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Objectives: The presence of a mechanical aortic valve has been a contraindication to the use of an arch branch aortic endograft due to the risk of damaging the valve, resulting in acute aortic regurgitation, or a trapped endograft. Methods: We present a 67-year-old woman, with a background of Marfan's syndrome and a previous Bentall's procedure, who presented with a symptomatic enlarging aortic arch and descending thoracic aortic aneurysm, with a type 1A endoleak. Results: Using an inner branch arch endograft (Cook Medical, Bloomington, Indiana), the nose cone of the delivery system was passed laterally through the semi-circular aperture of the mechanical aortic valve to facilitate deployment just distal to the coronary buttons. Conclusions: With advancement of endovascular technology, techniques and experience, endovascular aortic arch repair in the presence of a mechanical aortic valve is feasible. [ABSTRACT FROM AUTHOR]

Background: Blood glucose level variability has been associated with increased risk of complication in the postoperative setting of cardiovascular surgery. Although interesting for optimization of blood glucose management in this context, continuous blood glucose (CBG) devices can have a limited reliability in this context, in particular because of the use of paracetamol. The aim of this study was to evaluate the reliability of Dexcom G6®, a recently developed continuous glucose monitoring device. Methods: We performed a prospective, observational, non-randomized, single-centre study comparing Dexcom G6® CBG level monitoring with the standard methods routinely used in this context. The standard blood glucose values were paired to the time corresponding values measured with Dexcom G6®. Agreement between the two methods and potential correlation in case of paracetamol use were calculated. Results: From May 2020 to August 2021, 36 out of 206 patients operated for isolated coronary artery bypass grafting were enrolled; 673 paired blood glucose level were analyzed. Global agreement (ρc) was 0.85 (95% C.I.: 0.84–0.86), intensive care unit agreement was 0.78 (95%C.I.: 0.74–0.82) and ward agreement was 0.91 (95%C.I.: 0.89–0.93). In the diabetic population, it was 0.87 (95%C.I.: 0.85–0.90). When paracetamol was used, the difference was 0.02 mmol/l (95%C.I.: 0.29–0.33). Conclusions: Dexcom G6® provides good blood glucose level accuracy in the postoperative context of cardiac surgery compared to the standard methods of measurements. The results are particularly reliable in the ward where the need for repeated capillary glucose measurements implies patient discomfort and time-consuming manipulations for the nursing staff. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Acute aortic dissection in unusual/rare circumstances may become chronic and multi lumen. A high clinical acumen, examination and investigations in the acute setting, may help reduce late/misdiagnosis and complications in low resource settings. [ABSTRACT FROM AUTHOR]

Background: Acute aortic dissection is a life-threatening condition that requires urgent surgical treatment. The frozen elephant trunk (FET) technique, including the Thoraflex hybrid prosthesis, has emerged as an effective strategy for treating complex aortic pathologies. With the widespread application of the FET technique, it continues to evolve, aiming to simplify procedures and reduce complications. These advancements provide improved outcomes and help save lives in patients with acute aortic dissection. Methods: For this review, PubMed databases were utilized from inception to March 2023. A descriptive approach was employed to identify and present the evidence regarding the application of the FET technique in acute settings and its clinical implications on the postoperative course. Results: In the reviewed studies, FET was a commonly used treatment approach for acute type A aortic dissection. A comprehensive analysis of 12 studies, comprising over 4056 FET procedures, revealed varying rates of early mortality (up to 21.1%), perioperative stroke (ranging from 2.7 to 18.0%), and spinal cord ischemia (ranging from 0 to 8.2%). During the follow-up period, which ranged from 6 to 108 months, the mortality rate was reported to be as high as 38%. Conclusions: The surgical management of acute aortic dissection remains challenging, but FET has shown promising results. Experienced teams have achieved acceptable in-hospital mortality and stroke rates, along with a lower risk of spinal cord injury compared to conventional repair. Furthermore, the FET technique has demonstrated positive alterations in the structure of the distal aorta, potentially improving long-term survival and reducing the necessity for future procedures. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Acute aortic syndromes are associated with poor outcomes, despite diagnostic and therapeutic advances. We analysed trends in volumes and outcomes from 2000 to 2021. METHODS The study population includes 494 type A acute aortic syndromes (TAAAS) (54.2%) and 418 type B acute aortic syndromes (TBAAS) (45.8%). Primary outcomes were in-hospital mortality, long-term survival and freedom from aortic reoperation. RESULTS Regardless the type of acute aortic syndrome, patient volumes increased over time. Patients with TBAAS were older, more likely to have comorbid conditions and previous cardiac surgery (P  < 0.001), while cerebrovascular accidents were more frequent in TAAAS (P  < 0.05). Among TAAAS, 143 (28.9%) required total arch and 351 (71.1%) hemiarch replacement. TBAAS management was medical therapy in 182 (43.5%), endovascular in 198 (47.4%) and surgical in 38 (9.1%) cases. Overall in-hospital mortality was 14.6% [18.2% in TAAAS (95% confidence interval (CI) 14.4–21.2%) vs 10.7% in TBAAS (95% CI 7.8%–13.7%); P  = 0.0027]. After propensity score adjustment, in-hospital mortality exhibited a significantly decreasing trend from 2000 to 2021 (P  < 0.001) in TAAAS and TBAAS. 1-, 5- and 10-year survival was 74.2%, 62.2% and 45.5% in TAAAS and 75.4%, 60.7% and 41.0% in TBAAS (P  = 0.975), with no differences among treatment strategies. The adjusted cumulative reoperation risk at 10 years was more than two-fold in TBAAS versus TAAAS (9.5% vs 20.5%, hazard ratio (HR) = 2.30, 95% I 1.31–4.04). CONCLUSIONS In the last decades, better patient triage and surgical/endovascular techniques led to substantial improvements in the management of acute aortic syndrome, with reduction in early mortality and reoperation rate. However, long-term mortality is still >50%. [ABSTRACT FROM AUTHOR]

