RESUMEN
Introduction: Reconstruction surgery of the proximal aorta in most cases involves the use of an aortic conduit, followed by reimplantation of the coronary ostia. Although uncommon, the origin of the coronary arteries in certain anatomical variants poses additional difficulties when performing surgery on the aortic root and requires a different treatment rationale. Case report: We hereby present the case of a 60-year-old patient with multiple cardiovascular risk factors (smoking, arterial hypertension and dyslipidemia), suffering from severe degenerative stenosis of a bicuspid aortic valve, associated with ascending aorta aneurysm and a significant extrinsic stenosis of the left coronary artery caused by the aneurysm. The patient presented with severe degenerative bicuspid aortic valve stenosis associated with ascending aorta aneurysm and a significant extrinsic stenosis of the left coronary artery caused by the aneurysm. Following the preoperative assessment, it was decided that the best course of action was to perform surgery on the aortic valve and ascending aorta. During the surgery, the origin of the right and left coronary ostia were found at the level of the left coronary cusp, both forming a common coronary button. Due to this particular anatomical variant, it was decided to reimplant them as a common button onto the main conduit by means of an interposed No.10 PTFE (Polytetrafluoroethylene) vascular prosthesis. Conclusion: A rare case of aortic root surgery associated with coronary ostia origin variant "shotgun barrel", which required a different method of reimplantation: modified Cabrol technique.
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Estenosis de la Válvula Aórtica , Válvula Aórtica , Humanos , Masculino , Persona de Mediana Edad , Válvula Aórtica/cirugía , Válvula Aórtica/anomalías , Resultado del Tratamiento , Estenosis de la Válvula Aórtica/cirugía , Implantación de Prótesis Vascular/métodos , Enfermedad de la Válvula Aórtica Bicúspide/cirugía , Enfermedad de la Válvula Aórtica Bicúspide/complicaciones , Anomalías de los Vasos Coronarios/cirugía , Anomalías de los Vasos Coronarios/complicaciones , Enfermedades de las Válvulas Cardíacas/cirugía , Enfermedades de las Válvulas Cardíacas/complicaciones , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/complicaciones , Enfermedad de la Válvula Aórtica/cirugía , Enfermedad de la Válvula Aórtica/complicaciones , Estenosis Coronaria/cirugía , Estenosis Coronaria/complicaciones , Estenosis Coronaria/etiología , Implantación de Prótesis de Válvulas Cardíacas/métodos , Reimplantación/métodosAsunto(s)
Disección Aórtica , Insuficiencia de la Válvula Aórtica , Ecocardiografía Transesofágica , Seno Aórtico , Tomografía Computarizada por Rayos X , Humanos , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/complicaciones , Seno Aórtico/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/cirugía , Masculino , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/complicaciones , Persona de Mediana Edad , Enfermedad AgudaRESUMEN
BACKGROUND: Postoperative computed tomography imaging surveillance is an essential component of care after acute type A aortic dissection (ATAAD) repair. Prognostic imaging factors after ATAAD repair have not been systematically reviewed. METHODS AND RESULTS: We performed a systematic review to summarize postoperative computed tomography measurements including aortic diameter, cross-sectional area, volume, growth rate, and false lumen thrombosis in addition mid- to long-term clinical outcomes after ATAAD repair. Searches were conducted in Medline, Embase, and CENTRAL in October 2022. Studies were included if they reported clinical outcomes such as mortality or aortic reintervention after 1 year and included aforementioned computed tomography findings. Studies of chronic aortic dissection and studies of exclusive patient populations such as those with connective tissue diseases were excluded. Risk of bias was assessed with the Newcastle-Ottawa Scale. Searches retrieved 6999 articles. Sixty-eight studies met inclusion criteria (7885 patients). Extended repairs were associated with improved false lumen thrombosis, decreased aortic growth rate, and decreased rates of reintervention but not improved survival. Growth rates of the aorta post-ATAAD repair were highest in the descending thoracic aorta. The most frequent prognostic imaging factors reported were a patent/partially thrombosed false lumen and postoperative aortic diameter >40 to 45 mm. CONCLUSIONS: Established measurements of positive aortic remodeling, including complete false lumen thrombosis and stabilization of postoperative aortic diameter and growth are the most studied prognostic indicators for improved clinical outcomes after ATAAD repair. Growth rate of the aorta remains significant after ATAAD repair. Future studies should prospectively evaluate and compare prognostic factors for improved surveillance and management.
