189 results on '"Thoracic aortic disease"'
Search Results
2. Bovine aortic arch: Cases report
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B. Aziza
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Aortic arch ,Aorta ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Population ,Dissection (medical) ,medicine.disease ,medicine.artery ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,In patient ,Risk factor ,Thoracic aortic disease ,business ,education ,Earth-Surface Processes - Abstract
A bovine aortic arch is the most common variant of aortic arch branching in humans with a frequency ranging from 15 to 27% (1-2). It will be considered as a risk factor for aortopathy as anevrysm and dissection. Two cases were reported with association of bovine aortic arch and aortopathy. In both cases, the discovery of the anomaly of the aortic arch was fortuitous. A bovine aortic arch is frequent in patients with thoracic aortic disease than in the general population with a rapid evolution on the diameter of the aorta which expose patients to more complications such as anevrysm, rupture and dissection. It will be considered as a risk factor for aortopaty. Key words: Bovine aortic arch, aortopathy, common birth aortic arch.
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- 2021
3. From Court to Couch: Exercise and Quality of Life after Acute Type A Aortic Dissection
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Dermot Phelan, Amanda Artis, Eugene H. Blackstone, Selena R. Pasadyn, Cassandra L. Pasadyn, and Eric E. Roselli
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Aortic dissection ,medicine.medical_specialty ,Rehabilitation ,business.industry ,medicine.medical_treatment ,MEDLINE ,athletics ,physical activity ,thoracic aortic disease ,Dissection (medical) ,medicine.disease ,cardiac rehabilitation ,Posttraumatic stress ,McNemar's test ,Quality of life ,Acute type ,medicine ,Physical therapy ,Radiology, Nuclear Medicine and imaging ,Surgery ,Original Research Article ,Cardiology and Cardiovascular Medicine ,business ,cardiac surgery - Abstract
Background Acute Type A aortic dissection can be physically and mentally stressful with little known about survivors' postrepair activity levels, exercise habits, and quality of life (QOL). This study was aimed to describe pre- and postdissection changes regarding exercise, understand physician recommendations, quantify use of cardiac rehabilitation, and assess QOL in dissection survivors. Methods A total of 295 acute Type A aortic dissection survivors were surveyed about exercise, cardiac rehabilitation, QOL, sexual activity, and posttraumatic stress disorder (PTSD) with 137 (46%) respondents. Results Respondents were less likely to participate in competitive athletics after than before dissection (1/131 [0.76%] vs. 26/131 [20%], p [McNemar test] Conclusion Physicians should prescribe cardiac rehabilitation, encourage appropriate exercise, promote resumption of sexual activity, and identify and treat PTSD after surgery for acute Type A aortic dissection.
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- 2021
4. One-Stage Hybrid Total Aortic Arch and Descending Thoracic Aortic Repair is a Safe and Secure Procedure With Less Postoperative Complications for Extended Aortic Arch Aneurysms
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Hirokuni Arai, Masashi Takeshita, Tsuyoshi Hachimaru, Yushi Okumura, Masafumi Yashima, Kiyotoshi Oishi, Eiki Nagaoka, Tatsuki Fujiwara, Keiji Oi, and Tomohiro Mizuno
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Aortic arch ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Aorta, Thoracic ,Aortic repair ,Blood Vessel Prosthesis Implantation ,Postoperative Complications ,Risk Factors ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Thoracic aortic disease ,Retrospective Studies ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,One stage ,Aortic arch aneurysm ,Surgery ,Treatment Outcome ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose Hybrid aortic arch repair (HAR) has been implemented for extended aortic arch and descending thoracic aortic disease since 2012 in our institution. This study aimed to estimate the early and mid-term efficacy and safety of HAR. Materials and Methods From 2007 to 2019, 56 patients underwent HAR for extended aortic arch disease, and 75 patients underwent total arch replacement (TAR) for arch-limited disease. HAR comprises 3 procedures: replacement of the aorta, reconstruction of all arch vessels, and thoracic endovascular aortic repair (TEVAR) from zone 0 to the descending aorta after cardiopulmonary bypass is off in 1 stage. The type II-1 HAR procedure, in which the ascending aorta and aortic arch distal to the brachiocephalic artery are replaced, was the most frequently selected procedure (40/56 patients). The outcomes of the type II-1 HAR procedure were compared with those of TAR using the Cox regression analysis. Results The median follow-up period was 36 months. In HAR, the operative mortality, in-hospital mortality, and postoperative permanent neurological deficits were not observed. The paraplegia rate was 1.8%. TEVAR-related complications occurred in 3 patients. Among the patients with non-ruptured atherosclerotic aortic arch aneurysm (31 type II-1 HAR patients and 36 TAR patients, the postoperative respiratory support time in those who underwent type II-1 HAR was quicker than in those who underwent TAR (pConclusions HAR, especially the type II-1 procedure, can treat extended aortic arch disease with acceptable survival outcomes. The development of TEVAR technology will further improve the outcomes of HAR in the future.
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- 2021
5. Commentary: Thoracic aortic disease: One step closer to precision medicine
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Tom C. Nguyen and Teng C. Lee
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,MEDLINE ,Medicine ,Surgery ,Radiology ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,Precision medicine ,business - Published
- 2022
6. The Many Care Models to Treat Thoracic Aortic Disease in Canada: A Nationwide Survey of Cardiac Surgeons, Cardiologists, Interventional Radiologists, and Vascular Surgeons
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Randy D. Moore, Thomas L. Forbes, Darren Klass, Darrin Payne, V. Kotha, Robert F. Berry, Jasmine Grewal, M. Sean McMurtry, R. Scott McClure, François Dagenais, Kenton L. Rommens, and Michelle Keir
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Response rate (survey) ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Population ,MEDLINE ,Specialty ,Attendance ,Emergency medicine ,cardiovascular system ,Medicine ,Original Article ,Disease management (health) ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business ,education ,Health policy - Abstract
Several specialties treat thoracic aortic disease, resulting in multiple patient care pathways. This study aimed to characterize these varied care models to guide health policy.A 57-question e-survey was sent to staff cardiac surgeons, cardiologists, interventional radiologists, and vascular surgeons at 7 Canadian medical societies.For 914 physicians, the response rate was 76% (86 of 113) for cardiac surgeons, 40% (58 of 146) for vascular surgeons, 24% (34 of 140) for radiologists, and 14% (70 of 515) for cardiologists. Several services admitted type B dissections (vascular 37%, cardiology 31%, cardiac 18%, other 7%), and care was heterogeneous. Ownership of disease management was overestimated relative to the perspective of the other specialties. Type A dissection admissions and treatment were more uniform, but emergent call coverage varied. A 24/7 aortic specialist on-call schedule was present only 4% of the time. "Aortic" case rounds promoted attendance by a broader aortic specialty contingency relative to rounds that were specialty specific. Although 89% of respondents felt an aortic team was best for patient care, only 54% worked at an institution with an aortic team present, and only 28% utilized an aortic clinic. Questions designed to define an aortic team derived 63 different combinations.Thoracic aortic disease follows a network of undefined and variable care pathways, despite its high-risk population in need of complex treatment considerations. Multidisciplinary aortic teams and clinics exist in low volume, and the "aortic team" remains an obscure construct. A multispecialty initiative to define the aortic team and outline standardized navigation pathways within the health systems hospitals is advocated.La prise en charge de la maladie de l'aorte thoracique peut faire appel à plusieurs spécialités, ce qui a pour effet de multiplier les trajectoires de soins des patients. Cette étude visait à caractériser ces différents modèles de soins afin d'éclairer l'élaboration des politiques de santé.Un sondage électronique de 57 questions a été envoyé aux chirurgiens cardiaques, aux cardiologues, aux radiologistes interventionnels et aux chirurgiens vasculaires membres de 7 associations médicales canadiennes.Sur un total de 914 médecins, le taux de réponse a été de 76 % (86 sur 113) chez les chirurgiens cardiaques, de 40 % (58 sur 146) chez les chirurgiens vasculaires, de 24 % (34 sur 140) chez les radiologistes et de 14 % (70 sur 515) chez les cardiologues. Plusieurs services avaient admis des cas de dissection aortique de type B (chirurgie vasculaire 37 %, cardiologie 31 %, chirurgie cardiaque 18 %, autre 7 %) et les soins étaient hétérogènes. Les spécialistes surestimaient leur responsabilité de la prise en charge des cas par rapport à celle des autres spécialistes. Les admissions de cas de dissection de type A et leur traitement étaient plus uniformes, mais la présence de spécialistes de garde pouvant traiter les cas urgents était variable. La présence continue d'un spécialiste de l'aorte de garde n'était observée que pendant 4 % du temps. Les séances de discussion de cas « aortiques » favorisaient la participation par une gamme plus large de spécialistes de l'aorte que les discussions axées sur une spécialité donnée. Si 89 % des répondants estimaient qu'une équipe « aortique » était la meilleure option pour les soins aux patients, ils n'étaient que 54 % à travailler dans un établissement disposant d'une telle équipe et 28 % à utiliser les services d'une clinique de l'aorte. En réponse aux questions portant sur les éléments constitutifs d'une équipe aortique, 63 combinaisons différentes de spécialités ont été proposées.La prise en charge de la maladie de l'aorte thoracique emprunte un dédale de trajectoires de soins non définies et variables, alors que sa population à haut risque a besoin de traitements complexes. Les équipes multidisciplinaires et les cliniques spécialisées dans le traitement de l'aorte sont rares, et la notion d' « équipe aortique » demeure un concept obscur. Nous préconisons une initiative réunissant des spécialistes de différents domaines pour définir les éléments constitutifs d'une équipe aortique et établir des trajectoires de navigation normalisées au sein des hôpitaux du système de santé.
