2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

Hiratzka, Loren F.; Bakris, George L.; Beckman, Joshua A.; Bersin, Robert M.; Carr, Vincent F.; Casey, Donald E.; Eagle, Kim A.; Hermann, Luke; Isselbacher, Eric M.; Kazerooni, Ella A.; Kouchoukos, Nicholas T.; Lytle, Bruce W.; Milewicz, Dianna M.; Reich, David L.; Sen, Souvik; Shinn, Julie A.; Svensson, Lars; Williams, David M.; Jacobs, Alice K.; Smith, Sidney C.; Anderson, J. Lawford; Adams, Cynthia D.; Buller, Christopher E.; Creager, Mark A.; Ettinger, Steven M.; Guyton, Robert A.; Halperin, Jonathan L.; Hunt, Sharon A.; Krumholz, Harlan M.; Kushner, Frederick G.; Nishimura, Rick A.; Page, Richard L.; Riegel, Bárbara; Stevenson, William G.; Tarkington, Lynn G.; Yancy, Clyde W.

doi:10.1002/ccd.22537

Cited by 273 publications

(107 citation statements)

References 208 publications

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“…Heart donors were selected according to standard cardiac donation criteria, being younger than 55 years and not presenting previous heart or vascular diseases. Aneurysm patients went through thoracic aneurysm surgical repair intervention (Bentall or Wheat procedures [6]), according to cardiovascular surgeons criteria.…”

Section: Histopathologymentioning

confidence: 99%

“…From a clinical point of view, thoracic aortic aneurysm diagnosis relies on aorta diameter measurement through imaging techniques such as X-rays and echography [6]. During open aneurysm repair [6], where blood is not present, cardiovascular surgeons must select the area of the resected tissue.…”

Section: Introductionmentioning

confidence: 99%

“…During open aneurysm repair [6], where blood is not present, cardiovascular surgeons must select the area of the resected tissue. Decisions about an extension to aortic arch surgery may depend on the actual degradation of the vessel wall.…”

Section: Introductionmentioning

confidence: 99%

“…Decisions about an extension to aortic arch surgery may depend on the actual degradation of the vessel wall. In asymptomatic patients with ascending aortic aneurysm, this degradation is not always manifested through the diameter enlargement [6] so an alternative assessment technique is advisable. The conventional histopathological analysis provides the gold standard to evaluate the quality of the aortic wall [2], but its implementation is not straightforward during intervention.…”

Section: Introductionmentioning

confidence: 99%

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Identification of vessel wall degradation in ascending thoracic aortic aneurysms with OCT

Real¹,

Val-Bernal²,

Revuelta³

et al. 2014

Biomed. Opt. Express

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Section: Histopathologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Identification of vessel wall degradation in ascending thoracic aortic aneurysms with OCT

Real¹,

Val-Bernal²,

Revuelta³

et al. 2014

Biomed. Opt. Express

View full text Add to dashboard Cite

show abstract

“…Surgical repair of ascending thoracic aneurysms usually involves the substitution of the diseased portion of the aorta by a graft which has to be sewn onto both cut ends to replace the degraded vessel section that is removed [1]. The sewing point of the thoracic aortic graft has to be the closest adjacent healthy tissue to prevent further medical complications: dissections, pseudo-aneurysm formation, etc.…”