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Disección Aórtica , Humanos , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Enfermedad Aguda , Resultado del Tratamiento , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Angiografía por Tomografía Computarizada , Pronóstico , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagenRESUMEN
BACKGROUND: Selective antegrade cerebral perfusion (sACP) is a crucial cerebral protection technique employed during aortic dissection surgeries involving cardiopulmonary bypass. However, postoperative neurological complications, particularly those related to cannulation issues and perfusion problems, remain a significant concern. CASE PRESENTATION: This case report details an unusual instance where a 38-year-old male patient with Marfan syndrome experienced cerebral hypoperfusion during emergency surgery for Stanford Type A aortic dissection. Despite following standard protocols, a significant drop in regional cerebral oxygen saturation (rSO2) and abnormal blood pressure fluctuations were observed shortly after initiating sACP via the innominate artery. After initial attempts to optimize perfusion flow proved ineffective, the cannulation position was adjusted, leading to improvements. Nevertheless, the patient subsequently exhibited signs of cerebral hypoperfusion and was found to have suffered a new cerebral infarction. CONCLUSIONS: This case report underscores the importance of precise cannula placement during sACP procedures and the dire consequences that can arise from improper positioning. It emphasizes the need for continuous monitoring and prompt intervention in cases of abnormal cerebral oxygenation and blood pressure, as well as the value of considering cannulation-related issues as potential causes of postoperative neurological complications.
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Disección Aórtica , Humanos , Masculino , Adulto , Disección Aórtica/cirugía , Cateterismo/métodos , Circulación Cerebrovascular/fisiología , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta/cirugía , Puente Cardiopulmonar/métodos , Puente Cardiopulmonar/efectos adversos , Síndrome de Marfan/complicacionesRESUMEN
INTRODUCTION: Sinus of Valsalva aneurysm (SOVA), a rare cardiac malformation, is usually congenital and rarely acquired and most commonly occurring in the right coronary sinus. The clinical presentation of patients with SOVA varies. It is usually asymptomatic when it has not ruptured, and when it compresses neighboring structures or ruptures, it can lead to heart failure or shock, at which point urgent surgical intervention is usually required. Rupture of the sinus of Valsalva aneurysm (RSOVA) during pregnancy is really hard to come by, especially if the clinical presentations resemble that of an acute myocardial infarction. This report describes a pregnant woman with severe chest pain and hypotension with aVR and V1 ST-segment elevation due to RSOVA. PATIENT CONCERNS: Effects of RSOVA on the fetus, disease survival, and prognosis. DIAGNOSIS: RSOVA. INTERVENTIONS: Open SOVA repair. OUTCOMES: The patient's blood pressure returned to normal range and clinical symptoms disappeared after the surgery. After 3 months of follow-up, the patient was hemodynamically stable without chest discomfort, and an echocardiogram showed a normal aortic sinus. CONCLUSION: Progressive aneurysm dilatation or rupture has a poor prognosis. A thorough history and physical examination are fundamental, with echocardiography being the initial diagnostic tool of choice, and other ancillary tests (e.g., computed tomography) being used to complement and confirm the diagnosis. Surgery remains the current treatment of choice for patients with RSOVA, while the continuation of pregnancy in pregnant patients with RSOVA remains a case-by-case measure.