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- 2021
7. How to minimize the circulatory arrest time by using the Thoraflex Hybrid prosthesis: the ‘release and perfuse’ technique
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Nicola d’Ostrevy, Mathieu Pernot, Olivier Busuttil, and Antonio Piperata
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Aortic Aneurysm, Thoracic ,Elephant trunks ,business.industry ,medicine.medical_treatment ,Aorta, Thoracic ,General Medicine ,Aortic arch surgery ,Prosthesis ,Blood Vessel Prosthesis ,Circulatory arrest time ,Surgery ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Great vessels ,Humans ,Medicine ,In patient ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business - Abstract
Although the frozen elephant trunk technique permits a complete single-stage treatment in patients with extended thoracic aortic disease, the problem of circulatory arrest time remains unsolved. We propose a simplified use of the Thoraflex Hybrid prosthesis to minimize the circulatory arrest time.
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- 2021
8. Zone 0 Aortic Arch Reconstruction Using the RelayBranch Thoracic Stent Graft
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Kenton L. Rommens, Oliver Halliwell, Randy D. Moore, Eric J. Herget, and R. Scott McClure
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Aortic arch ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Open surgery ,Stent ,Case Report ,Surgery ,surgical procedures, operative ,medicine.artery ,RC666-701 ,medicine ,cardiovascular system ,Diseases of the circulatory (Cardiovascular) system ,cardiovascular diseases ,Thoracic aortic disease ,Arch ,Cardiology and Cardiovascular Medicine ,business ,Very high risk - Abstract
Endovascular therapies have had a considerable impact on contemporary management of thoracic aortic disease. Still, with the anatomic challenges of the aortic arch, endovascular experience with devices that traverse the arch and deploy in the Zone 0 position remains limited. We report the first Canadian experience with the RelayBranch Thoracic Stent Graft (Terumo Aortic, Sunrise, FL) with Zone 0 deployment for total endovascular aortic arch repair in a patient at very high risk for redo open surgery. We demonstrate safe deployment of the device and successful treatment of a type 1A endoleak. Features of the RelayBranch design that mitigate challenges of arch deployment are also discussed. Résumé: Les traitements endovasculaires ont eu un impact considérable sur la gestion contemporaine des pathologies de l'aorte thoracique. Pourtant, en raison des contraintes anatomiques de la crosse aortique, l'expérience endovasculaire avec des dispositifs qui traversent la crosse et se déploient dans la zone 0 reste limitée. Nous rapportons la première expérience canadienne de l'endoprothèse thoracique RelayBranch avec déploiement (Terumo Aortic, Sunrise, FL) en zone 0 pour une réparation endovasculaire totale de la crosse aortique chez un patient présentant un risque très élevé de reprise de chirurgie ouverte. Nous décrivons le déploiement en toute sécurité du dispositif et le traitement réussi d'une endofuite de type 1A. Enfin, nous examinons les caractéristiques du système RelayBranch qui limitent les difficultés liées au déploiement du dispositif dans la crosse aortique.
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- 2021
9. Sex differences in thoracic aortic disease: A review of the literature and a call to action
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Michael W.A. Chu, Thais Coutinho, Maral Ouzounian, and Jennifer Chung
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Aortic Aneurysm, Thoracic ,business.industry ,MEDLINE ,Aorta, Thoracic ,Call to action ,Sex Factors ,Treatment Outcome ,Internal medicine ,Humans ,Medicine ,Female ,Surgery ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
10. Type B Aortic Dissection in Young Individuals With Confirmed and Presumed Heritable Thoracic Aortic Disease
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Sherene Shalhub, Scott A. LeMaire, Kim A. Eagle, Artur Evangelista, Genetically Triggered Thoracic Aortic Aneurysms, Dianna M. Milewicz, Qianzi Zhang, and Mary J. Roman
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Cross-sectional study ,Aortic Diseases ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Marfan Syndrome ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Aneurysm ,Internal medicine ,medicine.artery ,medicine ,Humans ,Thoracic aortic disease ,Aorta ,Aortic Aneurysm, Thoracic ,Type B aortic dissection ,business.industry ,Age Factors ,Middle Aged ,medicine.disease ,Aortic Dissection ,Cross-Sectional Studies ,030228 respiratory system ,Cardiothoracic surgery ,Cohort ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
To investigate clinical course of patients with type B aortic dissection (TBAD) occurring at a young age with confirmed or suspected heritable thoracic aortic disease.Individuals with TBAD occurring at an age50 years enrolled in the National Registry of the Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions Consortium were selected for analysis. Three cohorts were compared: Marfan syndrome (MFS TBAD), nonsyndromic familial TBAD (FTBAD), and sporadic TBAD. Demographics, comorbidities, aortic dissection details, and repair were compared.A total of 150 individuals met inclusion criteria (mean age at TBAD, 36.9 ± 9 years): 73 MFS TBAD, 42 FTBAD, and 35 sporadic TBAD. The cohort of sporadic TBAD had more male patients (71.4%) and fewer individuals of European descent (51.4%) compared with MFS TBAD (57.5% male, 84.9% European descent) and FTBAD (59.5% male, 90.5% European descent). There was a stepwise increase in hypertension prevalence across the cohorts (28.8% MFS, 59.5% FTBAD, 71.4% sporadic TBAD, P.001). Repair of the descending thoracic aorta was performed in 92 cases (67.1% in MFS, 61.9% in FTBAD, and 48.6% sporadic TBAD, P = .18) at a mean of 3.4 ± 5.4 years from TBAD. The repair extent varied. The largest extent of repair was in MFS TBAD, in which thoracoabdominal aortic aneurysm repair was performed in 56.2% compared with 35.7% FTBAD and 17.1% sporadic TBAD (P.001).Control of hypertension is an essential component of care to decrease the risk of TBAD. Over half of the young individuals with TBAD require aortic repair, and individuals with MFS undergo a larger anatomical extent of repair after TBAD.
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- 2020
11. Physical exercise for people with hereditable thoracic aortic disease. A study of patient perspectives
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Gry Velvin, Kerstin S. Fugl-Meyer, Heidi Johansen, Kjersti Vardeberg, Jan-Erik Wilhelmsen, and Ingeborg Beate Lidal
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030506 rehabilitation ,medicine.medical_specialty ,business.industry ,Rehabilitation ,Aortic Diseases ,Physical exercise ,Fear ,03 medical and health sciences ,0302 clinical medicine ,Physical therapy ,Humans ,Medicine ,Ehlers-Danlos Syndrome ,In patient ,Sedentary Behavior ,Thoracic aortic disease ,0305 other medical science ,business ,Exercise ,030217 neurology & neurosurgery - Abstract
To improve the knowledge about physical exercise in patients with Hereditable Thoracic Aortic Disease, insight to the patient perspectives is necessary. The aim of this study was to explore aspects related to physical exercise as highlighted by the patients themselves.Focus group interviews with 36 people with Marfan syndrome, Loeys-Dietz syndrome and vascular Ehlers Danlos syndrome were conducted. Inductive systematic condensation analysis was performed.Four themes related to physical exercise were elucidated by the participants: (1) Being diagnosed. (2) Considerations of physical exercise. (3) Body image and function. (4) Future perspectives. The four themes are mutually interrelated in terms of barriers, facilitators and strategies for dealing with physical exercise. Our findings indicate that the participants experience exercise as a consistent dilemma between what is healthy and what is risky. Inconsistent professional advice, non-engaging activities, unpredictable health conditions and a fear of exercising were factors that may contribute to inactivity and a sedentary lifestyle.The complexity and existential internal conflict related to physical exercise seemed to be a huge dilemma among persons with Hereditable Thoracic Aortic Disease. The balance between safe and healthy activities should be a research priority in these groups.Implications for rehabilitationPhysical activity and exercise pose a difficult dilemma for patients with Hereditable Thoracic Aortic Disease, in terms of what is healthy and what is dangerous.People with Hereditable Thoracic Aortic Disease need help to minimize concern, stress and anxiety associated with exercise.Individualized adapted programs including physical, psychological and social rehabilitation goals are most likely to be successful in encouraging exercise in these patient groups.
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- 2019
12. A Large Ascending Aortic Aneurysm Secondary to Idiopathic Necrotizing Aortitis—A Rare but Important Cause of Thoracic Aortic Disease
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Michael Sabetai, Muslim Mustaev, and Benjamin Smeeton
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aortic aneurysms ,aortic valve replacement surgery ,Aorta ,medicine.medical_specialty ,business.industry ,Case Report ,medicine.disease ,ascending aorta hemiarch replacement surgery ,Surgery ,Aortic aneurysm ,Aortic valve replacement ,Giant cell ,medicine.artery ,Ascending aorta ,medicine ,cardiovascular system ,Radiology, Nuclear Medicine and imaging ,idiopathic necrotizing aortitis ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business ,Infiltration (medical) ,Aortitis - Abstract
Idiopathic necrotizing aortitis is characterized by lymphoplasmacytic or giant cell-associated inflammation of the aorta, with no specific identifiable cause. We present the case of a 79-year-old man who sought medical attention from his primary care physician because of worsening shortness of breath. The patient underwent an elective ascending aorta, hemiarch, and aortic valve replacement. Histological examination of the aortic specimen demonstrated an unusually thin aorta with features consistent with necrotizing aortitis with giant cell infiltration.
