Explore the vast range of titles available.

Key Clinical Message Supraventricular arrhythmias can sometimes be “only” epiphenomena appearing during acute hypoxia, pneumonia, pulmonary embolism, and thrombosis. Indeed, atrial fibrillation is not rare in acute aortic dissection as it is estimated in about one half of patients and may be secondary to a perfusion deficit of the sinoatrial node artery. Supraventricular arrhythmias can sometimes be “only” epiphenomena appearing during acute hypoxia, pneumonia, pulmonary embolism, and thrombosis. Indeed, atrial fibrillation is not rare in acute aortic dissection as it is estimated in about one half of patients and may be secondary to a perfusion deficit of the sinoatrial node artery.

To investigate the risk factors for postoperative hepatic dysfunction (HD) in patients undergoing acute Stanford type A aortic dissection (ATAAD) surgery and to develop an individualized prediction model. We retrospectively analyzed cardiac surgery patients with ATAAD treated at our hospital from January 2020 to March 2024, dividing them into 7:3 training and validation cohorts and grouping them into HD and non-HD categories based on postoperative liver function. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were used to identify independent predictive factors for postoperative HD, which formed the basis of a nomogram prediction model. We assessed model accuracy, calibration and clinical utility using C-statistics, calibration plots and decision curve analysis (DCA) curves. Internal validation with 1000 Bootstrap resamples was performed to reduce overfitting bias. LASSO and multivariate logistic regression identified key risk factors for HD in ATAAD patients, including chronic kidney disease, preoperative creatinine, international normalized ratio (INR), red blood cell (RBC) transfusion volume, peak intraoperative lactate, aortic cross-clamping time greater than 99 min, and reoperation. Based on these factors, a nomogram prediction model was successfully developed. The Hosmer–Leme show test yielded a p value of 0.952, indicating a good model fit. The area under the curve (AUC) values in the training and validation cohorts were 0.856 (95% CI 0.777–0.936) and 0.958 (95% CI 0.915–1) respectively, indicating good discriminatory power. The calibration curve shows that the bias corrected line is close to the ideal line. The DCA curve indicates that the use of the nomogram provides greater net clinical benefit. The AUC values before and after Bootstrap validation were 0.860 (95% CI 0.795–0.924) and 0.858 (95% CI 0.795–0.924), respectively, reflecting stable model performance and minimal risk of overfitting. The internally validated prognostic nomogram demonstrates excellent discriminative power, calibration, and clinical utility for predicting the risk of HD in patients who have undergone ATAAD surgery. This allows for an individualized evaluation and the optimization of clinical outcomes.

Introduction: This case is unique in that it documents isolated, painless vaginal bleeding as the sole presenting symptom of a Stanford type A aortic dissection (STAAD), a presentation notpreviously reported. It adds to the literature by expanding the spectrum of atypical aortic dissection presentations and underscores the need to consider this diagnosis in elderly patients with vascular risk factors, even when they present with non-classical symptoms such as unexplained bleeding. Case Report: We present a novel case of STAAD in a 72-year-old woman with a history of hypertension, dyslipidaemia, prior hysterectomy, and cholecystectomy. Her primary complaint was asingle, transient episode of painless vaginal bleeding. Notable clinical findings included a diminished right radial pulse, a significant inter-arm blood pressure discrepancy, and unremarkable systemic and vaginal examinations. Given these findings, further evaluation was pursued. Computed tomography aortography revealed a STAAD extending from the aortic arch to the bifurcation, involving the left internal iliac artery and a vaginal arterial branch. The patient underwent emergent surgical repair and was discharged in good condition on hospital day 11. At her most recent follow-up, three years post- event, she remained clinically stable with no recurrence. Conclusion: Isolated painless vaginal bleeding, although uncommon, may indicate life-threatening pathology. Subtle signs, such as inter-arm blood pressure discrepancy, can offer criticaldiagnostic clues, underscoring the importance of comprehensive evaluation in atypical emergency presentations.