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Complicaciones Cardiovasculares del Embarazo , Choque Cardiogénico , Seno Aórtico , Humanos , Embarazo , Femenino , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Adulto , Choque Cardiogénico/etiología , Choque Cardiogénico/diagnóstico , Seno Aórtico/diagnóstico por imagen , Seno Coronario/anomalías , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/complicaciones , Rotura de la Aorta/cirugía , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/cirugía , Electrocardiografía , EcocardiografíaRESUMEN
Aortic dissection, characterized by a high immediate mortality, is primarily caused by excessive bleeding within the walls of the aorta or a severe tear within the intimal layer of the aorta. Inflammation, as well as oxidative stress and the degradation of extracellular matrix (ECM), are significant factors in the development and occurrence of aortic dissection. Matrix metalloproteinases (MMPs) are pivotal enzymes responsible for degrading the ECM. Inflammatory factors and oxidants can interact with MMPs, indicating the potential significance of MMPs in aortic dissection. A substantial body of evidence indicates that numerous MMPs are significantly upregulated in aortic dissection, playing a critical role in ECM degradation and the pathogenesis of aortic dissection. Furthermore, targeting these enzymes has demonstrated potential in facilitating ECM restoration and reducing the incidence of aortic dissection. This review initially provides a brief overview of MMP biology before delving into their expression patterns, regulatory mechanisms, and therapeutic applications in aortic dissection. A profound comprehension of the catabolic pathways associated with aortic dissection is imperative for the future development of potential preventive or therapeutic bio-interventions for aortic dissection.
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Aneurisma de la Aorta , Disección Aórtica , Matriz Extracelular , Metaloproteinasas de la Matriz , Humanos , Disección Aórtica/enzimología , Disección Aórtica/patología , Disección Aórtica/metabolismo , Metaloproteinasas de la Matriz/metabolismo , Animales , Aneurisma de la Aorta/enzimología , Aneurisma de la Aorta/metabolismo , Aneurisma de la Aorta/patología , Matriz Extracelular/metabolismo , Matriz Extracelular/enzimología , Matriz Extracelular/patología , Inhibidores de la Metaloproteinasa de la Matriz/uso terapéutico , Inhibidores de la Metaloproteinasa de la Matriz/farmacología , Transducción de Señal , Aorta/enzimología , Aorta/patología , Aorta/metabolismoRESUMEN
BACKGROUND: The aim of this study is to explore the clinical value of computed tomography angiography (CTA) in the diagnosis of aortic aneurysm. METHODS: The imaging data of 60 patients suspected of having aortic aneurysms who were examined in the Radiology Department of the First Affiliated Hospital of Nanjing Medical University from April 2017 to April 2020 were analyzed retrospectively. CTA and digital subtraction angiography (DSA) were used to examine the patients, and CTA image findings were collected and compared with DSA findings. RESULTS: There was no significant difference in the accuracy of diagnosing aortic aneurysms (P > 0.05) between DSA [98.33% (59/60)] and CTA [95.00% (57/60)]. There was no significant difference in the diagnosis of image features (e.g., typing, site, form) of aortic aneurysms (P > 0.05). CONCLUSION: CTA can be used to successfully confirm if patients suffer from an aortic aneurysm; it produces quality images with high specificity, sensitivity, and accuracy and can be promoted in clinical practice.
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Angiografía de Substracción Digital , Aneurisma de la Aorta , Angiografía por Tomografía Computarizada , Humanos , Angiografía por Tomografía Computarizada/métodos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Aneurisma de la Aorta/diagnóstico por imagen , Angiografía de Substracción Digital/métodos , Adulto , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico , Sensibilidad y Especificidad , Reproducibilidad de los ResultadosRESUMEN
Aortic aneurysm and dissection (AD) represent a critical cardiovascular emergency with an alarmingly high mortality rate. Recent research has spotlighted the overexpression of genes associated with the m6A modification in AD patients, linking them to the presence of inflammatory M1-type macrophages. Moreover, glycolysis is widely recognized as a key feature of inflammatory M1-type macrophages, but biomarkers linking glycolysis and macrophage function to promote disease progression in AD have not been reported. We conducted an analysis of aortic immune cell infiltration, macrophages, and m6A-related biomarkers in AD patients using bioinformatics techniques. Subsequently, we employed a combination of RT-PCR, WB, and immunofluorescence assays to elucidate the alterations in the expression of M1- and M2-type macrophages, as well as markers of glycolysis, following the overexpression of key biomarkers. These findings were further validated in vivo through the creation of a rat model of AD with knockdown of the aforementioned key biomarkers. The findings revealed that the m6A-modified related gene RBM15 exhibited heightened expression in AD samples and was correlated with macrophage polarization. Upon overexpression of RBM15 in macrophages, there was an observed increase in the expression of M1-type macrophage markers CXCL9 and CXCL10, alongside a decrease in the expression of M2-type macrophage markers CCL13 and MRC1. Furthermore, there was an elevation in the expression of glycolytic enzymes GLUT1 and Hexokinase, as well as HIF1α, GAPDH, and PFKFB3 after RBM15 overexpression. Moreover, in vivo knockdown of RBM15 led to an amelioration of aortic aneurysm in the rat AD model. This knockdown also resulted in a reduction of the M1-type macrophage marker iNOS, while significantly increasing the expression of the M2-type macrophage marker CD206. In conclusion, our findings demonstrate that RBM15 upregulates glycolysis in macrophages, thus contributing to the progression of AD through the promotion of M1-type macrophage polarization. Conversely, downregulation of RBM15 suppresses M1-type macrophage polarization, thereby decelerating the advancement of AD. These results unveil potential novel targets for the treatment of AD.