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- 2019
13. Implications of different definitions for aortic arch classification provided by contemporary guidelines on thoracic aortic repair
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Massimiliano M. Marrocco-Trischitta and Mattia Glauber
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Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,Carotid Artery, Common ,medicine.medical_treatment ,Concordance ,Aortic Diseases ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Aortic arches ,Aortic repair ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Vascular ,medicine.artery ,medicine ,Humans ,Common carotid artery ,Thoracic aortic disease ,Retrospective Studies ,Aorta ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,Reproducibility of Results ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,cardiovascular system ,Stents ,Surgery ,Radiology ,Carotid stenting ,Cardiology and Cardiovascular Medicine ,business - Abstract
Contemporary guidelines on thoracic aortic repair provide inconsistent reporting standards for the definition of aortic arch classification in Types I, II and III. The different reported criteria cannot be used interchangeably, due to a very low level of concordance, and this finding has relevant implications for the comparisons between studies using different classifications, and between different datasets of multicentre trials, which are not consistently analyzed with the same criteria. Also, the reported definitions, which were originally proposed for predicting difficult carotid stenting and therefore were conceived for healthy aortic arches, can be influenced by the pathological derangements of the aortic wall, including aneurysms and dissections. In this respect, the Madhwal’s classification, which is based on the diameter of the left common carotid artery, appears to be the more suitable one for aortic arch classification in patients with thoracic aortic disease because it provides relevant clinical information along with an adequate reproducibility.
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- 2021
14. Utility of familial screening in non-syndromic thoracic aortic disease
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J.E. Lopez Haldon, A Adsuar Gomez, J Rodriguez Ortuno, and M.L. Pena Pena
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business ,Non syndromic - Abstract
Background Non-syndromic heritable thoracic aortic disease (nsHTAD) is an autosomal dominant disorder with high mortality rate if undetected. Familial evaluation could be useful to identify high-risk patients early. Purpose To assess the yield of clinical and genetic screening in a cohort of patients with suspected nsHTAD. Methods We collected clinical and genetic data about patients with suspected nsHTAD treated in a specialized clinic. Bicuspid aortic valve cases were excluded. Genetic study was performed with next-generation-sequencing, including at least 30 related genes. All first degree relatives were offered evaluation according to current guidelines. Results Twenty-five index cases were analysed (mean age: 48.3 years, male: 64%). Sixteen patients (64%) presented with acute aortic dissection (postmortem diagnosis was performed in 6 cases with sudden cardiac death). Hypertension was reported in 13 cases (52%) and 8 patients (32%) had smoking history. Family history of aortic aneurysm or dissection was identified in 13 cases (52%). Eighty-three first-degree relatives were evaluated. Clinically affected family members were detected in 10 families (40%). Genetic cause of the disease was identified in 6 families (24%). Table 1 describes main characteristics of index cases with pathogenic variants. Combined clinical and genetic screening was positive in 12 families (48%) and identified 24 relatives (29%) with aortic dilatation or carrier status for the disease. Conclusions The combination of clinical and genetic screening in suspected nsHTAD is a useful tool for early detection of the disease in family members at risk and for the prevention of future complications. Funding Acknowledgement Type of funding sources: None. Table 1
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- 2021
15. Arrhythmia and cardiomyopathy in Heritable Thoracic Aortic Disease: an international retrospective cohort study
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Laura Muiño Mosquera, Anthony Demolder, Katalin Szöcs, Artur Evangelista, Gisela Teixido-Tura, Guillaume Jondeau, A Sabate-Rotes, Elena Cervi, Ángela López-Sainz, Y Von Kodolitsch, Julie De Backer, A Pini, M Caruana, E Montanes-Delmas, and L Buttigieg
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiomyopathy ,Cardiology ,Retrospective cohort study ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Abstract
Background Marfan syndrome (MFS), Loeys-Dietz syndrome (LDS) and related heritable thoracic aortic diseases (HTAD) are well-known for their aortic complications. Myocardial dysfunction and arrhythmia are less known in this setting but have been increasingly reported as additional causes of morbidity and mortality. Related to the rarity of the disorders, data on the prevalence of these features and clinical characteristics of the patients are difficult to obtain, calling for a multicentre initiative. Purpose To study the prevalence of myocardial dysfunction and arrhythmia in patients with HTAD and describe their clinical and genetic profile. Methods Nine centres from seven countries participated in this multicentre retrospective study. Medical records of patients 12 years or older carrying a (likely) pathogenic variant in the FBN1 gene, LDS genes (TGFBR1, TGFBR2, TGFB2, TGFB3 and SMAD3) or ACTA2 gene were screened. Patients presenting myocardial dysfunction and/or arrhythmia were identified, and clinical and genetic data were collected. Myocardial dysfunction included (a)symptomatic reduced ejection fraction (EF Results In total, 3219 patients with HTAD were screened: 2761 with a variant in FBN1, 385 with a variant in one of the LDS genes (TGFBR1, TGFBR2, TGFB2, TGFB3 and SMAD3) and 73 carrying a variant in ACTA2. Myocardial dysfunction and arrhythmia were not reported in patients carrying an ACTA2 variant. Myocardial dysfunction was observed in patients with a variant in FBN1 and the LDS genes, without significant differences in prevalence (2.3% vs. 1.8%, p=0.563). Patients with a variant in the LDS genes presenting myocardial dysfunction were younger than patients carrying a variant in FBN1 (25±11 years vs. 39±17 years, p=0.034). The prevalence of VT/VF/SCD was similar in patients with a variant in one of the LDS genes compared to those with a variant in FBN1 (1.6% vs. 0.8%, p=0.132) and there was no difference in age at time of event (26±13 years vs. 33±14 years, p=0.289). Among patients with a variant in the LDS genes, the prevalence of VT/VF/SCD was highest in patients carrying a variant in the TGFBR2 gene and was significantly higher compared to patients with a variant in FBN1 (3.4% vs. 0.8%, p=0.017). In contrast, AF/AFL was significantly more often reported in patients with a variant in FBN1 compared to those with a variant in one of the LDS genes (1.7% vs. 0.3%, p=0.033). Conclusions Myocardial dysfunction and arrhythmia are rare features in patients with HTAD. They occur predominantly in patients with a variant in FBN1 and LDS genes, but were not reported in patients carrying a variant in the ACTA2 gene. Further analysis to identify other contributing factors is necessary. Funding Acknowledgement Type of funding sources: None. Figure 1
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- 2021
16. Impact of thoracic aortic disease on quality of life
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Sarah Jane Palmer
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medicine.medical_specialty ,Quality of life (healthcare) ,business.industry ,medicine ,General Earth and Planetary Sciences ,Thoracic aortic disease ,Intensive care medicine ,business ,General Environmental Science - Abstract
In this monthly feature, Sarah Jane Palmer delves into topical news, the latest research and what the experts are saying on subjects related to cardiology and cardiac nursing practice
- Published
- 2020
17. Left subclavian artery revascularization in thoracic endovascular aortic repair: single center’s clinical experiences from 171 patients
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Jin Min, Yunxing Xue, Wei Xie, Shuchun Li, Qing Zhou, and Dongjin Wang
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,RD1-811 ,Left subclavian artery ,medicine.medical_treatment ,Subclavian Artery ,Ischemia ,Thoracic endovascular aortic repair ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Revascularization ,Single Center ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Anesthesiology ,medicine ,Humans ,RD78.3-87.3 ,Thoracic aortic disease ,Stroke ,Retrospective Studies ,Aortic Aneurysm, Thoracic ,business.industry ,Incidence (epidemiology) ,Endovascular Procedures ,Retrospective cohort study ,General Medicine ,medicine.disease ,Surgery ,Cardiac surgery ,Treatment Outcome ,030228 respiratory system ,Cardiothoracic surgery ,Cardiology and Cardiovascular Medicine ,business ,Research Article - Abstract
Background Left subclavian artery revascularization (LSA) is frequently performed in the setting of thoracic endovascular repair (TEVAR). The purpose of this study was to compare different techniques for LSA revascularization during TEVAR. Methods We performed a single center’s retrospective cohort study from 2016 to 2019. Patients were categorized by LSA revascularization methods, including direct coverage without revascularization (Unrevascularized), carotid-subclavian bypass (CSB), fenestrated TEVAR (F-TEVAR). Indications, demographics, operation details, and outcomes were analyzed using standard statistical analysis. Results 171 patients underwent TEVAR with LSA coverage, 16.4% (n = 28) were unrevascularized and the remaining patients underwent CSB (n = 100 [58.5%]) or F-TEVAR (n = 43 [25.1%]). Demographics were similar between the unrevascularized and revascularized groups, except for procedure urgent status (p = 0.005). The incidence of postoperative spinal cord ischemia was significantly higher between unrevascularized and revascularized group (10.7% vs. 1.4%; p = 0.032). There was no difference in 30-day and mid-term rates of mortality, stroke, and left upper extremity ischemia. CSB was more likely time-consuming than F-TEVAR [3.25 (2.83–4) vs. 2 (1.67–2.67) hours, p = 0], but there were no statistically significant differences in 30-day or midterm outcomes for CSB versus F-TEVAR. During a mean follow-up time of 24.8 months, estimates survival rates had no difference. Conclusions LSA revascularization in zone 2 TEVAR is necessary which is associated with a low 30-day rate of spinal cord ischemia. When LSA revascularization is required during TEVAR, CSB and F-TEVAR are all safe and effective methods, and F-TEVAR appears to offer equivalent clinical outcomes as a less time-consuming and minimally invasive alternative.