A 47-year-old man with a history of hypertension was found to have a prominent aortic knob on routine chest X-ray and was referred to our hospital. Enhanced computed tomography angiography showed severe flexion at the proximal descending aorta with chronic type B dissection localized to the flexion region. Graft replacement of the distal aortic arch was performed. Surgical management of chronic pseudocoarctation dissection is sparsely reported in the literature because of its rare occurrence. We present an operative case of a patient with chronic dissection of distal aortic arch pseudocoarctation. [ABSTRACT FROM AUTHOR]

Despite advancements in surgical and postoperative management, spinal cord injury has been a persistent complication of both open and endovascular repair of thoracoabdominal and descending thoracic aortic aneurysm. Spinal cord injury can be explained with an ischemia-infarction model which results in local edema of the spinal cord, damaging its structure and leading to reversible or irreversible loss of its function. Perfusion of the spinal cord during aortic procedures can be enhanced by several adjuncts which have been described with a broad variety of evidence in their support. These adjuncts include systemic hypothermia, cerebrospinal fluid drainage, extracorporeal circulation and distal aortic perfusion, segmental arteries reimplantation, left subclavian artery revascularization, and staged aortic repair. The Authors here reviewed and discussed the role of such adjuncts in preventing spinal cord injury from occurring, pinpointing current evidence and outlining future perspectives. [ABSTRACT FROM AUTHOR]

Background: Endovascular aortic arch repair (EAR) has emerged as an alternative to open surgical repair. A growing interest in endovascular repair techniques for aortic arch aneurysms and dissection has been met with a focus on the clinical efficacy of EAR devices. We present multicentre comparative data on the clinical outcomes associated with EAR using the double- and triple-branched configurations of the RELAY™ (Terumo Aortic, Scotland, UK) endograft. Methods: Multicentre data on EAR procedures, carried out from January 2019 to January 2022, using the double- and triple-branched RELAY™ endograft were collected prospectively. Follow-up data were collected at 30 days, 6 months, 12 months, and 24 months postoperative. Retrospective descriptive analysis, logistic regression, and Kaplan–Meier analysis were carried out on procedural and follow-up data. Results: A total of 131 patients were included in the series. In total, 103 and 28 patients were treated with the double-branched and triple-branched RELAY™ endograft, respectively. Over the 24-month follow-up period, zero mortality, cases of stroke, or reinterventions were recorded in the triple-branched group. Four mortalities, 19 disabling strokes, and 50 reinterventions were recorded in the double-branched group within 30 postoperative days. Target vessel patency was maintained in all patients in the triple-branched group, while vessel patency was maintained in 74.0% of patients in the double-branched group. Conclusion: Outcomes associated with the triple-branched group are consistent with those reported in the literature. Our data suggest that EAR with the RELAY™ endograft is associated with favourable clinical outcomes and clinical efficacy. Further comparative research into EAR devices is needed. [ABSTRACT FROM AUTHOR]

Background: Total knee replacement is a major orthopedic procedure for severe, painful, and mobility-limiting knee arthritis. Aortic valve stenosis is the most frequent valvular heart disease and the most commonly performed valvular procedure. Stenosis of the valve may lead to left ventricular hypertrophy, ventricular dysfunction, myocardial ischemia, and a state of fixed cardiac output. Changes in hemodynamic parameters such as hypotension and bradycardia in patients with carotid artery stenosis may lead to cerebrovascular accidents, especially during anesthesia. Case presentation: A 76-year-old woman with a 6-year history of bilateral knee pain. The pain was dull, aching, and severe in intensity, and it prevented her from sleeping despite optimal analgesics. A general physical examination revealed an elderly, frail woman in mild respiratory distress. She had bilateral small-volume radial pulses, positive hepatojugular reflux, and heart sounds of S1, S2, and S4 with an ejection systolic murmur, and carotid bruits were heard bilaterally. Epidural anesthesia was done by injection of 2.5 mL of 0.5% plain bupivacaine in aliquots every 5 min until the level of the block reached the suprapubic region (titrated segmental epidural anesthesia). The patient was not preloaded with intravenous fluid prior to the establishment of epidural anesthesia, and the epidural anesthesia-induced hypotension that may ensue was managed with intraoperative dopamine infusion at 5 µg/kg/min. Conclusions: Titrated segmental epidural anesthesia with intraoperative infusion of low-dose dopamine reduces the perioperative risk of myocardial infarction, cerebrovascular accident, and neurocognitive deficit in a patient with severe aortic stenosis and severe bilateral carotid stenosis. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the safety and accuracy of aortic and periaortic computed tomography (CT)-guided percutaneous core needle biopsy performed at a single center over 12 years. Materials and methods: A retrospective review was conducted of cases performed between February 2010 and August 2022 in which the biopsied region was in direct contact with the aorta or great vessels including the pericardium and common iliac arteries. Clinical notes were reviewed for any early or delayed complications following the procedure, which if present were graded using the National Institute of Health's Common Terminology Criteria for Adverse Events, version 5.0. Pathology results were compared to subsequent outside biopsy results or follow-up surgical pathology, if available, as well as subsequent clinical decision making and/or clinical course, to determine concordance. Sensitivity, specificity, predictive value, and accuracy (indicative of diagnostic yield) were calculated. Results: 32 core needle biopsies were reviewed from 30 patients (average lesion longest diameter 3.1 cm, range 0.5–10.9 cm; average needle proximity to the vessel endothelium or deep side of the pericardium 1.0 cm, range 0.3–1.8 cm). Complications occurred in 46.9% of cases (15/32), 93.3% (14/15) of which were minor and included small amounts of bleeding or pain. One patient developed a small nonemergent pneumothorax. Of biopsies obtained, 96.9% provided adequate tissue for diagnosis (31/32). When evaluating concordance between pathological and final diagnosis, sensitivity was 94.7% and specificity was 83.3%; positive and negative predictive value were 90.0% and 90.9%, respectively. Accuracy (diagnostic yield) of biopsy was 90.3%. Conclusion: CT-guided percutaneous aortic and periaortic core needle biopsies are safe and efficacious procedures with high diagnostic yield. [ABSTRACT FROM AUTHOR]