Patients with Stanford type A aortic dissection (TAAD) have high postoperative mortality. This study aimed to develop a prediction model for in-hospital death after surgery in patients with TAAD. The derivation cohort came from a meta-analysis. Major risk factors were counted. The corresponding hazard ratio was reported to establish a prediction model for in-hospital death in patients with TAAD. Validation cohorts from 2 centres were used to evaluate the prediction model. The meta-analysis included 24 cohort studies with a total of 11,404 patients and 1,554 patients died early after surgery. Risk factors for the prediction model included age, body mass index, smoking, coronary heart disease, preoperative stroke, shock, preoperative cardiopulmonary resuscitation, pericardial tamponade and malperfusion. Patients with TAAD admitted to the First and the Fourth Hospital of Hebei Medical University between January 2020 and June 2024 were retrospectively collected. Patients from the 2 hospitals constituted validation cohorts A (n = 262) and B (n = 138). Risk scores were calculated for model validation and the prediction model demonstrated better differentiation for validation cohort A, with an area under the curve of 0.886 (95% confidence interval 0.842 to 0.931). This study established a simple risk prediction model, including 13 risk factors, to predict in-hospital death in patients with TAAD. However, multicenter data is still needed to evaluate the prediction accuracy of the model.

Objective Early thrombosed aortic dissection is a form of aortic dissection and includes the condition called aortic intramural hematoma. It was generally considered as surgical emergency. However, the optimal treatment strategy for acute type A intramural hematoma is becoming controversial after recent studies indicated more benign clinical course for this disease. We evaluated our strategy that integrated medical therapy, serial imaging, and timed surgery. Methods We reviewed 34 consecutive patients who were admitted to our hospital for early thrombosed Stanford type A acute aortic dissection from 2006 to 2011. Medical therapy or timed surgery was offered on the basis of radiological findings. Emergency or urgent surgery was not considered for a hemodynamically stable patient unless the ascending aortic diameter was ≧50 mm or the thickness of the thrombosed false lumen was ≧10 mm. Follow-up computed tomography was performed to detect a potential progression to aortic dissection. Results During the average follow-up period of 24.3 months, there was no aortic dissection-related mortality. And aortic dissection-related event was not recorded in patients who had surgical repair; however, in patients who did not have surgery, 3 (8.8 %) surgical conversions were recorded due to aortic dissection progression during the follow-up period. Twenty-one patients (61.8 %) ultimately had surgical repair, and 13 patients (38.2 %) had complete medical therapy. The overall survival rate at 3 years was 86.5 %. Conclusions Our strategy for the treatment of early thrombosed Stanford type A acute aortic dissection is reasonable, and the mid-term results were acceptable.

Background Stanford type A aortic dissection is a life-threatening cardiovascular emergency requiring urgent surgical intervention. Despite advances in treatment, post-operative recovery remains challenging with complex health management needs. Current care models often lack patient-centered insights into their evolving experiences across diagnosis, treatment, and rehabilitation phases. Therefore, exploring the disease management journey of patients from the perspective of patient experience is of great significance to improve the prognosis of patients. Objective This study aims to delineate patients' health management journey to identify critical care transitions and unmet support needs, ultimately informing targeted nursing interventions. Methods Based on the patient journey map framework and using a descriptive qualitative research method, 23 patients with Stanford type A aortic dissection were selected for semi-structured interviews from January 2023 to March 2024. Conventional inductive content analysis was used to analyze the interview data. The patient journey maps were drawn by using Word Processing System software. Results Three distinct phases of care were identified: diagnostic phase, in-hospital treatment phase, and long-term self-management phase. From the dimensions of tasks, emotions, and pain points, the study highlighted prominent health management issues and twenty-seven themes, including marked symptom distress during the entire disease journey, distinct psychological experiences characterize different phases of the disease journey, and evolving health service requirements throughout the disease trajectory. The patient journey maps were ultimately developed based on sub-themes. Conclusion The disease journey of patients with Stanford type A aortic dissection is lengthy, and their health management issues are complex, dynamic, and multidimensional. Our findings directly inform the development of targeted nursing interventions, such as structured pre-operative guidance to address acute symptoms and fears, nurse-led ICU interventions to reduce psychological problems, and a dedicated transition coordinator role to bridge the critical gap from hospital to home. Implementing such a phase-specific, patient-centered approach is essential to improving long-term outcomes. Future research could focus on developing nursing intervention strategies for key events under a time-matched model, targeting the health problems and care needs at different stages, to assist in comprehensive health care management.

Abstract Stanford type A aortic dissection is a condition associated with high mortality in the absence of prompt surgical management. In sub-Saharan Africa, both the diagnosis and management of the acute phase remain particularly challenging. Consequently, the few patients who survive the acute phase are often diagnosed during the chronic stage. We present a series of five cases of chronic type A aortic dissection surgically managed in Benin.

