Type A Aortic Dissection—Experience Over 5 Decades

Zhu, Yuanjia; Lingala, Bharathi; Baiocchi, Michael; Tao, Jacqueline J; Arana, Veronica Toro; Khoo, Jason W.; Williams, Kiah M; Traboulsi, Abd Al-Rahman; Hammond, Hilary C.; Lee, Anson M.; Hiesinger, William; Boyd, Jack; Oyer, Philip E.; Stinson, Edward B.; Reitz, Bruce A.; Mitchell, R. Scott; Miller, D. Craig; Fischbein, Michael P.; Woo, Y. Joseph

doi:10.1016/j.jacc.2020.07.061

Cited by 142 publications

(75 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Type A aortic dissection (TAAD) remains a catastrophic event with substantial morbidity and mortality, despite advances in surgical technique and perioperative care ( 1 ). Extensive aortic arch repair for TAAD has been gradually accepted for TAAD ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

Hybrid Technique on the Total Arch Replacement for Type A Aortic Dissection: 12-year Clinical and Radiographical Outcomes From a Single Center

Zhang

Sun

Liu

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

ObjectiveHybrid total arch replacement (HTAR) was an alternative for type A aortic dissection (TAAD). This study aimed to evaluate the clinical and radiographical outcomes of HTAR for TAAD and to evaluate the clinical outcomes of performing this procedure under mild hypothermia.MethodsA total of 209 patients who underwent HTAR for TAAD were retrospectively analyzed and stratified into mild (n = 48) and moderate (n = 161) hypothermia groups to evaluate the effects of mild hypothermia on the clinical outcomes. Long-term clinical outcomes were evaluated by the overall survival and adverse aortic events (AAEs). A total of 176 patients with preoperative and at least one-time postoperative aortic computed tomography angiography in our institute were included for evaluating the late aortic remodeling (aortic diameter and false lumen thrombosis).ResultsThe median follow-up period was 48.3 (interquartile range [IQR] = 28.4–73.7) months. The overall survival rate was 88.0, 83.2, and 77.1% at the 1, 5, and 10 years, respectively, and in the presence of death as a competing risk, the cumulative incidence of AAEs was 4.8, 9.9, and 12.1% at the 1, 5, and 10 years. The aortic diameters were stable in the descending thoracic and abdominal aorta (P > 0.05 in all the measured aortic segments). A total of 100% complete false lumen thrombosis rate in the stent covered and distal thoracic aorta were achieved at 1 year (64/64) and 4 years (18/18), respectively after HTAR. The overall composite adverse events morbidity and mortality were 18.7 and 10.0%. Mild hypothermia (31.2, IQR = 30.2–32.0) achieved similar composite adverse events morbidity (mild: 14.6 vs. moderate: 19.9%, P = 0.41) and early mortality (mild: 10.4 vs. moderate: 9.9%, P = 1.00) compared with moderate hypothermia (median 27.7, IQR = 27–28.1) group, but mild hypothermia group needed shorter cardiopulmonary bypass (mild: 111, IQR = 93–145 min vs. moderate: 136, IQR = 114–173 min, P < 0.001) and aortic cross-clamping (mild: 45, IQR = 37–56 min vs. moderate: 78, IQR = 54–107 min, P < 0.001) time.ConclusionHybrid total arch replacement achieved desirable early and long-term clinical outcomes for TAAD. Performing HTAR under mild hypothermia was as safe as under moderate hypothermia. After HTAR for TAAD, dissected aorta achieved desirable aortic remodeling, presenting as stable aortic diameters and false lumen complete thrombosis. In all, HTAR is a practical treatment for TAAD.

show abstract

Section: Introductionmentioning

confidence: 99%

Hybrid Technique on the Total Arch Replacement for Type A Aortic Dissection: 12-year Clinical and Radiographical Outcomes From a Single Center

Zhang

Sun

Liu

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…Stanford type A aortic dissection (TAAD) is one of the most dangerous types of AD. Although the in-hospital mortality rate of TAAD has decreased with innovations and improvements in imaging and surgical techniques, its diagnosis and treatment remain a challenge (2,3).…”

Section: Introductionmentioning

confidence: 99%

Role of ferroptosis-related genes in Stanford type a aortic dissection and identification of key genes: new insights from bioinformatic analysis

et al. 2021

View full text Add to dashboard Cite

Stanford type A aortic dissection (TAAD) is one of the most dangerous vascular diseases worldwide, and the mechanisms of its development remain unclear. Further molecular pathology studies may contribute to a comprehensive understanding of TAAD and provide new insights into diagnostic markers and potential therapeutic targets. Recent studies have identified that ferroptosis, a form of cell death, may play a previously unrecognized role in influencing the development of TAAD. In this study, we explored the pathological role of ferroptosis in TAAD by performing bioinformatics analyses. Gene set enrichment analysis (GSEA) showed that the ferroptosis-related gene (FRG) set was significantly different between normal and TAAD aortic samples at an overall level (p < 0.001). Further Gene Ontology (GO) enrichment analysis found that FRGs may influence the response to oxygen levels, transition metal ion homeostasis, and the response to hypoxia by regulating oxidoreductase activity and post-transcriptional ubiquitination modifications, which may regulate cellular ferroptosis and contribute to the structural abnormalities that render patients susceptible to TAAD. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis revealed the HIF-1 signaling pathway may be a key pathway regulating cellular ferroptosis in TAAD development. We further identified six key genes (CA9, HMOX1, IL6, CDKN1A, HIF1A, MYC) from differentially expressed FRGs in TAAD by constructing a protein-protein interaction (PPI) network, all key genes were upregulated in TAAD. Four of the key genes (CA9, IL6, CDKN1A, and HIF1A) were demonstrated to be correlated with cigarette smoke extract-induced ferroptosis in aortic vascular smooth muscle cells. These results suggest that ferroptosis is one of the essential pathological processes in the development of TAAD, and some FRGs affect TAAD development by mediating cellular ferroptosis, which provides deepening insights into the molecular mechanisms and potential therapeutic 3 targets of TAAD.

show abstract

“…First of all, we know that Stanford's classification of aortic dissection is a rough classification. In recent years, many scholars have proposed a variety of subtype schemes for Stanford type A aortic dissection based on their clinical experience, anatomical location, prognosis, and other factors 2,3 . We hope that this study will further show the general demographic characteristics of the selected cases, as well as the specific anatomical location of Stanford type A aortic dissection and other individual case characteristics, so as to further judge the clinical application scope and value of this study.…”

Section: Dear Editormentioning

confidence: 99%

Comment on “Protective effect of dexmedetomidine on perioperative myocardial injury in patients with Stanford type-A aortic dissection”

Wang

2021

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

Type A Aortic Dissection—Experience Over 5 Decades

Cited by 142 publications

References 55 publications

Hybrid Technique on the Total Arch Replacement for Type A Aortic Dissection: 12-year Clinical and Radiographical Outcomes From a Single Center

Hybrid Technique on the Total Arch Replacement for Type A Aortic Dissection: 12-year Clinical and Radiographical Outcomes From a Single Center

Role of ferroptosis-related genes in Stanford type a aortic dissection and identification of key genes: new insights from bioinformatic analysis

Comment on “Protective effect of dexmedetomidine on perioperative myocardial injury in patients with Stanford type-A aortic dissection”

Contact Info

Product

Resources

About