Blunt thoracic aortic injury (BTAI) is a potentially fatal condition that needs prompt recognition and expedited management. Clinical manifestations of BTAI are not straight forwarding and may be misdiagnosed. The grade of aortic injury is an important determinant of perioperative mortality and morbidity, as well as the indication of treatment, along with the presence of concomitant lesions of other involved organs. The mainstay of treatment nowadays for hemodynamically stable patients who survive the trauma scene is represented by delayed endovascular repair whenever anatomically and clinically feasible. Endovascular repair, in fact, is burdened by lower perioperative mortality and morbidity rates if compared to open surgical repair, but concerns remain about the need for long-term surveillance and radiation exposure in patients who are at a younger age than patients treated for the aneurysmal disease. The aim of the paper is to provide an update on the diagnostic modalities and strategies of treatment for patients affected by BTAI. [ABSTRACT FROM AUTHOR]

Multimorbidity, the coexistence of multiple health conditions in an individual, has emerged as one of the greatest challenges facing health services, and this crisis is partly driven by the aging population. Aging is associated with increased aortic stiffness (AoStiff), which in turn is linked with several morbidities frequently affecting and having disastrous consequences for the elderly. These include hypertension, ischemic heart disease, heart failure, atrial fibrillation, chronic kidney disease, anemia, ischemic stroke, and dementia. Two or more of these disorders (multimorbidity) often coexist in the same elderly patient and the specific multimorbidity pattern depends on several factors including sex, ethnicity, common morbidity routes, morbidity interactions, and genomics. Regular exercise, salt restriction, statins in patients at high atherosclerotic risk, and stringent blood pressure control are interventions that delay progression of AoStiff and most likely decrease multimorbidity in the elderly. [ABSTRACT FROM AUTHOR]

The group used a Medtronic Freestyle graft as a simulation of a native aortic root and then proceeded to alter it to simulate a Yacoub remodelling procedure, a David reimplantation on a straight graft and a David reimplantation performed using a Valsalva graft - which they referred to as De Paulis reimplantation. Keywords: Aortic; Valsalva; Aortic root; Valve-sparing operation; Reimplantation EN Aortic Valsalva Aortic root Valve-sparing operation Reimplantation 1 11 11 04/04/23 20230301 NES 230301 They say nature is the greatest artist, capable of the most perfect engineering and design. [Extracted from the article]

The European Association for Cardiothoracic Surgery (EACTS) and the American Society of Thoracic Surgeons (STS) have released new guidelines for the diagnosis and treatment of aortic diseases. These guidelines, which come ten years after the previous release, cover various aspects of aortic diseases and are summarized in 36 tables of recommendations. The guidelines emphasize the recognition of the aorta as an organ in its own right and recommend endovascular treatment as the first-line intervention for many aortic pathologies. The guidelines also highlight the importance of wide consensus among professionals and advocate for a lower threshold for elective surgery on the ascending aorta. However, it is important to note that the level of evidence supporting most of the recommendations is categorized as 'level C', indicating a reliance on small cohorts of patients, retrospective analyses, and expert consensus. The guidelines also stress the need for more research in various areas of aortic disease treatment. [Extracted from the article]