- Published
- 2021
18. Epidemiological Analysis of 5,595 Procedures of Endovascular Correction of Isolated Descending Thoracic Aortic Disease Over 12 Years in the Public Health System in Brazil
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Edson Amaro-Júnior, Claudia Szlejf, Alexandre Fioranelli, Nelson Wolosker, Marcelo Fiorelli Alexandrino da Silva, Marcelo Passos Teivelis, and Maria Fernanda Cassino Portugal
- Subjects
medicine.medical_specialty ,Medicine (General) ,Statistical difference ,Aorta, Thoracic ,Disease ,Aortic aneurysm ,Blood Vessel Prosthesis Implantation ,R5-920 ,medicine.artery ,Epidemiology ,medicine ,Thoracic aorta ,Humans ,Thoracic aortic disease ,Aneurysm Surgery ,health care economics and organizations ,Aortic Aneurysm, Thoracic ,business.industry ,Public health ,General surgery ,Significant difference ,Endovascular Procedures ,General Medicine ,medicine.disease ,Blood Vessel Prosthesis ,Aortic Aneurysm ,Treatment Outcome ,Aorta Thoracic ,Original Article ,Stents ,Public Health ,business ,Brazil - Abstract
OBJECTIVES: In Brazil, descending thoracic aorta disease, including aneurysms and dissections, is managed preferentially by endovascular treatment, owing to its feasibility and good results. In this study, we analyzed endovascular treatment of isolated descending thoracic aortic disease cases in the Brazilian public health system over a 12-year period. METHODS: Public data from procedures performed from 2008 to 2019 were extracted using web scraping techniques to assess procedure type frequency (elective or urgency), mortality, and governmental costs. RESULTS: A total of 5,595 procedures were analyzed, the vast majority of which were urgent procedures (61.82% vs. 38.18%). In-hospital mortality was lower for elective than for urgent surgeries (4.96 vs.10.32% p=0.008). An average of R$16,845.86 and R$20,012.04 was paid per elective and emergency procedure, respectively, with no statistical difference (p=0.095). CONCLUSION: Elective procedures were associated with lower mortality than urgent procedures. There was no statistically significant difference between elective and urgent procedures regarding costs.
- Published
- 2021
19. Effect of Aortic Stent Implantation in the Treatment of Thoracic Aortic Disease
- Author
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Cheng Chen
- Subjects
medicine.medical_specialty ,business.industry ,Significant difference ,Treatment method ,Aortic stent ,medicine.disease ,Surgery ,Clinical trial ,Aortic aneurysm ,medicine ,Inflammatory factors ,Thoracic aortic disease ,business ,After treatment - Abstract
Objective: To explore the effect of aortic stent implantation on patients in the treatment of thoracic aortic diseases. Methods: Selected patients from Yunnan Fuwai Cardiovascular (YFC) Hospital as a sample group to carry out the study, the main participants were thoracic aortic aneurysm patients admitted from June 2020 to June 2021. The number of patients involved were 80. The patients are divided into two groups and different treatment methods were adopted. A comparative analysis of the effects of aortic stent placement on patients was conducted. Results: Before treatment, there was no significant difference in the levels of various inflammatory factors between the two groups of patients, P>0.05. After treatment, the data indicators of the two groups were significantly different, as there were significant differences in the surgical indicators among the two groups of patients, P
- Published
- 2021
20. Zone 2 Hybrid Thoracic Endovascular Aortic Repair: Is It a Good Option for All Types of Thoracic Aortic Disease?
- Author
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Jae Hang Lee, Hyoung Woo Chang, Bongyeon Sohn, Kay-Hyun Park, Joon Chul Jung, Dong Jung Kim, Cheong Lim, and Jun Sung Kim
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,Aortic Diseases ,General Medicine ,Aortic repair ,Surgery ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Text mining ,cardiovascular system ,medicine ,Humans ,Stents ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business ,Retrospective Studies - Abstract
Background Zone 2 thoracic endovascular aortic repair (TEVAR) is performed for the treatment of various thoracic aortic diseases involving the left subclavian artery. This study aimed to analyze the late clinical outcomes of zone 2 hybrid TEVAR according to the various indications. Methods A total of 48 patients who underwent zone 2 TEVAR at our institution between December, 2010 and July, 2020 were enrolled. The indications were aortic aneurysm (AA, n = 15), acute type B aortic dissection (AD, n = 14), penetrating aortic ulcer (PAU, n = 8), traumatic aortic injury (TAI, n = 8), and others (n = 3). The clinical outcomes including early complications and mid-term aortic measurements were retrospectively reviewed. Results The technical success rate was 100% and in-hospital mortality occurred in one patient. The early postoperative complications included stroke (n = 1), transient spinal cord ischemia (n = 1), neck wound hematoma (n = 1), and left phrenic or vagus nerve injury (n = 9). In patients with AD, positive remodeling was observed in ten patients (76.9%) (false lumen regression in the entire or thoracic aorta [n = 9], false lumen thrombosis in the thoracic aorta [n = 1]). However, in patients with AA, increased aneurysm was found in six patients (40%). Persistent aneurysmal growth was found in patients with a maximal aortic diameter of > 60 mm on initial imaging (4/6, 50%). No aortic expansion was observed in those with TAI or PAU. Endoleak was noted in five patients (10.4%), and among them, aortic reintervention was required only in patients with large AAs. Conclusions Zone 2 hybrid TEVAR was associated with an acceptable early complication rate and provided acceptable mid-term aortic results for patients with AD, PAU, and TAI. However, patients with large AAs were at increased risk of aortic reintervention. In cases of large AA, clinicians should carefully consider whether zone 2 hybrid TEVAR or open surgical repair will be more effective for the patient.
- Published
- 2021
21. Paraplegia After Open Surgical Repair Versus Thoracic Endovascular Aortic Repair for Thoracic Aortic Disease: A Retrospective Analysis of Japanese Administrative Data
- Author
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Susumu Kunisawa, Takahiko Kamibayashi, Takeshi Umegaki, Yasufumi Nakajima, Kota Nishimoto, and Yuichi Imanaka
- Subjects
medicine.medical_specialty ,Aortic Diseases ,Aorta, Thoracic ,Logistic regression ,Blood Vessel Prosthesis Implantation ,Japan ,Risk Factors ,medicine ,Humans ,Thoracic aortic disease ,Retrospective Studies ,Surgical repair ,Paraplegia ,Aortic Aneurysm, Thoracic ,business.industry ,Incidence (epidemiology) ,Endovascular Procedures ,Retrospective cohort study ,Odds ratio ,medicine.disease ,Confidence interval ,Surgery ,Anesthesiology and Pain Medicine ,Treatment Outcome ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives To comparatively examine the risk of postoperative paraplegia between open surgical descending aortic repair and thoracic endovascular aortic repair (TEVAR) among patients with thoracic aortic disease. Design Retrospective cohort study. Setting Acute-care hospitals in Japan. Participants A total of 6,202 patients diagnosed with thoracic aortic disease. Interventions None. Measurements and Main Results The main outcome of this study was the incidence of postoperative paraplegia. Multiple logistic regression models, using inverse probability of treatment weighting and an instrumental variable (ratio of TEVAR use to open surgical repair and TEVAR uses), showed that the odds ratios of paraplegia for TEVAR (relative to open surgical descending aortic repair) were 0.81 (95% confidence interval: 0.42-1.59; p = 0.55) in the inverse probability of treatment-weighted model and 0.88 (0.42-1.86; p = 0.75) in the instrumental-variable model. Conclusions There were no statistical differences in the risk of paraplegia between open surgical repair and TEVAR in patients with thoracic aortic disease. Improved perioperative management for open surgical repair may have contributed to the similarly low incidence of paraplegia in these two surgery types.
- Published
- 2021
22. Commentary: Multidisciplinary teamwork and precision medicine for thoracic aortic disease save lives
- Author
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Marion A. Hofmann Bowman and Kim A. Eagle
- Subjects
Pulmonary and Respiratory Medicine ,Teamwork ,medicine.medical_specialty ,Aortic Aneurysm, Thoracic ,business.industry ,media_common.quotation_subject ,Precision medicine ,Aortic Dissection ,Multidisciplinary approach ,Humans ,Medicine ,Surgery ,Precision Medicine ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Aorta ,media_common - Published
- 2022
23. Aortic arch tortuosity, a novel biomarker for thoracic aortic disease, is increased in adults with bicuspid aortic valve
- Author
-
Artur Evangelista, Daniel Ocazionez, Hazim J. Safi, Van Thi Thanh Truong, Anthony L. Estrera, Harleen K. Sandhu, Lydia Dux-Santoy Hurtado, Sahand Sohrabi, Bader Aldeen Alhafez, Siddharth K. Prakash, and Andrea Guala
- Subjects
Male ,Aortic valve ,Aortic arch ,medicine.medical_specialty ,Aortic Diseases ,Heart Valve Diseases ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Thoracic aortic aneurysm ,Tortuosity ,Article ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Bicuspid aortic valve ,Aortic tortuosity ,Bicuspid Aortic Valve Disease ,Internal medicine ,medicine.artery ,medicine ,Humans ,030212 general & internal medicine ,Thoracic aortic disease ,business.industry ,Incidence ,Middle Aged ,medicine.disease ,United States ,medicine.anatomical_structure ,Echocardiography ,Aortic Valve ,cardiovascular system ,Cardiology ,Biomarker (medicine) ,Female ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
INTRODUCTION: Arterial tortuosity has emerged as a predictor of adverse outcomes in congenital aortopathies using 3D reconstructed images. We validated a new method to estimate aortic arch tortuosity on 2D CT. We hypothesize that arch tortuosity may identify bicuspid aortic valve (BAV) patients at high risk to develop thoracic aortic aneurysms or aortic dissections (TAD). METHODS: BAV subjects with chest CT scans were retrospectively identified in our clinical records and matched to tricuspid aortic valve (TAV) controls by age, gender, and presentation with TAD. Subjects with prior ascending aortic intervention were excluded. Measurements included aortic arch tortuosity, length, angle, width and height. Total aortic tortuosity was estimated in subjects with available abdominal images. RESULTS: 120 BAV and 234 TAV subjects were included. Our 2D measurements were highly correlated with 3D midline arch measurements and had high inter- and intra-observer reliability. Compared to TAV, BAV subjects had increased arch tortuosity (median 1.76 [Q1-Q3: 1.62-1.95] vs. 1.63 [1.53-1.78], P < 0.01), length (149 [136-160] vs. 135 [122-152] mm, P < 0.01),height (46 [41-53]vs. 39[34-7]mm, P < 0.01),and vertex acuity (70[61-77]vs.75 [68-81] degree, P < 0.01). In a multivariable analysis, arch tortuosity remained independently associated with BAV after adjusting for aortic diameter and other clinical characteristics. CONCLUSIONS: We found that aortic arch tortuosity is significantly increased in BAV and may identify BAV patients who are at increased risk for TAD. Further studies to evaluate the association between tortuosity and clinical outcomes are in progress.
