Based on our histological and genetic data, we underline that a surgical approach in patients with BAV, ascending aortic aneurysm and normal root, should consider not only the diameter of the aneurysmatic aortic portion but also the histological features of the whole ascending aorta and the genetic risk profile.

Telomeres have been postulated as a universal clock that shortens in parallel with cellular aging. They are specialized DNA-protein structures at the ends of chromosome with remarkable functions-preventing their recognition as double-stranded DNA breaks, protecting their recombination and degradation, and avoiding a DNA damage cellular response. Telomere shortening is currently considered the best aging marker, but is also a predictor for age-related diseases, including cardiovascular diseases. Biological age clearly seems to be a better predictor of vascular risk rather than chronological age. This concept is supported by key assumptions that peripheral blood leukocyte telomere content accurately reflects that of the vascular wall and its decrease is associated with premature vascular disease. Thus, we are analyzing whether the mean of blood leukocyte telomere length might also be a predictor for sporadic thoracic aortic aneurysm (S-TAA). The preliminary results seem to be promising. Shorter telomeres were detected in patients than in controls. Thus, mean of blood leukocyte telomere length could contribute to identify individuals at S-TAA risk.

The morphological identity of medial lesions observed in both the TAA phenotype III and in TAD aortas might be assumed to be the precursor-and consequently the optimal biomarker- of dissection, independently of aneurysm diameter or valvular disorder. Identification of genetic risk factors, useful both in diagnostics and in developing more targeted treatment for individual patients, might also be needed.

Objectives: Red blood cell distribution width (RDW) is a numerical measure of the variability in size of circulating erythrocytes and is emerging as a strong predictor of adverse advents for several categories of patients affected by cardiovascular disease. However, no data exist until now about the role of RDW in predicting mortality of aortic valve replacement (AVR) patients. Thus, in this pilot study we evaluated the value of RDW on early outcome following AVR. Methods: We enrolled 75 patients, who underwent AVR with or without concomitant procedure. A high value of RDW was defined as >43 fL for women and 47 fL for men. Multivariable and univariable analysis were used in determining the association between preoperative high RDW and postoperative outcome. Results: The prevalence of preoperative high RDW was 41% (31 patients). Univariable analysis showed that patients with high RDW were older (P < 0.02), with low weight (P = 0.12) and high level of platelets (P = 0.005). Patients with high RDW were more likely to require renal replacement therapy (P < 0.026) and prolonged ventilation (P < 0.01). Following multivariable adjustment, higher preoperative RDW was a combined predictor of mortality with higher creatinine level (P = 0.065). Conclusion: Increased RDW seems to be a good predictor of early outcome in patients who underwent AVR, in particular in patients with preoperative renal impairment and postoperative prolonged ventilation.Interactive CardioVascular and Thoracic Surgery

Objective: Association between aortic aneurysm wall and risk of rupture or dissection. Methods: Aortic specimens were obtained from 73 patients (51 men and 22 women, whose median age 61.7AE 10.7 years) undergoing surgical repair of thoracic ascending aneurysm (TAA). Histopathological and immunohistochemical analyses were performed using adequate tissue specimens, appropriate techniques and criteria. Furthermore, genetic risk factors were also investigated. Results: We identified three phenotypes of TAAs with different quality of aortic wall at the time of operation: phenotype I (normal wall); phenotype II (moderate wall thickness); phenotype III (thin and weak wall). No significant differences were detected in term of demographic and clinical data, co-morbidity conditions and pharmacological treatments. In contrast, significant statistical differences were observed by comparing abnormalities of extracellular matrix components among three phenotypes (fibrosis p<0.005; elastic fragmentation p¼0.002; medionecrosis p¼0.004; cystic necrosis p¼0.07; apoptosis p<0.0001; MMP-9 amount p¼0.004). In addition, significant differences both in genotype distributions and allele frequencies were observed for following SNPs (Single Nucleotide Polymorphism):-1562C/T MMP-9 (Metalloproteinases-9),-786T/C eNOs (endothelial Nitric Oxide Synthase) and D/I ACE (Angiotensin Converting Enzyme). Conclusion: Aneurysm with thin and weak wall at the time of operation should seem genetically and mainly associated with extracellular matrix disorders of aorta wall and consequently with aorta aneurysm complications (rupture and dissection).