Systematic review and meta-analysis of endovascular interventions for Stanford type A aortic dissection

Freitas, Simon De; Rossi, Matthew John; Abramowitz, Steven D.; Fatima, Javairiah; Kiguchi, Misaki M.; Vallabhaneni, Raghuveer; Walsh, Stewart R.; Woo, Edward Y.

doi:10.1016/j.jvs.2021.01.054

Cited by 13 publications

(11 citation statements)

References 37 publications

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“…In recent years, TEVAR has become the first-line treatment for complicated type B aortic dissection (TBAD) [2] and has also been used in treating type A aortic disease in patients who are unsuitable candidates for surgical repair. [3,5] However, we cannot ignore the fact that RTAD is a rare but lethal complication after TEVAR, [3,4] and RTAD is more common after TEVAR for TAAD than for TBAD. Lu et al [4] reported that the incidence of RTAD in TAAD was nearly 15%, while it was 1.3% to 8% in TBAD.…”

Section: Discussionmentioning

confidence: 99%

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Bentall procedure for retrograde type A dissection after endovascular repair in type A aortic dissection: A case report

Liu

Yan

et al. 2022

Medicine

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Rationale: The management of retrograde type A dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for type A aortic dissection (TAAD) has rarely been reported. We report the management of RTAD after TEVAR with in situ fenestration for TAAD.Patient concerns: A 59-year-old man with TAAD had undergone TEVAR with in situ fenestration 4 months prior to presenting to our emergency room complaining of acute chest and back pain. Computed tomography angiography showed RTAD starting from the proximal endograft and extending to the aortic root. Diagnosis:The patient was diagnosed with RTAD.Interventions: We performed only the Bentall procedure, and the patient did not require total arch replacement. We removed the bare spring of the proximal endograft and anastomosed the prosthetic graft with the endograft and the native ascending aortic wall.Outcomes: The postoperative course was uneventful, and the patient remained asymptomatic for 3 years after surgery. Computed tomography angiography at the 3-year follow-up showed no perivalvular or anastomotic leakage.Lessons: RTAD after TEVAR for TAAD was safely and effectively treated by anastomosing the prosthetic graft with the endograft and the native ascending aortic wall instead of total arch replacement.

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Section: Discussionmentioning

confidence: 99%

“…[3,4] Retrograde type A dissection (RTAD) is a life-threatening complication after TEVAR. [3] Here, we report a case of RTAD after TEVAR with an in situ-fenestrated endograft for TAAD that was successfully treated using the Bentall procedure and did not require total arch replacement.…”

Section: Introductionmentioning

confidence: 99%

Bentall procedure for retrograde type A dissection after endovascular repair in type A aortic dissection: A case report

Liu

Yan

et al. 2022

Medicine

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“…In the last decade, many clinicians reported the outcomes of endovascular repair for TAAD, most of which were case reports and case series ( 3 ). Off-label use of thoracic endograft was most common in these studies.…”

Section: Introductionmentioning

confidence: 99%

Anatomical Feasibility Study on Novel Ascending Aortic Endograft With More Proximal Landing Zone for Treatment of Type A Aortic Dissection