In this study, we report our local experience of type A aortic dissections in patients with cerebral malperfusion treated with carotid stenting before or after aortic surgery, and present a systematic literature review on these patients treated either with carotid stenting (CS) before or after aortic surgery (AS) or with aortic and carotid surgery alone (ACS). We report on patients treated in our center with carotid stenting for brain hemodynamic injury of carotid origin caused by type A dissection since 2018, and a systematic review was conducted in PubMed for articles published from 1990 to 2021. Out of 5307 articles, 19 articles could be included with a total of 80 patients analyzed: 9 from our center, 29 patients from case reports, and 51 patients from two retrospective cohorts. In total, 8 patients were treated by stenting first, 72 by surgery first, and 7 by stenting after surgery. The mean age; initial NIHSS score; time from symptom onset to treatment; post-treatment clinical improvement; post-treatment clinical worsening; mortality rate; follow-up duration; and follow-up mRS were, respectively, for each group (local cohort, CS before AS, ACS, CS after AS): 71.2 ± 5.3 yo, 65.5 ± 11.0 yo; 65.3 ± 13.1 yo, 68.7 ± 5.8 yo; 4 ± 8.4, 11.3 ± 8.5, 14.3 ± 8.0, 0; 11.8 ± 14.3 h, 21 ± 39.3 h, 13.6 ± 17.8 h, 13 ± 17.2 h; 56%, 71%, 86%, 57%; 11%, 28%, 0%, 14%; 25%, 12.3%, 14%, 33%; 5.25 ± 2.9 months, 54 months, 6.8 ± 3.8 months, 14 ± 14.4 months; 1 ± 1; 0.25 ± 0.5, 1.3 ± 0.8, 0.68 ± 0.6. Preoperative carotid stenting for hemodynamic cerebral malperfusion by true lumen compression appears to be feasible, and could be effective and safe, although there is still a lack of evidence due to the absence of comparative statistical analysis. The literature, albeit growing, is still limited, and prospective comparative studies are needed. [ABSTRACT FROM AUTHOR]

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In situ fenestration of stent-graft represents a potential option for the treatment of aortic diseases in patients unsuitable for standard endovascular repair. The best fenestration strategy to restore perfusion of collateral vessels after their coverage by an endograft depends mainly on the anatomical area. Several tools are employed as fenestration devices, including needles, radiofrequency probes, and laser systems, used in conjunction with other instrumentation to provide enough support and stability during the procedure. In this systematic review, the approaches to reach the correct fenestration site both in human, animal, and in in vitro environments are described and discussed, highlighting advantages and limitations. Both commercial and dedicated solutions for the intraoperative modification of the fabric material are reported as well. The clinical interest in this procedure has so far encouraged researchers to develop and refine both methods and tools to solve the current limitations of this technique, intending to extend the indications for endovascular treatment to a broader range of patients. [ABSTRACT FROM AUTHOR]

Surgery for acute type A aortic dissection remains challenging with considerable mortality and morbidity despite the remarkable advances in this field. Particularly, surgical outcomes of acute type A aortic dissection are known to be associated with the hospital volume. The optimal cerebral protective method and extent of surgery have been long-standing controversies in acute type A aortic dissection surgery. Given that data from randomized trial are not available and future trials are also unrealistic, observational data based on large registry or meta-analyses may alternatively provide reliable and reasonable evidence. With regard to neuroprotective methods for arch repair, currently available observational data strongly suggest that there are no overt superiority among unilateral-antegrade cerebral perfusion, bilateral-antegrade cerebral perfusion, and retrograde cerebral perfusion, by which their availabilities are still open in real clinical practices depending on institutional preferences. When deciding the extent of arch repair in acute DeBakey type I aortic dissection, multiple factors should be considered altogether such as aortic anatomic characteristics as well as patient's risk profiles for optimizing early safety and late aortic longevity. [ABSTRACT FROM AUTHOR]

Aortic valve stenosis (AVS) is the most frequent valvular heart disease in industrialized countries, presenting with very high mortality if left untreated. While drug treatment can sometimes alleviate symptoms, it fails to stop progression or cure the underlying disease. Until the first decade of this millennium, surgical aortic valve replacement (SAVR) remained the only available therapy option with a positive impact on mortality and morbidity. Even though several studies reported highly positive effects of SAVR regarding the improved quality of life and better physical performance, SAVR remained an intervention that, due to its remarkable complexity and the need for heart-lung machine and cardioplegia, was limited by the patients' comorbid profile. While unsatisfying hemodynamic results after transcatheter aortic balloon valvuloplasty in high-risk surgical patients limited its adoption as an alternative treatment, it provided the impetus for further interventional approaches to the therapy of AVS. This review considers the invention and development of transcatheter aortic valve implantation (TAVI), which established itself as a catheter-based, minimally invasive procedure over the past decade, and has become an equivalent treatment method for high-risk surgical patients. For that matter, early TAVI concepts, their amendments, and the associated pioneers are recognized for paving the way to a revolutionary diversification in AVS treatment. [ABSTRACT FROM AUTHOR]

Background: Enlargement of the left atrium has been thoroughly studied in many clinical situations, especially its association with mortality and morbidity. Patients and Methods: The study cohort included patients with rheumatic valve pathology such as stenosis and regurgitation. All patients underwent valvular surgical procedures including mitral valve replacement (MVR), aortic valve replacement (AVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with or without CABG. This study included patients who underwent surgery between 2002 and 2017. Results: Three hundred and forty-six patients were included in this study. The mean patient age was 51.6± 16.1 years; 37% of the patients underwent AVR, 28% underwent MVR, and 13% underwent a combination of MVR with AVR, AVR with CABG in 6%, and MVR with CABG in 10%. The operative mortality rate was 5.8% (n=20). Univariate analysis revealed that the predictors of mortality included age (P < 0.001), body mass index (BMI) (P = 0.003), type of surgery performed (P = 0.007), hypertension (P = 0.005), emergent surgeries (P = 0.018), left atrial diameter (P = 0.003), cross-clamp time greater than 90 minutes (P = 0.007), postoperative acute kidney injury (AKI) (P = 0.044), postoperative stroke (P = 0.049), and surgical site infection (P = 0.047). Multivariate analysis revealed that predictors of mortality included age (P = 0.028, AOR=10.6), BMI (P = 0.003, AOR=3.12), re-exploration (P = 0.006, AOR=8.38), length of intensive care unit stay (P ≤ 0.002, AOR=4.55), and left atrial diameter (P = 0.003, AOR=10.64). Conclusion: Enlargement of the left atrium has been studied extensively as a predictor of mortality and morbidity in different clinical situations, to the extent that some authors suggest adding it to risk stratification models. In this study, left atrial size > 4 cm was found to strongly predict mortality after rheumatic heart valve surgery. [ABSTRACT FROM AUTHOR]

