he efficacy of pharmacological and surgical treatments for chronic heart failure after myocardial infarction (MI) is limited. Cell-based regenerative therapy (cell transplantation) improved the blood supply to the damaged heart, and minimized the area of infarc-tion. 1-3 These beneficial effects are mediated, in part, by cytokines, such as hepatocyte growth factor (HGF) and Editorial p ????
Clinical studies have shown that β-blockers could reduce incidence of cardiovascular events, as well as the mortality of patients with chronic heart failure. 7 Carvedilol is a non-selective AR antagonist that blocks β1-and β2-ARs, as well as α1-AR. 8 Carvedilol suppresses SNS activities, and decreases heart rate (HR) and contractility. This action is beneficial to patients with heart failure whose SNS is activated. 9 Carvedilol also causes vasodilation and decreases peripheral vascular resistance without reflex tachycardia by concomitant blockade of α1-and β1-ARs. 10
Background: We examined the outcome of debranching thoracic endovascular aortic repair (d-TEVAR) without sternotomy for distal aortic arch aneurysm in patients aged ≥75 years. Methods: Patients who underwent d-TEVAR or TAR for aortic arch aneurysm between 2008 and 2015 at our hospital and aged ≥75 years were included. Age, sex, left ventricular ejection fraction, preoperative creatinine level, diabetes, cerebrovascular disease, and chronic obstructive pulmonary disease were matched using PS. Results: Among 74 patients (d-TEVAR: 51, TAR: 23), 17 patients in each group were matched. No difference in surgical outcome was detected between the d-TEVAR and TAR groups, including 30-day death (0% vs. 0%), hospital death (5.8% vs. 0%: p = 0.31) and incidence of cerebral infarction (5.8% vs. 7.6%: p = 0.27) as well as the long-term outcomes of 5-year survival (92.8% vs. 74.8%: p = 0.30) and 5-year aorta-related event-free rate (88.2% vs. 100%: p = 0.15). Average duration of ICU stay (1.3 ± 1.1 days vs. 5.6 ± 1.3 days: p = 0.025) and hospital stay (16.5 ± 5.2 days vs. 37.7 ± 19.6 days: p = 0.017) were significantly shorter in the d-TEVAR group. Conclusion: Our results indicated that d-TEVAR is less invasive without affecting long-term outcome up to 5 years. Although the number of the patients included in the study was small, debranching TEVAR could be one of the treatments of the choice in the elderly, especially with comorbidities.
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