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Aneurisma de la Aorta , Disección Aórtica , Progresión de la Enfermedad , Glucólisis , Macrófagos , Proteínas de Unión al ARN , Glucólisis/genética , Humanos , Animales , Macrófagos/metabolismo , Macrófagos/inmunología , Ratas , Disección Aórtica/patología , Disección Aórtica/genética , Disección Aórtica/metabolismo , Aneurisma de la Aorta/metabolismo , Aneurisma de la Aorta/genética , Aneurisma de la Aorta/patología , Proteínas de Unión al ARN/genética , Proteínas de Unión al ARN/metabolismo , Masculino , Modelos Animales de Enfermedad , Quimiocina CXCL10/metabolismo , Quimiocina CXCL10/genética , Biomarcadores/metabolismo , Quimiocina CXCL9/metabolismo , Quimiocina CXCL9/genética , Femenino , Adenosina/análogos & derivadosRESUMEN
OBJECTIVE: Aortic Dissection (AD) is one of the most fatal acute diseases in cardiovascular diseases, with rapid onset and progression and a high fatality rate. This study aims to investigate the clinical values of non-enhancement peripheral pulse-gating rapid magnetic resonance imaging in deterministic diagnosis of AD. METHODS: Aorta magnetic resonance imaging was performed in 21 healthy volunteers at a 1.5t MR scanner sequences including cardiac-gated and peripheral pulse-gated True-FISP and HASTE were carried out separately. Acquisition Time (TA), Signal to Noise Ratio (SNR), Contrast Noise Ratio (CNR), and entirety of vessel wall blood flow artifacts were measured and compared. A total of 56 AD cases were displayed by non-enhancement peripheral pulse-gating fast MR imaging, and the results were compared with pathological findings or CTA of the aorta. The dissection rupture, tear film, true and false lumen, thrombosis, hydropericardium, and the main branches of AD were evaluated respectively. RESULTS: There were no significant differences in SNR, CNR, entirety of the vessel wall, and blood flow artifact between cardiac-gated and peripheral pulse-gated fast MR imaging. Non-enhancement pulse-gated fast scanning takes less TA time. By the pulse-gated non-enhancement fast MR imaging, the dissection rupture, tear film, true and false cavity, thrombosis, hydropericardium, and the main branches of aortic dissection were shown clearly. Multi-planar and multi-angle scans helped to show the extent of entrapment rupture, whereas partial complex tears or bi-directional tears were slightly less well visualized. CONCLUSION: Non-enhancement peripheral pulse-gated rapid magnetic resonance imaging can be used for deterministic diagnosis of AD.