There are insufficient reports on the use of andexanet alfa in cardiac surgery. A 67-year-old man was diagnosed with type A aortic dissection and performed emergent surgery. His medical history included atrial fibrillation treated with Edoxaban. We performed total arch replacement. Despite administration of enough protamine, fresh frozen plasma, and platelet administration, controlling bleeding was difficult. Thus, Andexanet Alfa was initiated after CPB withdrawal. Surgical bleeding was dramatically controlled after its administration. There were no findings suggestive of an embolic event. In conclusion, administration of Andexanet Alfa is safe after cardiopulmonary bypass withdrawal. [ABSTRACT FROM AUTHOR]

A 58-year-old male underwent LVAD-Implantation after ECLS explantation. After removal of ECLS (A) transesophageal echocardiography revealed thrombus in the inferior vena cava (B) and right atrium (C). The thrombus was removed with a second pump run including RVAD-Implantation. (D) The diameter of thrombus formations was 6 × 1 cm and 5 × 1.5 cm. [ABSTRACT FROM AUTHOR]

(1) Background: The clinical burden of aortic stenosis (AS) remains high in Western countries. Yet, there are no screening algorithms for this condition. We developed a risk prediction model to guide targeted screening for patients with AS. (2) Methods: We performed a cross-sectional analysis of all echocardiographic studies performed between 2013 and 2018 at a tertiary academic care center. We included reports of unique patients aged from 40 to 95 years. A logistic regression model was fitted for the risk of moderate and severe AS, with readily available demographics and comorbidity variables. Model performance was assessed by the C-index, and its calibration was judged by a calibration plot. (3) Results: Among the 38,788 reports yielded by inclusion criteria, there were 4200 (10.8%) patients with ≥moderate AS. The multivariable model demonstrated multiple variables to be associated with AS, including age, male gender, Caucasian race, Body Mass Index ≥ 30, and cardiovascular comorbidities and medications. C-statistics of the model was 0.77 and was well calibrated according to the calibration plot. An integer point system was developed to calculate the predicted risk of ≥moderate AS, which ranged from 0.0002 to 0.7711. The lower 20% of risk was approximately 0.15 (corresponds to a score of 252), while the upper 20% of risk was about 0.60 (corresponds to a score of 332 points). (4) Conclusions: We developed a risk prediction model to predict patients' risk of having ≥moderate AS based on demographic and clinical variables from a large population cohort. This tool may guide targeted screening for patients with advanced AS in the general population. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 is the disease produced by severe acute respiratory syndrome-coronavirus-2, which is introduced into the host's cell thanks to the angiotensin-converting enzyme 2 receptor. Once there, it uses the cell's machinery to multiply itself. In this process, it generates an immune response that stimulates the lymphocytes to produce cytokines and reactive oxygen species that begin to deteriorate the endothelial cell. Complement activation, through the complement attack complex and C5a, contributes to this endothelial damage. The different mediators further promote the expression of adhesion molecules on the endothelial surface, which encourages all blood cells to adhere to the endothelial surface to form small conglomerates, called clots, which obstruct the lumen of the small blood vessels. Furthermore, the mediators of clot lysis are inhibited. All this promotes a prothrombotic environment within the pulmonary capillaries that is reflected in the elevation of D-dimer. The only solution for this cascade of events seems to be the implementation of an effective anticoagulation protocol that early counteracts the changes induced by thrombi in the pulmonary circulation and reflected in the functioning of the right ventricle. [ABSTRACT FROM AUTHOR]

Background: Excellent partial upper sternotomy outcomes have been reported for patients undergoing aortic surgery, but whether this approach is particularly beneficial to obese patients remains to be established. This study was developed to explore the outcomes of aortic surgical procedures conducted via a partial upper sternotomy or a full median sternotomy approach in obese patients.Methods: We retrospectively examined consecutive acute type A aortic dissection patients who underwent aortic surgery in our hospital between January 2015 to January 2021. Patients were divided into two groups based on body mass index: 'non-obese' and 'obese'. We then further stratified patients in the obese and non-obese groups into partial upper sternotomy and full median sternotomy groups, with outcomes between these two sternotomy groups then being compared within and between these two body mass index groups.Results: In total, records for 493 patients that had undergone aortic surgery were retrospectively reviewed, leading to the identification of 158 consecutive obese patients and 335 non-obese patients. Overall, 88 and 70 obese patients underwent full median sternotomy and partial upper sternotomy, respectively, while 180 and 155 non-obese patients underwent these respective procedures. There were no differences between the full median sternotomy and partial upper sternotomy groups within either BMI cohort with respect to preoperative baseline indicators and postoperative complications. Among non-obese individuals, the partial upper sternotomy approach was associated with reduced ventilation time (P = 0.003), shorter intensive care unit stay (P = 0.017), shorter duration of hospitalization (P = 0.001), and decreased transfusion requirements (Packed red blood cells: P < 0.001; Fresh frozen plasma: P < 0.001). Comparable findings were also evident among obese patients.Conclusions: Obese aortic disease patients exhibited beneficial outcomes similar to those achieved for non-obese patients via a partial upper sternotomy approach which was associated with significant reductions in the duration of intensive care unit residency, duration of hospitalization, ventilator use, and transfusion requirements. This surgical approach should thus be offered to aortic disease patients irrespective of their body mass index. [ABSTRACT FROM AUTHOR]