Zhu

Zhang

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveType A aortic dissection (TAAD) is associated with high morbidity and mortality, and open surgery is the best treatment option. Development of endovascular repair devices for TAAD will benefit patients deemed unfit for open surgery. In this study, we performed a thorough investigation of anatomical features in Asian patients with TAAD to learn about the patient eligibility of a novel ascending aortic endograft technique.MethodsComputed tomography angiography (CTA) images of TAAD cases in our institution from January 2015 to November 2021 were reviewed, and three-dimensional reconstructions were performed with the Endosize software (Therenva, Rennes, France). Anatomic structures including length measured along centerline and greater/lesser curvature, ascending aorta/aortic root dimensions, as well as location of entry tear and extent of dissection were analyzed.ResultsA total of 158 patients were included [median age 58 years, interquartile range (IQR), 30–76 years; 115 males, 72.8%]. In 99 (62.7%) of the cases, entry tear was distal to the sinotubular junction (STJ). In 106 (67.1%) of the cases, the pathology proximally extended into the aortic root, which was intramural hematoma in 37 (23.4%) of the cases, and the aortic root was free from the pathology in 52 (32.9%) of the cases. The median distance from the STJ to the proximal edge of the ostium of the innominate artery (IA) measured along the centerline was 65 mm (IQR 58–74 mm). The median distance from the distal edge of the higher coronary ostium to the STJ was 7.95 mm (IQR 5.625–10.9 mm). The bare metal stent part was set between the edge of the higher coronary ostium and the STJ. In our series, 63 (39.9%) of the cases had this distance >10 mm. The relative difference was <20% between the STJ and the proximal edge of the ostium of the IA in 92 (58.2%) of the cases. Ascending aorta radius of curvature was 52.2 mm (IQR 43.7–63.7 mm).ConclusionsOur study demonstrates that 56.3% of the TAAD cases would be amenable to endovascular repair by the novel ascending aortic endograft, with sufficient landing zone free of the dissected aorta.

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“…Stanford type A Aortic dissection (ATAAD) is one kind of devastating cardiovascular disease (CVD) that accounts for 66% of acute dissections, and it presents an early mortality rate of 1% ( Mészáros et al, 2000 ; De Freitas et al, 2021 ). Many hypotheses about the causes of ATAAD include the formation of pseudolumen in the aortic medium due to intimal rupture, which is attributed to tearing in the intimal layer of the aorta or bleeding within the aortic wall ( Svensson et al, 1999 ; del Porto et al, 2010 ; Tchana-Sato et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Identification of Immune-Related Gene Signature in Stanford Type A Aortic Dissection

Wang

et al. 2022

Front. Genet.

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Background: Stanford type A aortic dissection (ATAAD) is a common life-threatening event in the aorta. Recently, immune disorder has been linked to the risk factors that cause ATAAD at the molecular level. However, the specific immune-related gene signature during the progression is unclear.Methods: The GSE52093 and GSE98770 datasets related to ATAAD from the Gene Expression Omnibus (GEO) database were acquired. The immune gene expression levels were analyzed by single sample gene set enrichment analysis (ssGSEA). The correlations between gene networks and immune scores were determined by weighted gene correlation network analysis (WGCNA). The different immune subgroups were finally divided by consensus clustering. The differentially expressed genes (DEGs) were identified and subsequent functional enrichment analyses were conducted. The hub genes were identified by protein–protein interaction (PPI) network and functional similarities analyses. The immune cell infiltration proportion was determined by the CIBERSORT algorithm.Results: According to the ssGSEA results, the 13 ATAAD samples from the GEO database were divided into high- and low-immune subgroups according to the ssGSEA, WGCNA, and consensus clustering analysis results. Sixty-eight immune-related DEGs (IRDEGs) between the two subgroups were enriched in inflammatory-immune response biological processes, including leukocyte cell–cell adhesion, mononuclear cell migration, and myeloid leukocyte migration. Among these IRDEGs, 8 genes (CXCR4, LYN, CCL19, CCL3L3, SELL, F11R, DPP4, and VAV3) were identified as hub genes that represented immune-related signatures in ATAAD after the PPI and functional similarities analyses. The proportions of infiltrating CD8 T cells and M1 macrophages were significantly higher in ATAAD patients in the immune-high group than the immune-low group.Conclusion: Eight immune-related genes were identified as hub genes representing potential biomarkers and therapeutic targets linked to the immune response in ATAAD patients.

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Systematic review and meta-analysis of endovascular interventions for Stanford type A aortic dissection

Cited by 13 publications

References 37 publications

Bentall procedure for retrograde type A dissection after endovascular repair in type A aortic dissection: A case report

Bentall procedure for retrograde type A dissection after endovascular repair in type A aortic dissection: A case report

Anatomical Feasibility Study on Novel Ascending Aortic Endograft With More Proximal Landing Zone for Treatment of Type A Aortic Dissection

Identification of Immune-Related Gene Signature in Stanford Type A Aortic Dissection

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