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Disección Aórtica , Imagen por Resonancia Magnética , Humanos , Disección Aórtica/diagnóstico por imagen , Masculino , Femenino , Adulto , Persona de Mediana Edad , Imagen por Resonancia Magnética/métodos , Relación Señal-Ruido , Aneurisma de la Aorta/diagnóstico por imagen , Anciano , Reproducibilidad de los Resultados , Adulto Joven , Técnicas de Imagen Sincronizada Cardíacas/métodos , Valores de ReferenciaRESUMEN
The phenotypic switch of vascular smooth cells (VSMCs) from a contractile to a synthetic state is associated with the development and progression of aortic aneurysm (AA). However, the mechanism underlying this process remains unclear. In this issue of the JCI, Song et al. identified SLC44A2 as a regulator of the phenotypic switch in VSMCs. Inhibition of SLC44A2 facilitated the switch to the synthetic state, contributing to the development of AA. Mechanistically, SLC44A2 interacted with NRP1 and ITGB3 to activate the TGF-ß/SMAD signaling pathway, resulting in VSMCs with a contractile phenotype. Furthermore, VSMC-specific SLC44A2 overexpression by genetic or pharmacological manipulation reduced AA in mouse models. These findings suggest the potential of targeting the SLC44A2 signaling pathway for AA prevention and treatment.
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Aneurisma de la Aorta , Músculo Liso Vascular , Miocitos del Músculo Liso , Transducción de Señal , Animales , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patología , Aneurisma de la Aorta/metabolismo , Aneurisma de la Aorta/patología , Aneurisma de la Aorta/genética , Ratones , Miocitos del Músculo Liso/metabolismo , Miocitos del Músculo Liso/patología , Humanos , Fenotipo , Factor de Crecimiento Transformador beta/metabolismo , Factor de Crecimiento Transformador beta/genética , Integrina beta3/metabolismo , Integrina beta3/genética , Proteínas de Transporte de Membrana/metabolismo , Proteínas de Transporte de Membrana/genética , Neuropilina-1/metabolismo , Neuropilina-1/genéticaRESUMEN
Case 1 was a 59-year-old man who underwent aortic valve replacement (AVR) at the age of 38, for aortic regurgitation. Case 2 was a 51-year-old man who underwent AVR at the age of 34, for aortic regurgitation. Both cases required surgery for ascending aortic aneurysms. These patients showed aneurysm at the site of the prior aortotomy. In both of the patients used felt-strip was used for closing aortotomy. Intraoperative findings showed enlargement of the aorta around the felt-strip, which was a finding of true aneurysm. Both cases underwent ascending aortic replacement. The mechanism of aortic aneurysm development was thought to include persistent mechanical stimulation by the felt-strip and ischemia of the vasa-vasorum due to compression of the felt-strip. The use of felt-strips for the aortotomy suture should be avoided, especially in young patients.
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Válvula Aórtica , Humanos , Masculino , Persona de Mediana Edad , Aorta/cirugía , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/etiología , Aneurisma de la Aorta/diagnóstico por imagen , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/etiología , Implantación de Prótesis de Válvulas Cardíacas , Complicaciones PosoperatoriasRESUMEN
Aortic aneurysm and dissection (AAD) is a cardiovascular disease that poses a severe threat to life and has high morbidity and mortality rates. Clinical and animal-based studies have irrefutably shown that fluoroquinolones, a commonly prescribed antibiotic for treating infections, significantly increase the risk of AAD. Despite this, the precise mechanism by which fluoroquinolones cause AAD remains unclear. Therefore, this study aims to investigate the molecular mechanism and role of Ciprofloxacin definitively-a type of fluoroquinolone antibiotic-in the progression of AAD. Aortic transcriptome data were collected from GEO datasets to detect the genes and pathways expressed differently between healthy donors and AAD patients. Human primary Vascular Smooth Muscle Cells (VSMCs) were isolated from the aorta. After 72 h of exposure to 110ug/ml Ciprofloxacin or 100 nmol/L AngII, either or combined, the senescent cells were identified through SA-ß-gal staining. MitoTracker staining was used to examine the morphology of mitochondria in each group. Cellular Reactive Oxygen Species (ROS) levels were measured using MitoSox and DCFH-DA staining. Western blot assay was performed to detect the protein expression level. We conducted an analysis of transcriptome data from both healthy donors and patients with AAD and found that there were significant changes in cellular senescence-related signaling pathways in the latter group. We then isolated and