(1) Background: Our goal was to develop a risk prediction model for mortality in patients with moderate and severe aortic stenosis (AS). (2) Methods: All patients aged 40–95 years, with echocardiographic evidence of moderate and severe AS at a single institution, were studied over a median of 2.8 (1.5–4.8) years, between 2013–2018. Patient characteristics and mortality were compared using Chi-squares, t-tests, and Kaplan–Meier (KM) curves, as appropriate. The risk calculation for mortality was derived using the Cox proportional hazards model. A risk score was calculated for each parameter, and the total sum of scores predicted the individualized risks of 1-and 5-year mortality. (3) Results: A total of 1991 patients with severe and 2212 with moderate AS were included. Severe AS patients were older, had a lower ejection fraction %, were more likely to be Caucasian, and had lower rates of obesity and smoking, but had higher rates of cardiac comorbidities and AVR (49.3% vs. 2.8%, p < 0.0001). The unadjusted overall mortality was 41.7% vs. 41%, p = 0.6530, and was not different using KM curves (log rank, p = 0.0853). The models included only patients with complete follow-up (3966 in the 1-year, and 816 in the 5-year model) and included 13 variables related to patient characteristics, degree of AS, and AVR. The C-statistic was 0.75 and 0.72 for the 1-year and the 5-year models, respectively. (4) Conclusions: Patients with moderate and severe AS experience high morbidity and mortality. The usage of a risk prediction model may provide guidance for clinical decision making in complex patients. [ABSTRACT FROM AUTHOR]

Background and objectives: Fluid structure interaction (FSI) is defined as interaction of the structures with contacting fluids. The aortic valve experiences the interaction with blood flow in systolic phase. In this study, we have tried to predict the hemodynamics of blood flow through a normal and stenotic aortic valve in two relaxation and exercise conditions using a three-dimensional FSI method. Methods: The aorta valve was modeled as a three-dimensional geometry including a normal model and two others with 25% and 50% stenosis. The geometry of the aortic valve was extracted from CT images and the models were generated by MMIMCS software and then they were implemented in ANSYS software. The pulsatile flow rate was used for all cases and the numerical simulations were conducted based on a time-dependent domain. Results: The obtained results including the velocity, pressure, and shear stress contours in different systolic time sequences were explained and discussed. The maximum blood flow velocity in relaxation phase was obtained 1.62 m/s (normal valve), 3.78 m/s (25% stenosed valve), and 4.73 m/s (50% stenosed valve). In exercise condition, the maximum velocities are 2.86, 4.32, and 5.42 m/s respectively. The maximum blood pressure in relaxation phase was calculated 111.45 mmHg (normal), 148.66 mmHg (25% stenosed), and 164.21 mmHg (50% stenosed). However, the calculated values in exercise situation were 129.57, 163.58, and 191.26 mmHg. The validation of the predicted results was also conducted using existing literature. Conclusions: We believe that such model are useful tools for biomechanical experts. The further studies should be done using experimental data and the data are implemented on the boundary conditions for better comparison of the results. [ABSTRACT FROM AUTHOR]

Objectives: The introduction of selective antegrade cerebral perfusion technique as method of cerebral protection improved the outcome of open arch surgery. The aim of this study was to report early outcomes using this technique. Methods: Between 1997 and 2017, data were collected retrospectively for all patients who underwent surgical replacement of the aortic arch using selective antegrade cerebral perfusion (n = 938). To confirm the effectiveness of this cerebral protection method, early outcome and results were evaluated. Results: The incidence of postoperative permanent neurological dysfunction was 6.4%. Overall hospital mortality was 11.9% (n = 112). On multivariable analysis, age >75 years, female gender, euroscore at increment of 1 point, chronic renal failure, extension of thoracic aorta replacement and CPB time emerged as independent risk factors for hospital mortality. The mid-term survival at 1, 5, 10 and 15 years was 92%, 78%, 60% and 49%, respectively. The competing risk analysis for permanent neurological dysfunction and aortic reoperations was performed excluding the patients who died during the hospital stay. The cumulative incidence of permanent neurological dysfunction and aortic reoperations was 2% at 3 years, 3% at 5 years, 6% at 10 years, 12% at 3 years, 15% at 5 years and 19% at 10 years, respectively. Conclusions: From the early 90s to the present day, the selective antegrade cerebral perfusion has confirmed to be a useful and "safe" method of brain protection in aortic arch surgery in terms of postoperative neurological complications. [ABSTRACT FROM AUTHOR]