Intimo-intimal intussusception is a very rare and unusual complication of type A dissections, typically noted on TEE exam. It has been reported in a few cases in the cardiothoracic surgical and radiology literature, and even more rarely in the cardiac anesthesia/TEE literature. This uncommon variation occurs in severe, acute, type A dissections when the ascending aortic intima circumferentially strips and detaches from the media and forms a tube-like structure which may either prolapse antegrade into the ascending aortic lumen or retrograde into the left ventricular (LV) outflow tract and LV cavity. Antegrade intussusceptions may be severe enough to partially or completely occlude the ostia of the innominate, left common carotid, and left subclavian arteries producing acute neurologic symptoms. Retrograde intussusceptions may severely impair LV filling in diastole, can worsen aortic insufficiency, mitral regurgitation, as well as produce occlusion of the coronary ostia and acute coronary ischemia. Here, we describe the incidental finding of a retrograde intussusception that was not visualized on computed tomography scan but by intraoperative TEE examination, in a patient with a severe, extensive type A dissection.

Stanford type A aortic dissection (TAAD) is a life‐threatening disease. This study explored the role of LIM domain binding 3 (LDB3) in TAAD progression. Four datasets from the Gene Expression Omnibus were analyzed to identify TAAD‐related hub genes. LDB3 single nucleotide polymorphisms (SNPs) were assessed in the UK Biobank. Western blotting and immunofluorescence detected LDB3 expression in angiotensin II (Ang II) stimulated human aortic vascular smooth muscle cells (HA‐VSMC), human samples, and a murine model. Bioinformatics identified tissue inhibitor of metalloproteinase‐1 (TIMP1) and LDB3 as TAAD hub genes. TIMP1 was expressed in macrophages, mesenchymal cells, and smooth muscle cells, while LDB3 was mostly expressed in smooth muscle cells. Validation showed TIMP1 was upregulated and LDB3 downregulated in TAAD. Six LDB3 SNPs were associated with aortic aneurysm and dissection in the UK Biobank. In human and murine samples, LDB3 expression was reduced in diseased tissues and co‐localized with smooth muscle. Ang II‐stimulated HA‐VSMC exhibited LDB3 reduction and altered intercellular connections. The aforementioned findings suggest that the newly identified gene LDB3 is crucial in the progression of TAAD.

To determine the effect of dexmedetomidine on acute kidney injury (AKI) following endovascular aortic repair (EVAR) for Stanford type B aortic dissection (TBAD). Randomized, double-blind, placebo-controlled, pilot study. University Hospital. 102 TBAD patients undergoing EVAR procedures were enrolled. Patients with dissection involving aortic arch or renal artery were excluded. Patients were randomly assigned, in a 1:1 ratio, to a dexmedetomidine group (intravenous dexmedetomidine 0.4 μg/kg/h immediately after anesthesia induction and 0.1 μg/kg/h after extubation, which was maintained until 24 h) or a normal saline control group. The primary outcome was the incidence of AKI within the first two days after surgery, based on the Acute Kidney Injury Network (AKIN) criteria. The secondary outcomes included serum cystatin C and estimated glomerular filtration rate on postoperative days 1, 2, and 7, and in-hospital need for renal replacement therapy (RRT). Long-term outcomes included RRT and all-cause mortality. Ninety-eight patients completed the study (dexmedetomidine, n = 48; control, n = 50). AKIN stage 1 AKI occurred in 3/48 (6.3%) patients receiving dexmedetomidine, compared with 11/50 (22%) patients receiving normal saline (odds ratio = 0.24, 95% CI: 0.07 to 0.89, P = 0.041). This difference remained significant after adjusting for baseline covariates (adjusted odds ratio = 0.21, 95% CI: 0.05 to 0.84; P = 0.028). Dexmedetomidine led to a lower serum cystatin C on postoperative day 1 (median [IQR] mg/L: 1.31 [1.02–1.72] vs. 1.58 [1.28–1.96]). There were no between-group differences in other secondary or long-term outcomes. During the follow-up (median = 28.4 months), 1 patient in the dexmedetomidine group and 3 patients in the control group required RRT. Dexmedetomidine reduced the incidence of AKI in TBAD patients after EVAR procedures. The long-term benefits of dexmedetomidine in this patient population warrant further investigation. Trial registration: ChiCTR-IPR-15006372. •Dexmedetomidine reduced AKI after EVAR procedures in TBAD patients.•Dexmedetomidine reduced serum cystatin C in the early postoperative days.•The effects of dexmedetomidine remained significant after adjusting for baseline covariates.