identified human primary VSMCs from healthy donors (control-VSMCs) and patients' (AAD-VSMCs) aortic tissue, respectively. We found that VSMCs from patients exhibited senescent phenotype as compared to control-VSMCs. The higher levels of p21 and p16 and elevated SA-ß-gal activity demonstrated this. We also found that pretreatment with Ciprofloxacin promoted angiotensin-II-induced cellular senescence in control-VSMCs. This was evidenced by increased SA-ß-gal activity, decreased cell proliferation, and elevation of p21 and p16 protein levels. Additionally, we found that Angiotensin-II (AngII) induced VSMC senescence by promoting ROS generation. We used DCFH-DA and mitoSOX staining to identify that Ciprofloxacin and AngII pretreatment further elevated ROS levels than the vehicle or alone group. Furthermore, JC-1 staining showed that mitochondrial membrane potential significantly declined in the Ciprofloxacin and AngII combination group compared to others. Compared to the other three groups, pretreatment of Ciprofloxacin plus AngII could further induce mitochondrial fission, demonstrated by mitoTracker staining and western blotting assay. Mechanistically, we found that Ciprofloxacin impaired the balance of mitochondrial fission and fusion dynamics in VSMCs by suppressing the phosphorylation of AMPK signaling. This caused mitochondrial dysfunction and ROS generation, thereby elevating AngII-induced cellular senescence. However, treatment with the AMPK activator partially alleviated those effects. Our data indicate that Ciprofloxacin may accelerate AngII-induced VSMC senescence through modulating AMPK/ROS signaling and, subsequently, hasten the progression of AAD.
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Proteínas Quinasas Activadas por AMP , Angiotensina II , Disección Aórtica , Senescencia Celular , Ciprofloxacina , Músculo Liso Vascular , Miocitos del Músculo Liso , Especies Reactivas de Oxígeno , Transducción de Señal , Humanos , Senescencia Celular/efectos de los fármacos , Músculo Liso Vascular/efectos de los fármacos , Músculo Liso Vascular/patología , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/enzimología , Disección Aórtica/inducido químicamente , Disección Aórtica/patología , Disección Aórtica/enzimología , Disección Aórtica/metabolismo , Transducción de Señal/efectos de los fármacos , Especies Reactivas de Oxígeno/metabolismo , Miocitos del Músculo Liso/efectos de los fármacos , Miocitos del Músculo Liso/patología , Miocitos del Músculo Liso/enzimología , Miocitos del Músculo Liso/metabolismo , Angiotensina II/toxicidad , Células Cultivadas , Ciprofloxacina/farmacología , Proteínas Quinasas Activadas por AMP/metabolismo , Estudios de Casos y Controles , Aneurisma de la Aorta/inducido químicamente , Aneurisma de la Aorta/patología , Aneurisma de la Aorta/metabolismo , Aneurisma de la Aorta/enzimología , Masculino , Persona de Mediana Edad , Estrés Oxidativo/efectos de los fármacosRESUMEN
Background. Surgery for acute type A aortic dissection confers a risk for significant bleeding. We analyzed the impact of massive bleeding on complications after surgery for acute type A aortic dissection. Methods. Patients undergoing surgery for acute type A aortic dissection from the retrospective multicenter Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database 2005-2014 were eligible. Massive bleeding was defined according to the Universal Definition of Perioperative Bleeding. The primary outcome measure was early mortality and secondary outcome measures were perioperative stroke, mechanical ventilation more than 48 h, new-onset dialysis, and intensive care unit stay. Propensity score matching was performed to adjust for differences in covariates. Results. Nine hundred ninety-seven patients were included, of whom 403 (40.4%) had massive bleeding. In the propensity score-matched cohort (344 pairs), patients with massive bleeding had higher 30-day mortality (17.2 versus 7.6%, p < .001), mechanical ventilation more than 48 h (52.8 versus 22.6%, p < .001), perioperative stroke (24.3 versus 14.8%, p = .002), new-onset dialysis (22.5 versus 4.9%, p < .001), and longer intensive care unit stay (6 versus 3 days, p < .001), compared with patients without massive bleeding. Risk factors for massive bleeding were previous cardiac surgery, preoperative clopidogrel or ticagrelor therapy, DeBakey type I dissection, and localized or generalized malperfusion. Conclusions. Massive bleeding in surgery for acute type A aortic dissection is associated with a markedly increased risk for severe complications as well as early death. Further improvement of surgical technique and pharmacological optimization of coagulation is paramount to possibly improve outcomes in acute type A aortic dissection repair.
