Explore the vast range of titles available.

Objective This study aims to investigate the clinical manifestations, operative techniques, and outcomes of patients who undergo open repair after thoracic endovascular aortic repair (TEVAR). Methods From January 2010 to June 2022, 113 consecutive type A aortic dissection (TAAD) patients underwent secondary open operation after TEVAR at our institution, and the median interval from primary intervention to open surgery was 12 (1.9–48.0) months. We divided the patients into two groups (RTAD (retrograde type A dissection) group, N  = 56; PNAD (proximal new aortic dissection) group, N  = 57) according to their anatomical features. Survival analysis during the follow-up was evaluated using a Kaplan–Meier survival curve and a log-rank test. Results The 30-day mortality was 6.2% (7/113), the median follow-up period was 31.7 (IQR 14.7–65.6) months, and the overall survival at 1 year, 5 years, and 10 years was 88.5%, 88.5%, and 87.6%, respectively. Fourteen deaths occurred during the follow-up, but there were no late aorta-related deaths. Three patients underwent total thoracoabdominal aortic replacement 1 year after a second open operation. The RTAD group had a smaller ascending aorta size (42.5 ± 7.7 mm vs 48.4 ± 11.4 mm; P  < .01) and a closer proximal landing zone ( P  < .01) compared to the PNAD group. However, there were no differences in survival between the two groups. Conclusions TAAD can present as an early or a late complication after TEVAR due to stent-grafting-related issues or disease progression. Open operation can be performed to treat TAAD, and this has acceptable early and mid-term outcomes. Follow-up should become mandatory for patients after TEVAR because these patients are at increased risk for TAAD.

Background During total aortic arch replacement surgery (TARS) for patients with acute type A aortic dissection, the organs in the lower body, such as the viscera and spinal cord, are at risk of ischemia even when antegrade cerebral perfusion (ACP) is performed. Combining ACP with retrograde inferior vena caval perfusion (RIVP) during TARS may improve outcomes by providing the lower body with oxygenated blood. Methods This study is designed as a multicenter, computer-generated, randomized controlled, assessor-blind, parallel-group study with a superiority framework in patients scheduled for TARS. A total of 636 patients will be randomized on a 1:1 basis to a moderate hypothermia circulatory arrest (MHCA) group, which will receive selective ACP with moderate hypothermia during TARS; or to an RIVP group, which will receive the combination of RIVP and selective ACP under moderate hypothermia during TARS. The primary outcome will be a composite of early mortality and major complications, including paraplegia, postoperative renal failure, severe liver dysfunction, and gastrointestinal complications. All patients will be analyzed according to the intention-to-treat protocol. Discussion This study aims to assess whether RIVP combined with ACP leads to superior outcomes than ACP alone for patients undergoing TARS under moderate hypothermia. This study seeks to provide high-quality evidence for RIVP to be used in patients with acute type A aortic dissection undergoing TARS. Trial registration Clinicaltrials.gov, ID: NCT03607786 . Registered on 30 July 2018.

Currently, evidence concerning the link between maximal aortic diameter and in-hospital mortality in cases of acute type B aortic dissection (ATBAD) is insufficient. Thus, this study aimed to explore the relationship between the maximal aortic diameter at the time of admission and the early prognosis of patients diagnosed with ATBAD. A total of 678 patients with ATBAD were included between January 2016 and December 2018, during which their clinical data was gathered. The independent variable analyzed was the maximal diameter of the aorta, while the dependent variable was mortality during hospitalization. Factors considered in this analysis included the patients’ age, gender, body mass index (BMI), medical history of hypertension, stroke, diabetes, atherosclerosis, smoking habits, chronic kidney insufficiency, time until presentation, systolic and diastolic blood pressures, ejection fraction, presence of aortic regurgitation, symptoms, involvement of abdominal vessels, laboratory findings, and treatment approaches. Of these patients collected, the mean age was 56.03 ± 12.22 years, and approximately 82.45% of them were male. After analysis, it was found that the maximal aortic diameter of patients with ATBAD was positively correlated with in-hospital mortality (OR = 1.06, 95% CI 1.03 to 1.10). Surprisingly, a J curve relationship was detected between maximal aortic diameter (point 31 mm) and in-hospital death for patients with ATBAD. The effect sizes and confidence intervals of the right (maximal aortic diameter > 31 mm) and left (maximal aortic diameter ≤ 31 mm) aspects of the inflection point were 1.06 (1.02–1.11) and 1.03 (0.83–1.28), respectively. In addition, the stratified analysis showed a stable relationship between maximal aortic diameter and in-hospital mortality, while there was no significant difference in the interaction between different subgroups. In patients with ATBAD, a J-curve relationship was identified between the maximal aortic diameter and in-hospital mortality. Specifically, when the maximal aortic diameter exceeds 31 mm, a positive correlation with in-hospital death was observed.