- Published
- 2019
24. Sex-Related Differences in Patients Undergoing Thoracic Aortic Surgery
- Author
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Mark D. Peterson, Jennifer Chung, John Bozinovski, Maral Ouzounian, Andreanne Cartier, Rony Atoui, Munir Boodhwani, Christopher L. Tarola, Ming Guo, Bindu Bittira, François Dagenais, Louis-Mathieu Stevens, Darrin Payne, Michael W.A. Chu, Carly Lodewyks, Michael H. Yamashita, Ismail El-Hamamsy, and Ismail Bouhout
- Subjects
medicine.medical_specialty ,business.industry ,Sex related ,030204 cardiovascular system & hematology ,Aortic surgery ,medicine.disease ,Aortic disease ,Cardiac surgery ,Surgery ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Physiology (medical) ,medicine ,In patient ,030212 general & internal medicine ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Contemporary outcomes after surgical management of thoracic aortic disease have improved; however, the impact of sex-related differences is poorly understood. Methods: A total of 1653 patients (498 [30.1%] female) underwent thoracic aortic surgery with hypothermic circulatory arrest between 2002 and 2017 in 10 institutions of the Canadian Thoracic Aortic Collaborative. Outcomes of interest were in-hospital death, stroke, and a modified Society of Thoracic Surgeons–defined composite for mortality or major morbidity (stroke, renal failure, deep sternal wound infection, reoperation, prolonged ventilation). Multivariable logistic regression was used to determine independent predictors of these outcomes. Results: Women were older (mean±SD, 66±13 years versus 61±13 years; P P P =0.02), stroke (8.8% versus 5.5%; P =0.01), and Society of Thoracic Surgeons–defined composite end point for mortality or major morbidity (31% versus 27%; P =0.04). On multivariable analyses, female sex was an independent predictor of mortality (odds ratio, 1.81; P P P Conclusions: Women experience worse outcomes after thoracic aortic surgery with hypothermic circulatory arrest. Further investigation is required to better delineate which measures may reduce sex-related outcome differences after complex aortic surgery.
- Published
- 2019
25. Exercise and sports participation in patients with thoracic aortic disease: a review
- Author
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M. Mostafa Mokhles, Jolien W. Roos-Hesselink, Carlijn G.E. Thijssen, Roland R.J. van Kimmenade, Antonio Pelliccia, Arjen L. Gökalp, Johanna J.M. Takkenberg, Lidia R. Bons, Cardiology, and Cardiothoracic Surgery
- Subjects
Marfan syndrome ,medicine.medical_specialty ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Aortic Diseases ,Aorta, Thoracic ,Dissection (medical) ,030204 cardiovascular system & hematology ,Risk Assessment ,Mice ,03 medical and health sciences ,0302 clinical medicine ,Bicuspid aortic valve ,Internal medicine ,Internal Medicine ,Animals ,Humans ,Medicine ,In patient ,030212 general & internal medicine ,Thoracic aortic disease ,Exercise ,biology ,business.industry ,Athletes ,General Medicine ,medicine.disease ,biology.organism_classification ,Disease Models, Animal ,Cardiology ,cardiovascular system ,Thoracic aortic dissection ,Cardiology and Cardiovascular Medicine ,business ,Sports - Abstract
Introduction: Current guidelines recommend patients with thoracic aortic disease (TAD) including inherited aortopathies to avoid heavy exercise. However, evidence supporting the negative advice on exercise is scarce. We aimed to provide an up-to-date systematic review of the available evidence on risks and benefits of exercise and sports participation in TAD patients. Areas covered: A systematic search was performed in Medline, Embase and Web of Science: thoracic aortic aneurysm or thoracic aortic dissection or inheritable aortopathies including Marfan Syndrome (MFS), Loeys-Dietz syndrome, Turner Syndrome, Ehlers-Danlos syndrome, bicuspid aortic valve (BAV) and sports, exercise or athletes. The resulting 1,652 manuscripts were reviewed by two independent observers. Eventually, 26 studies and 12 case-reports were included, reporting on thoracic aortic dimensions in athletes, exercise related acute aortic dissections, and exercise in BAV and MFS patients. Expert opinion: Blood pressure elevation during exercise may be associated with an increased risk of acute aortic dissection; however, no controlled trials have longitudinally evaluated the effect of exercise on survival or the risk of aortic dissection in TAD patients. Mouse-model studies suggest beneficial effects of exercise in the setting of a dilated aorta in MFS. There is a clear need for prospective research in this field.
- Published
- 2019
26. Congenital Thoracic Aortic Disease
- Author
-
Luis Landeras and Jonathan H. Chung
- Subjects
medicine.medical_specialty ,Computed Tomography Angiography ,Sedation ,Aortic Diseases ,Contrast Media ,Aorta, Thoracic ,Computed tomography ,Asymptomatic ,030218 nuclear medicine & medical imaging ,Imaging modalities ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,medicine ,Humans ,Thoracic aorta ,Radiology, Nuclear Medicine and imaging ,Thoracic aortic disease ,medicine.diagnostic_test ,business.industry ,General Medicine ,030220 oncology & carcinogenesis ,Embryology ,Angiography ,Radiology ,medicine.symptom ,business - Abstract
Congenital abnormalities of the thoracic aorta encompass a variety of disorders with variable clinical manifestations ranging from asymptomatic to life threatening. A variety of imaging modalities are available for the evaluation of these anomalies with computed tomography (CT) commonly preferred due to its excellent spatial resolution and rapid acquisitions, avoiding the need of general anesthesia or even sedation. We review the embryology, imaging findings, and associations of multiple congenital thoracic aorta malformations with emphasis in the role of CT angiography in the evaluation of these pathologies.
- Published
- 2019
27. Commentary: Genetic variants in thoracic aortic disease—the root of all evil?
- Author
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Abe DeAnda and Gal Levy
- Subjects
Pulmonary and Respiratory Medicine ,Root (linguistics) ,business.industry ,Genetic variants ,MEDLINE ,Medicine ,Surgery ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business ,Bioinformatics - Published
- 2021
28. Aortic stiffness in families with inherited non-syndromic thoracic aortic disease
- Author
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Bo Carlberg, Bengt Johansson, and Matias Hannuksela
- Subjects
Adult ,Male ,medicine.medical_specialty ,Heredity ,aortic stiffness ,Disease occurrence ,Adolescent ,pulse wave velocity ,Aorta, Thoracic ,thoracic aortic dissection ,Pulse Wave Analysis ,030204 cardiovascular system & hematology ,Thoracic aortic aneurysm ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,Vascular Stiffness ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Genetic Predisposition to Disease ,Cardiac and Cardiovascular Systems ,Thoracic aortic disease ,Pulse wave velocity ,Aged ,Kardiologi ,Aortic Aneurysm, Thoracic ,business.industry ,aortic distensibility ,Age Factors ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Pedigree ,Aortic Dissection ,Phenotype ,Echocardiography ,cardiovascular system ,Cardiology ,Thoracic aortic dissection ,Female ,Aortic stiffness ,Aortic diameter ,Cardiology and Cardiovascular Medicine ,business ,Non syndromic - Abstract
Background. In families with an inherited form of non-syndromic thoracic aortic disease (TAAD), aortic diameter alone is not a reliable marker for disease occurrence or progression. To identify other parameters of aortic function, we studied aortic stiffness in families with TAAD. We also compared diameter measurements obtained by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI). Methods. Seven families, including 116 individuals, with non-syndromic TAAD, were studied. The aortic diameter was measured by TTE and MRI. Aortic stiffness was assessed as local distensibility in the ascending aorta and as regional and global pulse wave velocity (PWV). Individuals with a dilated thoracic aorta (n = 21) were compared with those without aortic dilatation (n = 95). Results. Ascending aortic diameter measured by TTE strongly correlated with the diameter measured by MRI (r2 = 0.93). The individuals with dilated aortas were older than those without dilatation (49 vs 37 years old). Ascending aortic diameter increased and distensibility decreased with increasing age; while, PWV increased with age and diameter. Some young subjects without aortic dilatation showed increased aortic stiffness. Individuals with a dilated thoracic aorta had significantly higher PWV and lower distensibility, measured by MRI than individuals without dilatation. Conclusions. Diameters measured with TTE agree with those measured by MRI. Aortic stiffness might be a complementary marker for aortic disease and progression when used with aortic diameter, especially in young individuals. Originally included in thesis in manuscript form.
- Published
- 2018
29. When is extra-anatomical bypass for the left subclavian artery required to prevent ischaemia after thoracic endovascular stent grafting?