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Aneurisma de la Aorta , Disección Aórtica , Bases de Datos Factuales , Hemorragia Posoperatoria , Respiración Artificial , Humanos , Disección Aórtica/cirugía , Disección Aórtica/mortalidad , Disección Aórtica/complicaciones , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Factores de Riesgo , Anciano , Resultado del Tratamiento , Factores de Tiempo , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/mortalidad , Aneurisma de la Aorta/complicaciones , Medición de Riesgo , Hemorragia Posoperatoria/mortalidad , Hemorragia Posoperatoria/etiología , Enfermedad Aguda , Países Escandinavos y Nórdicos/epidemiología , Tiempo de Internación , Diálisis Renal , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/mortalidadRESUMEN
BACKGROUND: Triglyceride-glucose (TyG) index is an emerging surrogate indicator of insulin resistance, which has been demonstrated as a risk factor for various cardiovascular diseases including coronary syndrome, in-stent restenosis, and heart failure. However, association of TyG index with incident aortic dissection (AD) and aortic aneurysm (AA) remains to be investigated. METHODS: This study included 420,292 participants without baseline AD/AA from the large-scale prospective UK Biobank cohort. The primary outcome was incident AD/AA, comprising AD and AA. Multivariable-adjusted Cox proportional hazards regression models and restricted cubic spline (RCS) analyses were applied to assess the relationship between TyG index and the onset of AD/AA. In addition, the association between TyG index and incident AD/AA was examined within subgroups defined by age, gender, smoking status, drinking status, diabetes, hypertension, and BMI. RESULTS: Over a median follow-up period of 14.8 (14.1, 15.5) years, 3,481 AD/AA cases occurred. The incidence of AD/AA rose along with elevated TyG index. RCS curves showed a linear trend of TyG index with risk of incident AD/AA. TyG index was positively associated with risk of incident AD/AA after adjusting for age, gender, smoking status, drinking status, BMI, hypertension, LDL-c, and HbA1c, with adjusted HRs of 1.0 (reference), 1.20 (95% CI 1.08-1.35), 1.21 (95% CI 1.08-1.35), and 1.30 (95% CI 1.16-1.45) for TyG index quartiles 2, 3, and 4, respectively. Especially, participants in the highest TyG index quartile had highest risk of developing AA, with an adjusted HR of 1.35 (95% CI 1.20-1.52). CONCLUSIONS: TyG index is independently associated with a higher risk of incident AD/AA, indicating the importance of using TyG index for risk assessment of AD/AA, especially for AA.
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Aneurisma de la Aorta , Disección Aórtica , Biomarcadores , Glucemia , Triglicéridos , Humanos , Masculino , Femenino , Persona de Mediana Edad , Disección Aórtica/epidemiología , Disección Aórtica/sangre , Disección Aórtica/diagnóstico , Estudios Prospectivos , Factores de Riesgo , Incidencia , Reino Unido/epidemiología , Medición de Riesgo , Triglicéridos/sangre , Aneurisma de la Aorta/epidemiología , Aneurisma de la Aorta/sangre , Aneurisma de la Aorta/diagnóstico , Anciano , Glucemia/metabolismo , Biomarcadores/sangre , Factores de Tiempo , Adulto , Bancos de Muestras Biológicas , Pronóstico , Resistencia a la Insulina , Valor Predictivo de las Pruebas , Biobanco del Reino UnidoRESUMEN
Yang et al.1 generate tissue engineered blood vessels from hiPSC-derived smooth muscle cells harboring a mutation found in Loeys-Dietz syndrome. In vitro and in vivo data from these vessels provide new insight into the molecular physiology of aortic aneurysms and may create a paradigm for understanding a suite of vascular diseases.