BackgroundAcute aortic dissection (AD) in pregnancy poses a lethal risk to both mother and fetus. However, well-established therapeutic guidelines are lacking. This study aimed to investigate clinical features, outcomes and optimal management strategies for pregnancy-related AD.MethodsWe conducted a retrospective multicentre cohort study including 67 women with acute AD during pregnancy or within 12 weeks postpartum from three major cardiovascular centres in China between 2003 and 2021. Patient characteristics, management strategies and short-term outcomes were analysed.ResultsMedian age was 31 years, with AD onset at median 32 weeks gestation. Forty-six patients (68.7%) had type A AD, of which 41 underwent immediate surgery. Overall maternal mortality was 10.4% (7/67) and fetal mortality was 26.9% (18/67). Compared with immediate surgery, selective surgery was associated with higher risk of composite maternal and fetal death (adjusted RR: 12.47 (95% CI 3.26 to 47.73); p=0.0002) and fetal death (adjusted RR: 8.77 (95% CI 2.33 to 33.09); p=0.001).ConclusionsImmediate aortic surgery should be considered for type A AD at any stage of pregnancy or postpartum. For pregnant women with AD before fetal viability, surgical treatment with the fetus in utero should be considered. Management strategies should account for dissection type, gestational age, and fetal viability.Trial registration number NCT05501145.

Objectives To investigate the short-term/long-term impact of pulmonary artery intramural hematoma (PA-IMH) in patients with acute Stanford type A aortic dissection (ATAAD) following surgical repair. Materials and methods Consecutive patients with ATAAD who received surgical repair at Beijing and Yunnan Fuwai Hospital in 2010–2021 were retrospectively reviewed. Patients with hemorrhage extending along the PA were identified as the PA-IMH group. Multivariable logistics regression was used to obtain the odds ratio (OR), and the Kaplan-Meier method was used to estimate the survival rate. Results Of the 2046 ATAAD patients, 324 (15.8%) patients were identified with PA-IMH, and 1722 (84.2%) were without PA-IMH. PA-IMH had a higher prevalence in patients with older age, female gender, aortic IMH, and type II aortic dissection. PA-IMH patients incurred excess early mortality compared with non-PA-IMH patients (9.3% vs. 5.6%, OR = 1.86, 95%CI 1.19–2.91, p  = 0.006). The results were stable in the subgroup analysis, with an increased risk in older (> 70 years) or DeBakey type II ATAAD patients. Notably, an increase in the degree and extent of PA-IMH exacerbated the risk of early mortality. However, after landmark analysis at 30-day postsurgery, no significant difference was noted in the long-term outcomes between PA-IMH and non-PA-IMH groups ( p  = 0.440). The 5-year survival rates were 87.1% (95%CI: 83.3%, 91.1%) and 90.1% (95%CI: 88.5%, 91.7%), respectively. Conclusions The presence of PA-IMH in ATAAD patients is common and is independently associated with increased early mortality after surgical repair, especially in those with older age (> 70) or type II dissection. However, such detrimental effects do not persist in the long-term follow-up among patients who survived hospital discharge. Clinical relevance statement We confirmed that PA-IMH significantly increases early postoperative mortality in patients with acute type A aortic dissection, especially in older patients or DeBakey type II dissection. This should prompt further investigation of the incremental role of PA-IMH in this pathology. Key Points Acute type A aortic dissection mortality gets worse when pulmonary artery intramural hematoma is present. Pulmonary artery-intramural hematoma increased the risk of early mortality but not affect long-term prognosis. Further research should investigate the effects of pulmonary artery intramural thrombus on aortic dissection.

