males and 5 females with caorctation of the aorta and hypoplastic aortic arch underwent coarctation resection plus aortoplasty with pulmonary autograft patch in our hospital.The age ranged from 23 days to 17 months,with a median of 4.33 months.The mean body weight was (6.14 ±2.36) kg.All patients were diagnosed as aortic coarctation combined with VSD and hypoplastic aortic arch.The surgery was performed under deep hypothermia cardiopulmonary bypass with selective cerebral perfusion in 8 cases and circulation arrest in 6 cases.Fresh pulmonary autograft patch harvested from the main pulmonary artery was used for aortoplasty.The associated VSD was repaired in the same stage.ResultsAll patients survived except one died from circulatory failure during the perioperative period.Low cardiac output syndrome occurred in another case who was cured afterwards by correspondent treatments.No residual obstruction was detected by echocar-diography after the operation.Follow-up was carried out in 13 cases from 4 months to 3 years.Echocardiographic examination showed that the pressure gradient across the aortic arch was less than 16 mm Hg in all cases.The blood velocity at the descending aortic arch was not significantly changed during the follow-up period as compared with that of the immediate after operation.Computed tomography showed that the morphology of aortic arch was normal.The left bronchus compression was relieved obviously or totally disappeared in patients who suffered from left bronchus stenosis before operation,and no aortic aneurysm were detected in these patients.ConclusionConclusion Coarctation resection plus aortoplasty with pulmonary autograft patch is the optimal surgical method for treating coarctation of the aorta combined with hypoplastic aortic arch in infant.

Surgical management of aortic diseases / 中国普通外科杂志

Objective To explore the surgical management of aortic diseases. Methods The clinical data of 45 cases of aortic diseases were analysed retrospectively. Results There were 37 males and 8 females.The age ranged from 21 85 years with a mean age of 64.7 years, Among these cases, 11 were thoracic aortic dissection, 2 were ruptured descending aortic local dissection and formed an aneurysm;above and below the renal artery abdominal aortic aneurysms( AAAs) were 3 and 23 respectively; complicated with rupture of the AAA in 2, and with aortojejumal fistula in 1;the other 3 cases were traumatic aortal rupture. Among the 45 cases, 18 underwent endoluminal treatment, 25 underwent AAA resection and artificial vessel implantment, and 3 underwent repair of the ruptured aorta. The operative mortality was 6.67% ( 3/45 ). 36 patients were followed up for 2 months to 4 years, all the 36 patients still alive well. Conclusions In the management of appropriate aortic diseases, endoluminal technique is much simple,safe, less trauma, and less complications, it can also short the hospital stay of the patient . However, with improvement of the surgical skills,the surgical operation is still very important and effective, especially for the cases who can not be treated via endovascular technique.

Surgical management of arterial diseases / 中国普通外科杂志

Objective To explore the surgical management for arterial diseases. Methods The clinical data of 86 cases of arterial diseases were analysed retrospectively. These cases included:3 cases of thoracic aortic aneurysm,2 cases of descending aortic dissection with rupture and aneurysm formation,2 cases of abdominal aortic dissection with false aneurysm,1 case of abdominal aortic aneurysm(AAA)with duodenojejunal fistula and GI bleeding,5 cases of ruptured AAA with shock, 3 cases of traumatic rupture of abdominal aorta,21 cases of AAA combined with unilateral or bilateral iliac aneurysms,6 cases of iliac aneurysms,9 cases of popliteal aneurysms,21 cases of false aneurysm of iliac or popliteal artery,1 case of rupture of junction of subclavian and vertebral artery with false aneurysm,3 cases of rupture of subclavian artery with false aneurysm,2 cases of aneurysm of carotid artery and 7 cases of false aneurysm of carotid artery. Prosthetic vascular graft was performed in 71(cases),autologous vein graft in 3 cases and suture(repair) of arterial rupture in 12 cases.Results Operative (mortalty) was 3.5%(3/86)in this series.Seventy-one cases were followed-up for 1 month to 5 years, the results showed that all the patients were alive and well.Conclusions In the(management) of(appropriate) aortic diseases, the use of endoluminal technique is simple, microtraumtic, safe and has few complications. It also can shorten the hospital stay of the patient. Endovascular technique should be the first choice for patients with aortic diseases.