- Author
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Damian M. Bailey, Andrew Wood, Ian M. Williams, Michael H Lewis, Mohamad Bashir, Katherine S. Moore, Rhodri Thomas, Andrew Gordon, and Richard D. White
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Ischemia ,Subclavian Artery ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Aortic repair ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Thoracic aortic disease ,Retrospective Studies ,Aorta ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,General Medicine ,Stent grafting ,medicine.disease ,Surgery ,Blood Vessel Prosthesis ,Treatment Outcome ,cardiovascular system ,Left subclavian artery ,Stents ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction Thoracic endovascular aortic repair (TEVAR) has become an accepted treatment for thoracic aortic disease. However, the principal complications relate to coverage of the thoracic aortic wall and deliberate occlusion of aortic branches over a potentially long segment. Complications include risk of stroke, spinal cord ischaemia (SCI) and arterial insufficiency to the left arm (left arm ischaemia (LAI)). This study specifically scrutinised the development of SCI and LAI after TEVAR for interventions for thoracic aortic disease from 1999 to 2020. In particular, those who underwent extra-anatomical bypass (both immediate and late) were compared to the length of thoracic aortic coverage by the stent graft. Materials and methods Ninety-eight patients underwent TEVAR. The presenting symptoms, pathology, procedural and follow-up data were collected prospectively with particular evidence of stroke, SCI and LAI both immediate onset and after 48 h of graft placement. Results Fifty underwent TEVAR for an aneurysm (thoracoabdominal aortic aneurysm), 22 for dissection, 19 for acute transection and 7 for intramural haematoma/pseudoaneurysm of the thoracic aorta. Twenty-nine (30%) required a debranching procedure to increase the proximal landing zone (1 aorto-carotid subclavian bypass, 10 carotid/carotid subclavian bypass and 18 carotid/subclavian bypass). Ten patients (10%) died within 30 days of TEVAR. Twenty-four grafts covered the left subclavian artery origin without a carotid/subclavian bypass. Five required a delayed carotid/subclavian bypass for LAI (4) and SCI (1). Six developed immediate signs of SCI after TEVAR and these 11 (group i) had a mean (SD) length of coverage of the thoracic aorta of 30.2 (10.6) cm compared to 21.5 (11.2) cm (group g) in those who had no LAI or SCI post TEVAR, p Conclusions In this series, delayed carotid/subclavian bypass may be required for chronic arm ischaemia and less so for SCI. The length of coverage of thoracic aorta during TEVAR is a factor in the development of delayed SCI and LAI occurrence. Carotid subclavian bypass is required for certain patients undergoing TEVAR (particularly if greater than 20 cm of thoracic aorta is covered).
- Published
- 2021
30. Aortic Anatomy and the Pathophysiology of Acute Aortic Syndromes
- Author
-
Lauren V. Huckaby and Thomas G. Gleason
- Subjects
Aorta ,business.industry ,Embryology ,medicine.artery ,cardiovascular system ,medicine ,Thoracic aorta ,Anatomy ,Thoracic aortic disease ,business ,Pathophysiology ,Aortic wall - Abstract
The ability to manage acute aortic syndromes or catastrophes begins with a detailed understanding of the anatomy and pathophysiology of the thoracic aorta. This chapter reviews the embryology, anatomy, histology and pathophysiology of the normal and diseased thoracic aorta. We begin with explanations of the embryologic origin of the aorta and its thoracic branches. The histology of the aortic wall is then detailed. Next, the various forms of thoracic aortic disease are outlined with an emphasis on their histology and pathophysiology, and finally, several important inherited forms of thoracic aortic disease are outlined.
- Published
- 2021
31. Thoracic aortic disease in women: Sex disparities in etiology, presentation, and outcomes
- Author
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Kaspar Trocha, Dimitra Lotakis, and Pallavi Manvar-Singh
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,medicine ,Etiology ,Presentation (obstetrics) ,Thoracic aortic disease ,business - Published
- 2021
32. Clinical outcome of acute thoracic aortic syndrome in nonagenarians
- Author
-
Atsushi Miyagawa, Hideo Adachi, Mamoru Arakawa, Yuichiro Kitada, and Homare Okamura
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Time Factors ,Aortic Rupture ,Clinical Decision-Making ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Aneurysm ,Postoperative Cognitive Complications ,Risk Factors ,medicine.artery ,medicine ,Thoracic aorta ,Humans ,Hospital Mortality ,Thoracic aortic disease ,Dissecting aortic aneurysm ,Survival analysis ,Surgical repair ,Aged, 80 and over ,Aortic Aneurysm, Thoracic ,business.industry ,Patient Selection ,Age Factors ,General Medicine ,Syndrome ,Length of Stay ,medicine.disease ,Sternotomy ,Surgery ,Aortic Dissection ,Treatment Outcome ,030228 respiratory system ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Decision-making regarding the operability of thoracic aortic disease in nonagenarian patients remains controversial because outcomes of open surgical repair of the thoracic aorta are unclear. We investigated the surgical and nonsurgical outcomes of acute thoracic aortic syndrome treatment in nonagenarians. Methods After evaluating data in our institute from April 2016 to March 2020, we included 10 nonagenarians who needed surgical intervention on the thoracic aorta via a median sternotomy for acute thoracic aortic syndrome. The mean age of the cohort was 91.9 ± 2.1 years. Five patients underwent open surgical repair of the thoracic aorta (surgical group), and 5 refused surgery (nonsurgical group). All patients in the surgical group performed activities of daily living independently, with a mean clinical frailty scale of 3.2 ± 0.4. The surgical group included 4 patients with type A aortic dissection and one with a ruptured thoracic aortic aneurysm. Hemiarch replacement was performed in 3 patients and total arch replacement in 2. The mean follow-up period was 17.8 ± 5.1 months. Results Hospital mortality rates were 0% in the surgical and 80% in the nonsurgical group. The mean length of hospitalization was 28.4 ± 6.7 days in the surgical group. The 1-year survival rates were 100% in the surgical group and 20% in the nonsurgical group. Conclusion Open surgical repair for acute thoracic aortic syndrome via median sternotomy is a reasonable treatment option even in nonagenarians. Involvement of family members is important for decision-making to devise the optimal treatment strategy (surgical vs. medical).
- Published
- 2020
33. Report of a Delphi exercise to inform the design of a research programme on screening for thoracic aortic disease
- Author
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R. G. Abbasciano, J. Barwell, R. Sayers, M. Bown, D. Milewicz, G. Cooper, G. Mariscalco, N. Wheeldon, C. Fowler, G. Owens, G. J. Murphy, and on behalf of the Aortic Dissection Awareness Day UK 2019 Working Group
- Subjects
Adult ,medicine.medical_specialty ,Delphi Technique ,Cost-Benefit Analysis ,Delphi method ,Aortic dissection ,Aortic Diseases ,Medicine (miscellaneous) ,Target population ,Cardiovascular surgery ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Patient and public involvement ,Medicine ,Humans ,Mass Screening ,Pharmacology (medical) ,030212 general & internal medicine ,Thoracic aortic disease ,Genetic testing ,computer.programming_language ,lcsh:R5-920 ,Public health ,Clinical Trials as Topic ,medicine.diagnostic_test ,business.industry ,Research ,medicine.disease ,United Kingdom ,Clinical trial ,Research Design ,Physical therapy ,lcsh:Medicine (General) ,business ,computer ,Ireland ,Delphi - Abstract
Objectives To inform the design of a clinical trial of a targeted screening programme for relatives of individuals affected by thoracic aortic disease, we performed a consensus exercise as to the acceptability of screening, the optimal sequence and choice of tests, long-term patient management, and choice of trial design. Methods Working with the Aortic Dissection Awareness UK & Ireland patient association, we performed a Delphi exercise with clinical experts, patients, and carers, consisting of three rounds of consultation followed by a final multi-stakeholder face-to-face workshop. Results Thirty-five experts and 84 members of the public took part in the surveys, with 164 patients and clinicians attending the final workshop. There was substantial agreement on the need for a targeted screening pathway that would employ a combined approach (imaging + genetic testing). The target population would include the first- and second-degree adult (> 15 years) relatives, with no upper age limit of affected patients. Disagreement persisted about the screening process, sequence, personnel, the imaging method to adopt, computed tomography (CT) scan vs magnetic resonance imaging (MRI), and the specifics of a potential trial, including willingness to undergo randomisation, and measures of effectiveness and acceptability. Conclusion A Delphi process, initiated by patients, identified areas of uncertainty with respect to behaviour, process, and the design of a targeted screening programme for thoracic aortic disease that requires further research prior to any future trial.
- Published
- 2020
34. A paradigm shift in the management of thoracic aortic disease
- Author
-
Ali Azizzadeh
- Subjects
medicine.medical_specialty ,business.industry ,Paradigm shift ,Internal medicine ,Cardiology ,Medicine ,Surgery ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
35. Thoracic aortic disease: Can we safely cover the branches?
- Author
-
Wassim Shatila and Zvonimir Krajcer
- Subjects
medicine.medical_specialty ,Aortic Diseases ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Aortic repair ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,030212 general & internal medicine ,Thoracic aortic disease ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,General Medicine ,equipment and supplies ,Surgery ,Blood Vessel Prosthesis ,surgical procedures, operative ,Bridge (graph theory) ,Treatment Outcome ,Metals ,cardiovascular system ,Retrograde approach ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Fenestration - Abstract
Thoracic aortic disease has usually been treated with surgery. Thoracic endovascular aortic repair is challenging if supra-aortic vessels are involved. In situ fenestration of the main graft from a retrograde approach while using bare-metal stents as bridge stents appears to be a safe and practical technique.
- Published
- 2020
36. Hans Georg Borst Preis: Midterm Results with the Frozen-Elephant Trunk Technique (E-vita Open) in Thoracic Aortic Disease: A Single-Center Experience in 199 Patients
- Author
-
Wolfgang Hemmer, D Roser, T. Hupp, Markus Liebrich, Denis R. Merk, Nicolas Doll, V. Voth, S. Schlereth, and H. Strauss
- Subjects
Elephant trunks ,business.industry ,Medicine ,Anatomy ,Thoracic aortic disease ,business ,Single Center - Published
- 2020
37. Building on a genetic framework: Can we personalize the timing of surgical repair for patients with heritable thoracic aortic disease?