Complications after open arch repair much decreased over time thanks to better methods of organ and cerebral protection. The crossroads was the introduction of antegrade cerebral perfusion as a method of cerebral protection. Other intraoperative techniques also contributed to facilitate arch reconstruction, such as performing circulatory arrest at higher core temperature, using hybrid grafts or endografts, and monitoring cerebral functions during the procedure. As part of this exciting process, we go back in Bologna in the early 1970s to relive some of these fundamental steps on aortic arch surgery. Today a large number of issues on cerebral protection remain for which we have incomplete responses. Probably, a super specialized approach and endovascular techniques will continue to improve the quality of care of patients with different arch pathologies. [ABSTRACT FROM AUTHOR]

Purpose: Chimney endovascular abdominal aortic aneurysm repair (CHEVAR) has predominantly been described as an alternative technique for the management of urgent presentations of degenerative pararenal aortic aneurysms (dPAAs). However, the role of CHEVAR in the treatment of asymptomatic patients remains unknown. The aim of current multinational study was to evaluate the outcomes of elective CHEVAR of dPAAs. Material and Methods: Retrospective analysis of 267 consecutive dPAA patients treated with elective CHEVAR at 13 European and US centers from 2008 to 2014. Primary endpoints were 30 days and out of hospital CHEVAR-related mortality. Secondary endpoints included persistent type Ia endoleak or endotension, angiographically confirmed occlusion and/or high-grade chimney graft (CG) or involved splanchnic vessel stenosis identified at index procedure and/or during follow-up, as well as CHEVAR-related re-intervention. Results: Mean follow-up time was 25.5±13.3 months. The 442 visceral vessels were involved and mean number of CGs per patient was 1.63±0.7. 436 targeted vessels were successfully cannulated. The aortic graft intentionally covered 6 renal arteries and immediate technical success was 98.6%. The 30 days mortality was 1.9% (n=5), while the in-hospital complication rate was 10.1% (n=27) including 3 strokes, 1 permanent dialysis, and 1 intestinal ischemia. No 30 day type Ia endoleaks were detected and 3.2% of CGs (n=14, including the intentionally covered) had evidence of occlusion and/or stenosis. The overall CHEVAR-related mortality was 2.2% (n=6). Freedom from primary and secondary type Ia endoleak/endotension rates at 3 years was 93.0% and 98.0%, respectively. Primary and secondary CG patency was 87.0% and 89.0%. Primary and secondary endovascular freedom from any endpoint at 3 years was 81.0% and 94.0% respectively. Conclusion: Elective use of CHEVAR in the management of dPAAs seems to be durable. These results are comparable to published outcomes with other total endovascular strategies, which justifies an expanded role for CHEVAR in the treatment of asymptomatic patients presenting with dPAAs. [ABSTRACT FROM AUTHOR]

This review discusses the management of acute Type A aortic dissection (ATAAD) complicated by cerebral malperfusion (CMP). While prompt surgical repair is the accepted standard of care for ATAAD, there remains uncertainty and debate about the optimal management of the subgroup of ATAAD patients with CMP. Examined topics include overall survival and neurologic outcomes after surgical repair of ATAAD with CMP, how the severity of presenting neurologic deficits impacts the decision and timing of operation, predictors of postoperative neurologic recovery, and a suggested management algorithm for ATAAD with CMP based upon the best available clinical evidence. [ABSTRACT FROM AUTHOR]

Permanent pacemaker (PPM) implantation after surgical aortic valve (SAVR) is associated with short- and long-term complications. However, the impact of PPM implantation on long-term mortality has not been fully established. The aim of this meta-analysis was to determine whether PPM post-SAVR increases the risk of mortality. We searched Cochrane, MEDLINE, and EMBASE from inception to December 2020 for studies comparing mortality between patients who received PPM post-SAVR and those who did not. Random effects meta-analysis was performed to determine the effect of PPM on early and late mortality. The effect sizes were reported as hazard ratio (HR) with 95% confidence intervals. Three studies met criteria, which yielded a total of 9,105 patients. The most common indication was post-operative complete atrioventricular block. While there was no difference in early mortality between the PPM and no PPM groups (RR 1.19; 95%CI 0.20–7.08; I2 = 23%), PPM implantation was shown to significantly increase late mortality (RR 1.49; 95%CI 1.25–1.77; I2 = 0%). The need for permanent pacemaker after surgically isolated aortic valve replacement is associated with increased risk of long-term mortality. This warrants further exploration on the effect of PPM on long-term mortality in patients receiving sutureless prostheses or transcatheter aortic valve implants. Abbreviations PPM Permanent PacemakerSAVR Surgical Aortic Valve Replacement [ABSTRACT FROM AUTHOR]

Background: Enlargement of the left atrium has been thoroughly studied in many clinical situations, especially its association with mortality and morbidity.Patients and Methods: The study cohort included patients with rheumatic valve pathology such as stenosis and regurgitation. All patients underwent valvular surgical procedures including mitral valve replacement (MVR), aortic valve replacement (AVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with or without CABG. This study included patients who underwent surgery between 2002 and 2017.Results: Three hundred and forty-six patients were included in this study. The mean patient age was 51.6±16.1 years; 37% of the patients underwent AVR, 28% underwent MVR, and 13% underwent a combination of MVR with AVR, AVR with CABG in 6%, and MVR with CABG in 10%. The operative mortality rate was 5.8% (n=20). Univariate analysis revealed that the predictors of mortality included age (P < 0.001), body mass index (BMI) (P = 0.003), type of surgery performed (P = 0.007), hypertension (P = 0.005), emergent surgeries (P = 0.018), left atrial diameter (P = 0.003), cross-clamp time greater than 90 minutes (P = 0.007), postoperative acute kidney injury (AKI) (P = 0.044), postoperative stroke (P = 0.049), and surgical site infection (P = 0.047). Multivariate analysis revealed that predictors of mortality included age (P = 0.028, AOR=10.6), BMI (P = 0.003, AOR=3.12), re-exploration (P = 0.006, AOR=8.38), length of intensive care unit stay (P ≤ 0.002, AOR=4.55), and left atrial diameter (P = 0.003, AOR=10.64).Conclusion: Enlargement of the left atrium has been studied extensively as a predictor of mortality and morbidity in different clinical situations, to the extent that some authors suggest adding it to risk stratification models. In this study, left atrial size >4 cm was found to strongly predict mortality after rheumatic heart valve surgery. [ABSTRACT FROM AUTHOR]