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Aneurisma de la Aorta , Prótesis Vascular , Ingeniería de Tejidos , Humanos , Aneurisma de la Aorta/patología , Aneurisma de la Aorta/fisiopatología , Animales , Células Madre Pluripotentes Inducidas/metabolismo , Miocitos del Músculo Liso/metabolismo , Miocitos del Músculo Liso/patología , Síndrome de Loeys-Dietz/genética , Síndrome de Loeys-Dietz/patologíaRESUMEN
An orthotopic heart transplant and an aortic operation can be done concomitantly at centres that are experienced in both aortic operations and heart transplants with meticulous surgical strategy.
Asunto(s)
Trasplante de Corazón , Humanos , Trasplante de Corazón/métodos , Masculino , Esternón/cirugía , Aneurisma de la Aorta/cirugía , Persona de Mediana Edad , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico , Implantación de Prótesis Vascular/métodos , Aorta/cirugía , Aneurisma de la Aorta AscendenteRESUMEN
Objective: This study aims to investigate the associations between specific bacterial taxa of the gut microbiome and the development of aortic aneurysm diseases, utilizing Mendelian Randomization (MR) to explore these associations and overcome the confounding factors commonly present in observational studies. Methods: Employing the largest available gut microbiome and aortic aneurysm Genome-Wide Association Study databases, including MiBioGen, Dutch Microbiome Project, FinnGen, UK Biobank, and Michigan Genomics Initiative, this study performs two-sample bidirectional MR analyses. Instrumental variables, linked to microbiome taxa at significant levels, were selected for identifying relationships with abdominal aortic aneurysms (AAA), thoracic aortic aneurysms (TAA), and aortic dissection (AD). Methods like inverse variance weighted, MR-PRESSO, MR-Egger, weighted median, simple mode, and mode-based estimate were used for MR analysis. Heterogeneity was assessed with the Cochran Q test. MR-Egger regression and MR-PRESSO addressed potential unbalanced horizontal pleiotropy. Results: The analysis did not find any evidence of statistically significant associations between the gut microbiome and aortic aneurysm diseases after adjusting for the false discovery rate (FDR). Specifically, while initial results suggested correlations between 19 taxa and AAA, 25 taxa and TAA, and 13 taxa with AD, these suggested associations did not hold statistical significance post-FDR correction. Therefore, the role of individual gut microbial taxa as independent factors in the development and progression of aortic aneurysm diseases remains inconclusive. This finding underscores the necessity for larger sample sizes and more comprehensive studies to further investigate these potential links. Conclusion: The study emphasizes the complex relationship between the gut microbiome and aortic aneurysm diseases. Although no statistically significant associations were found after FDR correction, the findings provide valuable insights and highlight the importance of considering gut microbiota in aortic aneurysm diseases research. Understanding these interactions may eventually contribute to identifying new therapeutic and preventive strategies for aortic aneurysm diseases.
Asunto(s)
Microbioma Gastrointestinal , Estudio de Asociación del Genoma Completo , Análisis de la Aleatorización Mendeliana , Humanos , Microbioma Gastrointestinal/genética , Aneurisma de la Aorta Abdominal/microbiología , Aneurisma de la Aorta Abdominal/genética , Aneurisma de la Aorta/microbiología , Aneurisma de la Aorta/genética , Bacterias/clasificación , Bacterias/genética , Bacterias/aislamiento & purificación , Aneurisma de la Aorta Torácica/microbiología , Aneurisma de la Aorta Torácica/genética , Disección Aórtica/microbiologíaAsunto(s)
Disección Aórtica , Humanos , Disección Aórtica/mortalidad , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Factores de Riesgo , Masculino , Femenino , Tasa de Supervivencia , Enfermedad Aguda , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/mortalidad , Aneurisma de la Aorta/diagnóstico por imagen , Persona de Mediana Edad , Anciano , Resultado del Tratamiento , Prevalencia , Comorbilidad , Medición de RiesgoRESUMEN
Aortic dissection is a catastrophic, life-threatening event. Its management depends on the anatomic location of the intimal tear (type A v B) and the clinical presentation in type B aortic dissection. In this article, the current evidence supporting clinical practice, gaps in knowledge, and the need for more rigorous research and higher-quality studies are reviewed.