- Author
-
Ashley Dawson and Scott A. LeMaire
- Subjects
Pulmonary and Respiratory Medicine ,Surgical repair ,medicine.medical_specialty ,Aorta ,Aortic Aneurysm, Thoracic ,business.industry ,MEDLINE ,Aorta, Thoracic ,medicine.disease ,Surgery ,Aortic aneurysm ,medicine.artery ,medicine ,Humans ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
38. MR Imaging of Thoracic Aortic Disease
- Author
-
Jason S. Kim, John P. Lichtenberger, Brett W. Carter, and Derek F. Franco
- Subjects
medicine.medical_specialty ,Aortic Diseases ,Contrast Media ,Aorta, Thoracic ,Computed tomography ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,medicine ,Humans ,Thoracic aorta ,Radiology, Nuclear Medicine and imaging ,Thoracic aortic disease ,Aorta ,medicine.diagnostic_test ,business.industry ,Mr angiography ,Magnetic resonance imaging ,Magnetic Resonance Imaging ,Mr imaging ,cardiovascular system ,Radiology ,Tomography ,Tomography, X-Ray Computed ,business ,Magnetic Resonance Angiography - Abstract
A number of congenital defects and acquired disease processes affect the thoracic aorta, and traditionally, computed tomography (CT) has been the mainstay of imaging, especially in evaluation of the acute aorta. However, recent advances in magnetic resonance (MR) imaging such as electrocardiographically (ECG) triggered breath-hold sequences and ultrafast 3-dimensional MR angiography (MRA) are bringing MR imaging to the forefront of imaging of the thoracic aorta. By providing high-resolution morphological imaging and sophisticated vascular flow analysis for functional data, this modality can provide a comprehensive, reproducible evaluation of the thoracic aorta. In this review, we discuss the role of MR imaging in the evaluation of thoracic aorta pathology along with pertinent examples of aortic abnormalities.
- Published
- 2018
39. Is the frozen elephant trunk frozen?
- Author
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Di Bartolomeo R, Alessandro Leone, Ciro Amodio, Davide Pacini, Jacopo Alfonsi, Gregorio Gliozzi, Di Marco L, Giacomo Murana, Di Bartolomeo, R., Murana, G., Di Marco, L., Alfonsi, J., Gliozzi, G., Amodio, C., Leone, A., and Pacini, D.
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Cerebral perfusion ,Elephant trunks ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Frozen ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Aortic arch ,Blood vessel prosthesis ,medicine ,Humans ,Thoracic aortic disease ,Aorta ,Elephant trunk ,Aortic Aneurysm, Thoracic ,business.industry ,Aortic ,General Medicine ,Blood Vessel Prosthesis ,Surgery ,Aortic Dissection ,030228 respiratory system ,Regional Blood Flow ,Cerebrovascular Circulation ,Cardiology and Cardiovascular Medicine ,business - Abstract
The elephant trunks, either conventional or frozen represent the major technical improvements in the treatment of complex thoracic aortic disease. In the last decades, these useful techniques progressively evolved along with the introduction of new devices to facilitate the procedure and ameliorate post-operative results. The latest multi-branched hybrid FET prostheses give us the opportunity to greatly facilitate graft implantation and reduce operative times. The following review will provide an overview of the FET technique throughout the current available devices, possible surgical indications and principal surgical steps. © 2018 The Japanese Association for Thoracic Surgery
- Published
- 2018
40. 'Over-SIRIX': A New Method for Sizing Aortic Endografts in Combination with the Chimney Grafts: Early Experience with Aortic Arch Disease
- Author
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Vittorio Alberti, Matteo Orrico, Nicola Mangialardi, Stefano Fazzini, Barbara Praquin, Sonia Ronchey, and Ombretta Martinelli
- Subjects
Male ,Aortic arch ,medicine.medical_specialty ,Endoleak ,Computed Tomography Angiography ,medicine.medical_treatment ,Rome ,Aortic Diseases ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Prosthesis Design ,Aortography ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,chimney technique ,0302 clinical medicine ,Predictive Value of Tests ,medicine.artery ,medicine ,Humans ,Chimney ,Thoracic aortic disease ,030212 general & internal medicine ,Aged ,Computed tomography angiography ,Aged, 80 and over ,Observer Variation ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Reproducibility of Results ,Stent ,General Medicine ,Multiplanar reconstruction ,Sizing ,Blood Vessel Prosthesis ,Surgery ,endovascular surgery ,Treatment Outcome ,gutters ,Feasibility Studies ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Proximal neck - Abstract
Background Large gutters after chimney procedures are one of the main causes of type I endoleak (EL-I). This study aims to evaluate a new tailored planning named “Over-SIRIX,” based on Osirix Imaging Software, to choose the correct main graft oversizing in order to minimize EL-I incidence. Methods From 2008 to 2015, 34 patients were treated with parallel grafts for aortic arch diseases at our institution. The study included 22 patients with single stent and antegrade flow configuration; they were divided into 2 groups (PRE- and POST-“Over-SIRIX”). “Over-SIRIX” was carried out in the retrospective group (PRE-“Over-SIRIX”), and it was used to plan the endovascular procedure in the prospective group (POST-“Over-SIRIX”). Through the multiplanar reconstruction (MPR) of the preoperative computed tomography angiography (CTA), the proximal neck of the chimney grafts was studied. Stent and endograft configurations were drawn in order to minimize the “gutters.” To obtain the ideal main graft sizing (I-Size), a formula was used by adding the custom sizing (C-Size) to the disease oversizing (D-Over). The same MPR imaging was evaluated on postoperative CTA to study gutters area and presence of EL-I. Results The mean I-Size was 41.67 mm that was equivalent to an ideal oversizing of 19.3% (range 10–28%). The gutters area decreased from 7.3 to 1.7 mm 2 (PRE/POST) and EL-I rate from 28.5% to 0% (PRE/POST). Gutters area bigger than 7.5 mm 2 and planning made without “Over-SIRIX” were significantly associated ( P Conclusions “Over-SIRIX” appears to be a feasible method to customize planning during chimney technique, reducing the risk of EL-I which is significantly related to the presence and size of the gutters.
- Published
- 2018
41. Genetic counselling and testing in congenital heart defects and hereditary thoracic aortic disease: Complex but essential
- Author
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Jeroen Breckpot
- Subjects
Adult ,Heart Defects, Congenital ,Peripheral Vascular Diseases ,Pediatrics ,medicine.medical_specialty ,Consensus ,Epidemiology ,business.industry ,Genetic counseling ,Aortic Diseases ,Genetic Counseling ,medicine ,Humans ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
42. Sex Differences in Proximal Thoracic Aortic Disease Pathology: A Call to Action
- Author
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L M Buja, Anthony L. Estrera, H Sadaf, Alana C. Cecchi, Ana Maria Segura, Laura Lelenwa, Dianna M. Milewicz, Bihong Zhao, and Hazim J. Safi
- Subjects
Pathology ,medicine.medical_specialty ,Aorta ,business.industry ,General Medicine ,medicine.disease ,Extracellular matrix ,Bicuspid aortic valve ,Smooth muscle ,medicine.artery ,Medicine ,Thoracic aortic disease ,business ,Tissue Dissection ,Sex characteristics - Abstract
Introduction/Objective Sex disparity is reported across all forms of cardiovascular diseases. Only few studies have focused on sex differences in thoracic aortic disease pathology. We aim to identify and understand sex differences in this patient group to bridge the knowledge gap and improve clinicopathologic outcomes. Methods/Case Report This is a retrospective analysis of 83 proximal thoracic aortic aneurysm and dissection (TAAD) cases treated at a single quaternary care center in 2019. Chart review was done for demographics. Consensus criteria (Stone JR et al. Cardiovasc Pathol 2015; 24:267-78; Halushka MK et al. Cardiovasc Pathol 2016; 25:247-57) and a scoring system (Waters KM et al. Cardiovasc Pathol 2017; 30:6-11) were used for pathology reporting. Clinical correlation was also made. Pearson’s chi-square test was used for statistical analysis. Results (if a Case Study enter NA) 83 patients (61 male and 22 female) were retrieved. Overall thoracic aortopathy was higher among males, accounting for 73.4% of individuals with TAAD. In a subgroup analysis, there was no sex difference in dissection, aortic root involvement, and bicuspid aortic valve (p>0.05). Genetic aortopathy was more prevalent in females than males (27.2% vs 9.8%, p=0.04) alongside early age at first aortic event (median age: 31y vs 52y). Histopathologically, females had frequent translamellar mucoid extracellular matrix accumulation (45.4% vs 22.9%, p=0.04), extensive (54.5% vs 27.8%, p=0.02) and severe (59% vs 34.4%, p=0.04) elastic fiber fragmentation, higher band like (9% vs 6.5%, p>0.05) plus extensive (13.6% vs 4.9%, p>0.05) smooth muscle nuclei loss, and extensive (13.6% vs 1.6%, p=0.01) plus dense (4.5% vs 1.6%, p>0.05) laminar medial collapse than males. Conclusion In our patient population, females have a lower prevalence of thoracic aortic disease treated with open repair. However, those who develop TAAD harbor a greater burden of wall pathology and probable worse outcomes. We recommend sex-based analysis of all research on thoracic aortic diseases.
- Published
- 2021
43. Perioperative cerebrospinal fluid drainage for the prevention of spinal ischemia after endovascular aortic repair
- Author
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Philipp Geisbüsch, M. Wortmann, and Dittmar Böckler
- Subjects
medicine.medical_specialty ,Cerebrospinal Fluid Drainage ,Thoracic endovascular repair ,Cerebrospinal fluid drainage ,030204 cardiovascular system & hematology ,Aortic repair ,Aortic disease ,Endovaskuläre Therapie ,03 medical and health sciences ,Liquordrainage ,0302 clinical medicine ,Cerebrospinal fluid ,Leitthema ,Medicine ,Spinal ischemia ,Thorakale Aortenerkrankung ,Thorakoabdominelle Aortenerkrankung ,Thoracic aortic disease ,Endovascular treatment ,business.industry ,Perioperative ,Thoracoabdominal aortic disease ,Vascular surgery ,Spinale Ischämie ,Surgery ,Anesthesia ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Endovascular treatment of thoracic and thoracoabdominal aortic diseases is accompanied by a risk of spinal ischemia in 1-19% of patients, depending on the entity and extent of the disease. The use of perioperative drainage of cerebrospinal fluid is one of the invasive measures to reduce the occurrence of this severe complication. This article reviews the incidence of spinal ischemia, its risk factors, the evidence for carrying out cerebrospinal fluid drainage and its modern use by means of an automated, pressure controlled system (LiquoGuard®7).Die endovaskuläre Therapie von thorakalen und thorakoabdominellen Aortenerkrankungen geht, abhängig von der Entität und Ausprägung der jeweiligen Erkrankung, mit einem Risiko von 1–19 % für eine spinale Ischämie einher. Der Einsatz einer perioperativen Liquordrainage ist eine der invasiven Maßnahmen zur Verringerung des Auftretens dieser schwerwiegenden Komplikation. Diese Übersichtsarbeit legt die Inzidenz spinaler Ischämien, die Evidenz zur Durchführung einer perioperativen Liquordrainage und deren moderne Anwendung in Form eines automatisierten, druckkontrollierten Systems (LiquoGuard®7) dar.