Uncomplicated type B aortic dissections was regarded benign and treated with optimal medical therapy (OMT). However, studies showed highly unpredictable of disease progression, which suggested the need of earlier intervention. To search for features associated with worse outcomes with OMT is important due to risk of intervention. We investigated mortality and aortic remodeling between aggressive (OMT and pre-emptive endovascular intervention) and conservative therapy (OMT and necessary operations). Retrospective analysis was performed in acute and subacute uncomplicated type B dissections patients, including typical aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer, diagnosed between June 2005 and May 2021. Patients with Marfan, traumatic, iatrogenic, zone 0 (ascending aorta) involvement, and maximal aortic diameter > 45mm were excluded. Patients are classified according to initial management. 77 and 33 patients in the aggressive and conservative groups were included respectively. There was no differences in baseline clinical and radiological characteristics between them. During mid-term follow-up (median 62.5 months), there was no difference in the mortality but the incidence of 30-day acute kidney injury was significantly higher in aggressive group. Positive aortic remodeling was noted in aggressive group, with development to complete or incomplete false lumen thrombosis (p < 0.01). Aggressive pre-emptive endovascular therapy though has acceptable outcomes and positive aortic remodelling in early uncomplicated type B dissection with maximal aortic diameter ≤ 45mm. However, it could not translate into better mid-term survival than conservative therapy, but with higher risk of 30-day acute kidney injury. Aggressive pre-emptive endovascular intervention should be cautious in these patients.

The neutrophil percentage to albumin ratio (NPAR) has been associated with prognosis of various cardiovascular diseases, but its role in acute type A aortic dissection (AAAD) mortality remains unclear. The aim of this study was to investigate the relationship between preoperative NPAR and in‐hospital mortality in AAAD patients. Clinical data from patients who underwent AAAD surgery at the Cardiac Medical Center of Fujian Province between January 2020 and April 2024 were retrospectively analyzed. Patients were categorized into three groups based on NPAR tertiles. Univariate and multivariate logistic regression analyses were employed to identify factors contributing to in‐hospital mortality. The predictive performance of NPAR was assessed using ROC curve analysis. The results revealed that out of 813 AAAD patients meeting the inclusion criteria, 137 (16.9%) died in hospital. Multivariate logistic regression analysis indicated that compared to the low tertile group, the odds ratios (95% CI) for in‐hospital mortality in the middle and high tertile groups were (OR 3.041, 95% CI: 1.502–6.158, p = 0.002) and (OR 6.586, 95% CI: 3.324–13.049, p<0.001), respectively. Additionally, cardiopulmonary bypass time (OR 1.010, 95% CI: 1.007‐1.013, p<0.001) and mechanical ventilation time (OR 1.115, 95% CI: 1.082–1.150, p<0.001) were also independently associated with in‐hospital mortality in AAAD patients. The area under the curve for NPAR was 0.708 (95% CI: 0.676–0.739) (p<0.001), with an optimal cut‐off value of 24.105, yielding a sensitivity of 73.7% and a specificity of 64.8%. In conclusion, higher preoperative NPAR may be independently associated with increased in‐hospital mortality, suggesting its potential as a novel indicator for monitoring AAAD patients.

The study aimed to assess the predictive value of blood urea nitrogen (BUN)-to-albumin ratio (BA-R) for in-hospital mortality in patients undergoing emergency surgery for acute type A aortic dissection (ATAAD). Patients who were diagnosed with ATAAD and underwent emergency surgery within 48 hours of onset at our hospital between January 2015 and December 2021 were included in this study. The primary endpoint of this study was postoperative in-hospital mortality (POIM). The data of the survivors and non-survivors were retrospectively compared analyses. A total of 557 ATAAD patients were included, with 505 survivors and 52 non-survivors. The preoperative BA-R of the non-survivor group was significantly higher than that of the survivor group ( P  < 0.001). Univariate regression analysis showed that preoperative BA-R, serum creatinine level, SA level, D-dimer level, age, myocardial ischemia, cerebral ischemia, and aortic clamp time were risk factors for POIM. In addition, multivariable regression analysis showed that preoperative BA-R ≥ 0.155 mmol/g was a risk factor for POIM (odds ratio, 6.815 [3.582–12.964]; P  < 0.001). Receiver operating characteristic curve indicated that the cut-off point for preoperative BA-R was ≥0.155 mmol/g (area under the curve =0.874). The sensitivity and specificity of preoperative BA-R in predicting the POIM of patients who underwent emergency surgery for ATAAD were 84.6% and 71.3%, respectively (95% confidence interval, 0.829–0.919; P  < 0.001). In conclusion, Preoperative BA-R is a simple, rapid, and potentially useful prognostic indicator of POIM in patients with ATAAD.

