The Aortic Pathologies: How Far We Understand It and Its Implications on Thoracic Aortic Surgery

Abstract

Thoracic aortic diseases contribute to a major part of cardiac surgeries. The severity of pathologies varies significantly from emergency and life-threatening to conservatively managed conditions. Life-threatening conditions include type A aortic dissection and rupture. Aortic aneurysm is an example of a conservatively managed condition. Pathologies that affect the arterial wall can have a profound impact on the presentation of such cases. Several risk factors have been identified that increase the risk of emergency presentations such as connective tissue disease, hypertension, and vasculitis. The understanding of aortic pathologies is essential to improve management and clinical outcomes.

Oxidative Stress in the Pathogenesis of Aorta Diseases as a Source of Potential Biomarkers and Therapeutic Targets, with a Particular Focus on Ascending Aorta Aneurysms

“…For stopping or retarding the development of aorta diseases, such as AsAA, and reversing its progression into aortic dissection, potential pharmacological treatments currently under investigation include β-adrenergic blocking agents, losartan, irbesartan, angiotensin-converting-enzyme inhibitors, statins, antiplatelet agents, and doxycycline, which represent the elective treatments used for AsAA [ 83 , 84 ]. However, as mentioned above, other drugs, such as those with antioxidant action, are the object of several studies.…”

Acute thoracic aorta dissection: unraveling the pathophysiology of a silent killer

“…T lymphocytes and macrophages can be found diffusely along the medial layer, in focal accumulations between the layers of SMCs, and within the wall of the vasa vasorum, suggesting its possible migration from the adventitia to the media of the aortic wall. These inflammatory cells are potential sources of proteases that can degrade the ECM and lead to aortic wall weakening, called tunica media degeneration [13][14][15][16][17][18] .…”

“…In contrast, the increased expression and disordered collagen deposition may correspond to a slow repairing and pro-fibrotic process triggered by the fragmentation and depletion of elastic fibers. This fibrosis can also be due to an increase in the expression and release of growth factors that can culminate in an increase in collagen and consequent increase in arterial stiffness (Figure 3) [13][14][15][16][17][18][19][20][21][22][23][24][25] .…”

Malperfusion in Acute Type A Aortic Dissection: Management Strategies

“…6 Typically, patients with ATAAD will present with severe chest pain radiating to the neck. 7 However, a clinician should be aware that tenderness elsewhere in the body may be indicative of malperfusion at the site. 4 Managing malperfusion in ATAAD is a major area of debate with differing views on when surgery should be offered.…”

“…6 Typically, patients with ATAAD will present with severe chest pain radiating to the neck. 7 However, a clinician should be aware that tenderness elsewhere in the body may be indicative of malperfusion at the site. 4…”