- Published
- 2017
44. LONG TERM SEX SPECIFIC OUTCOMES IN PATIENTS WITH THORACIC AORTIC DISEASE
- Author
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Michael H. Yamashita, Kanwal Kumar, Carly Lodewyks, Rakesh C. Arora, Brett Hiebert, Navdeep Tangri, Heather J. Prior, and Maral Ouzounian
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Medicine ,In patient ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business ,Sex specific ,Term (time) - Published
- 2020
45. A Systematic Review and Meta-analysis of the Bovine Aortic Arch Variant as a Determinant of Thoracic Aortic Disease
- Author
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Francesco Secchi, Paolo Righini, Massimiliano M. Marrocco-Trischitta, Rodrigo M. Romarowski, Giovanni Nano, and Moad Alaidroos
- Subjects
Aortic arch ,medicine.medical_specialty ,business.industry ,medicine.artery ,Internal medicine ,Meta-analysis ,medicine ,Cardiology ,Surgery ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business ,A determinant - Published
- 2019
46. Aortic arch variant with a common origin of the innominate and left carotid artery as a determinant of thoracic aortic disease: a systematic review and meta-analysis
- Author
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Valentina Milani, Rodrigo M. Romarowski, Giovanni Nano, Moad Alaidroos, Federico Ambrogi, Massimiliano M. Marrocco-Trischitta, Mattia Glauber, and Francesco Secchi
- Subjects
Carotid Artery Diseases ,Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,Carotid Artery, Common ,business.industry ,Aortic Diseases ,Aorta, Thoracic ,General Medicine ,Publication bias ,Odds ratio ,Confidence interval ,Systematic review ,Thoracic Diseases ,Meta-analysis ,medicine.artery ,Internal medicine ,Cardiology ,medicine ,Humans ,Surgery ,Arch ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business - Abstract
The aim of this study was to investigate whether the ‘bovine’ arch [i.e. arch variant with a common origin of the innominate and left carotid artery (CILCA)] is associated with an increased risk of thoracic aortic disease (TAD). The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, EMBASE and Cochrane databases were searched to identify all case series reporting about CILCA arch and TAD between January 2008 and December 2018. A total of 485 studies were screened. The prevalence of CILCA arch was assessed, and data analysis was performed considering the difference in the risk of TAD for presence versus absence of CILCA arch. Eight studies enrolling 11 381 subjects were retrieved for quantitative analysis. The proportion of TAD among CILCA arch patients was higher [41.5% (28.1–56.4)] than the proportion among patients with standard arch configuration 34.0% (20.1–51.4). The odds ratio of developing TAD was 1.4 times higher in subjects with CILCA arch (95% confidence interval 1.068–1.839). The test for an overall effect indicated a significant association between CILCA arch and TAD (P
- Published
- 2019
47. 6127Maternal, fetal and obstetric outcome in patients with thoracic aortic disease: an ancillary analysis of the ROPAC registry
- Author
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Laurence Campens, Lucia Baris, J.W. Roos-Hesselink, and J. De Backer
- Subjects
Fetus ,medicine.medical_specialty ,business.industry ,cardiovascular system ,Medicine ,In patient ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business ,Outcome (game theory) ,Surgery - Abstract
Background Cardiovascular disease is the leading cause of death during pregnancy with thoracic aortic dissection being one of the main causes. Thoracic aortic disease (TAD) is most commonly related to hereditary disorders and congenital heart malformations such as bicuspid aortic valve (BAV). Pregnancy is considered as a trigger for aortic complications in women with underlying aortic disease. With this analysis, we aim to study the maternal and fetal outcome of pregnancy in women with TAD. Methods The Registry Of Pregnancy And Cardiac disease (ROPAC) is a large, prospective and global registry and enrolled 4418 women from January 2011 onwards with known cardiac disease (mainly congenital and valvular disease) before pregnancy. Results TAD was present in 217 woman prior to pregnancy. Almost half of them were Marfan patients (MFS), 20% had a BAV, 7.4% Turner syndrome and 23% of patients had no underlying genetic defect or associated congenital heart defect. 35.5% of patients had aortic dilatation of which 6% had an aortic diameter above 45mm. Half of patients had previous pregnancies with no significant difference in parity between woman with and without aortic dilatation. Four patients of which 3 MFS patients had an acute aortic dissection (three type A and one type B aortic dissection) but no lethal (maternal of fetal) events occurred. Two patients presented with ventricular arrhythmia of whom one MFS patient. Caesarian section was not performed significantly more frequent in patients with aortic dilatation. Birth weight was lower in the group of woman with aortic dilatation, related to the use of beta-blocking agents. However, intra-uterine growth retardation and prematurity did not occur more frequently. Conclusion This ancillary analysis of the ROPAC data provides the first large prospective data on pregnancy risk of patients with a wide range of TAD. MFS patients are highly represented in the registry and are a vulnerable group to develop severe complications during pregnancy or peripartum with occurrence of aortic dissection in 3% of patients and ventricular arrhythmia in one. Serial follow-up by a specialized multidisciplinary team throughout pregnancy and postpartum period and patient tailored management of delivery is advised.
- Published
- 2019
48. Unexpected intraoperative obstruction of frozen elephant trunk in patients who underwent total arch replacement
- Author
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Yoshinori Kuroda, Tetsuro Uchida, Mitsuaki Sadahiro, and Atsushi Yamashita
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Elephant trunks ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Medicine ,Humans ,In patient ,Arch ,Thoracic aortic disease ,Intraoperative Complications ,Aged ,Aortic Aneurysm, Thoracic ,business.industry ,Clinical course ,Tar ,Structural property ,Surgery ,Blood Vessel Prosthesis ,Aortic Dissection ,030228 respiratory system ,Stents ,Cardiology and Cardiovascular Medicine ,business - Abstract
Currently, total arch replacement (TAR) using frozen elephant trunk (FET) technique is gaining popularity for various thoracic aortic pathologies. FROZENIX is the first commercialized open stent-graft (OSG) in Japan, and it is a useful alternative to previously self-made OSG. FROZENIX is easy to deploy compared with formerly launched OSGs. However, some challenges have been identified with FROZENIX. Herein, we present the cases of two patients in whom we encountered serious unexpected kinking of FROZENIX during TAR performed using FET, which was related to its structural property. The clinical course and the bailout are described.
- Published
- 2019
49. A Province-Wide Analysis of the Epidemiology of Thoracic Aortic Disease: Incidence Is Increasing in a Sex-Specific Way
- Author
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Nathan C. Nickel, Maral Ouzounian, Navdeep Tangri, Carly Lodewyks, Kanwal Kumar, Rakesh C. Arora, Brett Hiebert, Heather J. Prior, and Michael H. Yamashita
- Subjects
Male ,medicine.medical_specialty ,Pediatrics ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Thoracic aortic aneurysm ,Risk Assessment ,Hospital records ,03 medical and health sciences ,0302 clinical medicine ,Sex Factors ,Epidemiology ,Female patient ,Medicine ,Humans ,030212 general & internal medicine ,Thoracic aortic disease ,Aged ,Retrospective Studies ,Aortic Aneurysm, Thoracic ,business.industry ,Incidence (epidemiology) ,Incidence ,Manitoba ,Middle Aged ,medicine.disease ,Sex specific ,Dissection ,Aortic Dissection ,Female ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Follow-Up Studies - Abstract
Background The contemporary incidence and prevalence of thoracic aortic aneurysm and dissection (TAAD) remains understudied. Epidemiological research on TAAD has been limited by incomplete case identification within administrative data sources. The objectives of this study were to develop a case identification method and determine the incidence and prevalence of TAAD, based on data from Manitoba, Canada. Methods Hospital records and medical claims housed at the Manitoba Centre for Health Policy, and data from the Manitoba Thoracic Aortic Diseases Clinic were used to develop a case definition and identify patients with TAAD in Manitoba, Canada. The age-standardized incidence and prevalence of thoracic aortic disease was determined and stratified by sex from 1998 to 2016. Results We identified 4264 patients with TAAD, of whom 63% were male. The age standardized incidence was 2 times higher in men, peaking at 42 cases per 100,000 in 2013. Although the overall incidence was lower in female patients, the number of incident cases increased 68% compared with 25% in male patients. In hospitalized patients, the incidence and prevalence of aneurysms increased over time, whereas the incidence of dissection and rupture has remained stable. Conclusions The use of a novel case identification method provided a more complete description of the epidemiology of TAAD. The incidence and prevalence of TAAD is rising, more so in female patients over time. These data support increased resource allocation to thoracic aortic diseases clinics to ensure appropriate monitoring, treatment, and follow-up for the growing number patients with thoracic aortic disease.
- Published
- 2019
50. Routine genetic testing for thoracic aortic disease may levy high costs to patients with little benefit
- Author
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Pietro Bajona and Ryan J. Vela
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Aortic Aneurysm, Thoracic ,Epidemiology ,business.industry ,Aortic Diseases ,Text mining ,medicine ,Humans ,Genetic Testing ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Genetic testing - Published
- 2019
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