Background Previous research identifies the atherosclerotic index of plasma (AIP) as a key marker for cardiovascular risk, but its role in predicting outcomes in type B aortic dissection (TBAD) patients after thoracic endovascular aortic repair (TEVAR) is uncertain. This study aimed to investigate the association between AIP and long-term outcomes in TBAD patients after TEVAR. Methods This retrospective cohort study included 1335 patients with TBAD who underwent TEVAR. Patients were stratified into tertiles based on AIP levels. The primary endpoints were aortic-related adverse events (ARAEs) at 1 and 5 years after TEVAR. Cox regression analyses were used to evaluate the independent effect of AIP on outcomes. Kaplan–Meier (KM) analysis was conducted to compare the incidence of ARAEs among different groups. Restricted cubic spline (RCS) models were utilized to investigate the nonlinear relationship between AIP and ARAEs, and subgroup analyses assessed the stability of this association. Time-dependent receiver operating characteristic (ROC) curves were applied to assess the predictive accuracy of AIP for ARAEs over a 5-year period. Results The KM analysis revealed a significantly higher incidence of ARAEs in the high AIP group compared to the low AIP group ( P  < 0.001). However, no statistically significant differences were found in all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCEs) (all P  > 0.05). Cox regression analysis demonstrated that a high level of AIP was associated with an increased risk of ARAEs (all P  < 0.001). Additionally, RCS analysis indicated a linear relationship between AIP and the risk of ARAEs. In subgroup analyses, the timing of operation showed a significant interaction with 1-year ARAEs ( P for interaction = 0.008). Time-dependent ROC analysis demonstrated an area under the curve approaching 0.8 throughout the 5-year period. Conclusion Our research indicates that AIP is independently associated with 1-year and 5-year ARAEs in patients with TBAD following TEVAR, providing a novel metabolic perspective for the prognostic evaluation of this population. Graphical abstract

Preoperative inflammatory biomarker ratios to predict adverse outcomes in patients with acute type A aortic dissection (AAD) were assessed in this study, and a prognostic nomogram to guide anti-inflammatory therapy was developed.. We retrospectively analyzed 673 adult AAD patients who underwent surgery. Preoperative hematological parameters, including neutrophil, lymphocyte, and platelet counts; hemoglobin (Hb) and albumin levels; and composite indices including the neutrophil‒lymphocyte ratio (NLR), platelet‒lymphocyte ratio, neutrophil‒platelet ratio, and platelet‒albumin ratio, were evaluated. The univariate and multivariate logistic regression identified in-hospital mortality predictors, and a nomogram was constructed. The internal validation included bootstrapping with discrimination assessed by the C-index and calibration by the Hosmer-Lemeshow test. The univariate analysis revealed Hb, D-dimer, blood urea nitrogen, and albumin levels; the NLR; the aortic root concomitant procedure; ventilation support time and multiple organ dysfunction syndrome (MODS) as perioperative mortality predictors; after multivariate adjustment, decreased Hb level, elevated NLR, and the presence of MODS independently predicted in-hospital mortality. The nomogram that integrated these predictors achieved a corrected C-index of 0.846 and an area under the curve of 0.843, which demonstrated strong calibration and a Hosmer-Lemeshow P = 0.91. At the optimal probability cutoff of 0.124, the sensitivity was 77.2%, the specificity was 78.2%, and the accuracy was 78.1%. The NLR and preoperative Hb level, combined with postoperative MODS, independently predict in-hospital death in patients with AAD. Additionally, a nomogram combining these factors accurately predicts short-term mortality and aids in the personalized risk assessment and may assist in improving the prognosis.