Treatment of dissecting aneurysms of the aorta without surgery

Wheat, Myron W.; Palmer, Robert C.; Bartley, Thomas D.; Seelman, Robert C.

doi:10.1016/s0022-5223(19)33192-7

Cited by 326 publications

(39 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…32 Controlling BP and the aortic impulse plays a large role in decreasing the rate of continued damage to the already diseased aorta. [36][37][38][39] Our laboratory has previously demonstrated that an increase in BP of 26 mm Hg has a stress equivalent to an increase of aortic diameter of 1 centimeter. 40 We feel strongly that patients should be on b-blocker therapy with stringent BP control to minimize the reoperative risk over their lifetime.…”

Section: Discussionmentioning

confidence: 99%

Importance of Blood Pressure Control After Repair of Acute Type A Aortic Dissection: 25‐Year Follow‐Up in 252 Patients

Melby

Zierer

Damiano

et al. 2012

J of Clinical Hypertension

View full text Add to dashboard Cite

The purpose of this study was to evaluate factors that impact outcome following repair of type A aortic dissection. Over 25 years , 252 patients underwent repair of acute type A dissection. Mean follow-up for reoperation or death was 6.9AE5.9 years. Operative mortality was 16% (41 of 252). Multivariate analysis identified one risk factor for operative death: presentation malperfusion (P=.003). For operative survivors, 5-, 10-, and 20-year survival was 78%AE3%, 59%AE4%, and 24%AE6%, respectively. Late death occurred earlier in patients with previous stroke (P=.02) and chronic renal insufficiency (P=.007). Risk factors for late reoperation included male sex (P=.006), Marfan syndrome (P<.001), elevated systolic blood pressure (SBP, P<.001), and absence of b-blocker therapy (P<.001). Kaplan-Meier analysis demonstrated at 10-year follow-up that patients who maintained SBP <120 mm Hg had improved freedom from reoperation (92AE5%) compared with those with SBP 120 mm Hg to 140 mm Hg (74%AE7%) or >140 mm Hg (49%AE14%, P<.001). At 10-year follow-up, patients on b-blocker therapy experienced 86%AE5% freedom from reoperation compared with only 57%AE11% for those without (P<.001).Operative survival was decreased with preoperative malperfusion. Long-term survival was dependent on comorbidities but not operative approach. Reoperation was markedly increased in patients not on b-blocker therapy and decreased with improved SBP control. Strict control of hypertension with b-blocker therapy is warranted following repair of acute type A dissection. J Clin Hypertens (Greenwich). 2013; 15:63-68. Ó2012 Wiley Periodicals, Inc.Despite contemporary surgical advances, patients with acute type A aortic dissection still present significant operative challenges both in terms of short-and longterm outcomes. Reported operative mortality rates are high (15%-28%) with stroke rates of 2% to 15%.

show abstract

Section: Discussionmentioning

confidence: 99%

Importance of Blood Pressure Control After Repair of Acute Type A Aortic Dissection: 25‐Year Follow‐Up in 252 Patients

Melby

Zierer

Damiano

et al. 2012

J of Clinical Hypertension

View full text Add to dashboard Cite

show abstract

“…Fragmentation and swollen elastic fibres in all tunicae of the abdominal aorta of the turkey fed BAPN are the lesions of the disease observed by lightand electron-microscopy (Simpson, Pritchard, Harms & Sautter, 1962). Since similar ultrastructural alterations of elastic fibres have been described in the aorta of man with a spontaneous aneurysm (Simpson & Harms, 1969), and since aortic aneurysms in the human and BAPN-fed turkey respond favourably to the same therapy, reserpine (Wheat, Palmer, Bartley & Seelman, 1965) and propranolol (Palmer & Wheat, 1967), it has been suggested that the BAPN-fed turkey could be utilized as an experimental animal for the evaluation of drugs potentially valuable for the treatment of aortic dissecting aneurysms in man.…”

Section: Introductionmentioning

confidence: 83%

Sotalol for the protection of turkeys from the development of β‐aminopropionitrile‐induced aortic ruptures

Simpson

1972

British J Pharmacology

View full text Add to dashboard Cite

Summary The influence of feeding 2 levels of sotalol on the incidence of β‐aminopropionitrile (BAPN)‐induced aortic ruptures of immature turkeys was determined. Four of 22 turkeys fed 0·12% sotalol and 0·07% BAPN died of aortic ruptures, but 6 of 21 turkeys fed only BAPN died of the syndrome. Blood pressure, heart rate, aortic tensile strength, and aortic structure as seen by light‐ and electron‐microscope were similar in turkeys fed BAPN alone or both BAPN and 0·12% sotalol concurrently. In a second experiment, 13 of 24 turkeys fed 0·7% BAPN alone died of aortic ruptures, but only 2 of 24 turkeys fed BAPN and 0·2% sotalol concurrently died of the disease. Aortic tensile strength was lower, heart rate was faster, alterations of aortic elastic fibres as seen by light‐ and electron‐microscope were more severe, and aortic salt soluble collagen with a higher amino acid content was increased in turkeys fed only BAPN, as compared to turkeys fed both BAPN and 0·2% sotalol.

show abstract

“…2,3 The Stanford classification of AD 4 differentiates type A, which requires surgical management, 5 from type B, which is treated medically. 6 Malperfusion syndrome (MPS), caused by reduced flow in the aortic branch vessels, is the second most common complication (20%-50%) of AD, 7 after cardiac complications, 8 and causes higher mortality (51% vs 29% in survivors of AD). [9][10][11] Two ischemic mechanisms have been described 12 : dynamic compression due to an aortic true lumen collapse; and static compression related to direct extension of AD into an aortic branch.…”

Section: See Editorial Commentary Page 116mentioning

confidence: 99%

Aortic dissection with acute malperfusion syndrome: Endovascular fenestration via the funnel technique

Vendrell

Frandon

Rodière

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

Treatment of dissecting aneurysms of the aorta without surgery

Cited by 326 publications

References 10 publications

Importance of Blood Pressure Control After Repair of Acute Type A Aortic Dissection: 25‐Year Follow‐Up in 252 Patients

Importance of Blood Pressure Control After Repair of Acute Type A Aortic Dissection: 25‐Year Follow‐Up in 252 Patients

Sotalol for the protection of turkeys from the development of β‐aminopropionitrile‐induced aortic ruptures

Aortic dissection with acute malperfusion syndrome: Endovascular fenestration via the funnel technique

Contact Info

Product

Resources

About