Section: Introductionmentioning

confidence: 99%

Enhanced delineation of degradation in aortic walls through OCT

et al. 2015

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Degradation of the wall of human ascending thoracic aorta has been assessed through Optical Coherence Tomography (OCT). OCT images of the media layer of the aortic wall exhibit micro-structure degradation in case of diseased aortas from aneurysmal vessels or in aortas prone to aortic dissections. The degeneration in vessel walls appears as lowreflectivity areas due to the invasive appearance of acidic polysaccharides and mucopolysaccharides within a typical ordered microstructure of parallel lamellae of smooth muscle cells, elastin and collagen fibers. An OCT indicator of wall degradation can be generated upon the spatial quantification of the extension of degraded areas in a similar way as conventional histopathology. This proposed OCT marker offers a real-time clinical insight of the vessel status to help cardiovascular surgeons in vessel repair interventions. However, the delineation of degraded areas on the B-scan image from OCT is sometimes difficult due to presence of speckle noise, variable SNR conditions on the measurement process, etc. Degraded areas could be outlined by basic thresholding techniques taking advantage of disorders evidences in Bscan images, but this delineation is not always optimum and requires complex additional processing stages. This work proposes an optimized delineation of degraded spots in vessel walls, robust to noisy environments, based on the analysis of the second order variation of image intensity of backreflection to determine the type of local structure. Results improve the delineation of wall anomalies providing a deeper physiological perception of the vessel wall conditions. Achievements could be also transferred to other clinical scenarios: carotid arteries, aorto-iliac or ilio-femoral sections, intracranial, etc.

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Association of Intraoperative Transesophageal Echocardiography and Clinical Outcomes After Open Cardiac Valve or Proximal Aortic Surgery

et al. 2022

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IMPORTANCEIntraoperative transesophageal echocardiography (TEE) is used frequently in cardiac valve and proximal aortic surgical procedures, but there is a lack of evidence associating TEE use with improved clinical outcomes. OBJECTIVE To test the association between intraoperative TEE use and clinical outcomes following cardiac valve or proximal aortic surgery. DESIGN, SETTING, AND PARTICIPANTS This matched, retrospective cohort study used national registry data from the Society of Thoracic Surgeon (STS) Adult Cardiac Surgery Database (ACSD) to compare clinical outcomes among patients undergoing cardiac valve or proximal aortic surgery with vs without intraoperative TEE. Statistical analyses used optimal matching within propensity score calipers to conduct multiple matched comparisons including within-hospital and within-surgeon matches, a negative control outcome analysis, and sensitivity analyses. STS ACSD data encompasses more than 90% of all hospitals that perform cardiac surgery in the US. The study cohort consisted of all patients aged at least 18 years undergoing open cardiac valve repair or replacement surgery and/or proximal aortic surgery between 2011 and 2019. Statistical analysis was performed from October 2020 to April 2021. EXPOSURES The exposure was receipt of intraoperative TEE during the cardiac valve or proximal aortic surgery. MAIN OUTCOMES AND MEASURESThe primary outcome was death within 30 days of surgery.The secondary outcomes were (1) a composite outcome of stroke or 30-day mortality and (2) a composite outcome of reoperation or 30-day mortality. RESULTSOf the 872 936 patients undergoing valve or aortic surgery, 540 229 (61.89%) were male; 63 565 (7.28%) were Black and 742 384 (85.04%) were White; 711 326 (81.5%) received TEE and 161 610 (18.5%) did not receive TEE; the mean (SD) age was 65.61 years (13.17) years. After matching, intraoperative TEE was significantly associated with a lower 30-day mortality rate compared with no TEE: 3.81% vs 5.27% (odds ratio [OR], 0.69 [95% CI, 0.67-0.72]; P < .001), a lower incidence of stroke or 30-day mortality: 5.56% vs 7.01% (OR, 0.77 [95% CI, 0.74-0.79]; P < .001), and a lower incidence of reoperation or 30-day mortality: 7.18% vs 8.87% (OR, 0.78 [95% CI, 0.76-0.80]; P < .001). Results were similar across all matched comparisons (including within-hospital, withinsurgeon matched analyses) and were robust to a negative control and sensitivity analyses.CONCLUSIONS AND RELEVANCE Among adults undergoing cardiac valve or proximal aortic surgery, intraoperative TEE use was associated with improved clinical outcomes in this cohort study.These findings support routine use of TEE in these procedures.

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2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

Cited by 273 publications

References 208 publications

Identification of vessel wall degradation in ascending thoracic aortic aneurysms with OCT

Identification of vessel wall degradation in ascending thoracic aortic aneurysms with OCT

Enhanced delineation of degradation in aortic walls through OCT

Association of Intraoperative Transesophageal Echocardiography and Clinical Outcomes After Open Cardiac Valve or Proximal Aortic Surgery

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