Background: Despite the association of physical activity with improved cardiovascular outcomes and the association of high coronary artery calcification (CAC) scores with poor prognosis, elite endurance athletes have increased CAC. Yet, they nevertheless have better cardiovascular survival. We hypothesized that exercise may transform vascular calcium deposits to a more stable morphology.Methods: To test this, hyperlipidemic mice (Apoe-/-) with baseline aortic calcification were separated into 2 groups (n = 9/group) with control mice allowed to move ad-lib while the exercise group underwent a progressive treadmill regimen for 9 weeks. All mice underwent blood collections and in vivo 18F-NaF μPET/μCT imaging both at the start and end of the exercise regimen. At euthanasia, aortic root specimens were obtained for histomorphometry.Results: Results showed that, while aortic calcification progressed similarly in both groups based on µCT, the fold change in 18F-NaF density was significantly less in the exercise group. Histomorphometric analysis of the aortic root calcium deposits showed that the exercised mice had a lower mineral surface area index than the control group. The exercise regimen also raised serum PTH levels twofold.Conclusion: These findings suggest that weeks-long progressive exercise alters the microarchitecture of atherosclerotic calcium deposits by reducing mineral surface growth, potentially favoring plaque stability. [ABSTRACT FROM AUTHOR]

Copyright of Archivos de Cardiología de México is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Guillain‐Barré syndrome incidence within 8 weeks of a surgical procedure appears to be more common than previously thought. GBS following open‐heart surgery is exceedingly rare, perhaps underdiagnosed or underreported given surveillance data incidence. Clinicians should be keenly aware of this association and quickly consider a GBS diagnosis. [ABSTRACT FROM AUTHOR]

Background: Patients with aortic dissection during pregnancy and postpartum period exhibit a high mortality. At present, a complete overview of aortic dissection during pregnancy and postpartum period is lacking. ​Methods: This systematic review included 80 reports published from 2000 to 2020, comprising a total study population of 103 patients with aortic dissection. ​Results: We found that Stanford Type A aortic dissection was more common in prepartum cases, especially in the third trimester, while postpartum cases of aortic dissection were more common in Stanford Type B. The most common risk factor was connective tissue disease, with no other known risk factors. The mode of delivery had no significant effect on the type of postpartum aortic dissection. Reduced maternal and fetal mortality was observed when patients with Stanford Type A aortic dissection occurring after 28 gestational weeks underwent cesarean section followed by aortic replacement. Patients with Stanford Type B aortic dissection were treated mainly with medication and/or endovascular repair. ​Conclusion: Contemporary management of patients during pregnancy and within 12 weeks postpartum requires multidisciplinary cooperation and includes serial, noninvasive imaging, biomarker testing, and genetic risk profiling for aortopathy. Early diagnosis and accurate treatment are essential to reduce maternal and fetal mortality. [ABSTRACT FROM AUTHOR]

Background: Spatial transcriptomics enables gene expression events to be pinpointed to a specific location in biological tissues. We developed a molecular approach for low-cell and high-fiber Stanford type A aortic dissection and preliminarily explored and visualized the heterogeneity of ascending aortic types and mapping cell-type-specific gene expression to specific anatomical domains. Methods: We collected aortic samples from 15 patients with Stanford type A aortic dissection and a case of ascending aorta was randomly selected followed by 10x Genomics and spatial transcriptomics sequencing. In data processing of normalization, component analysis and dimensionality reduction analysis, different algorithms were compared to establish the pipeline suitable for human aortic tissue. Results: We identified 19,879 genes based on the count level of gene expression at different locations and they were divided into seven groups based on gene expression trends. Major cell that the population may contain are indicated, and we can find different main distribution of different cell types, among which the tearing sites were mainly macrophages and stem cells. The gene expression of these different locations and the cell types they may contain are correlated and discussed in terms of their involvement in immunity, regulation of oxygen homeostasis, regulation of cell structure and basic function. Conclusion: This approach provides a spatially resolved transcriptome− and tissue-wide perspective of the adult human aorta and will allow the application of human fibrous aortic tissues without any effect on genes in different layers with low RNA expression levels. Our findings will pave the way toward both a better understanding of Stanford type A aortic dissection pathogenesis and heterogeneity and the implementation of more effective personalized therapeutic approaches. [ABSTRACT FROM AUTHOR]

The frozen elephant trunk (FET) procedure enables easier replacement of the entire aortic arch because it does not require reaching the distal part of the left subclavian artery (LSCA). However, it requires additional management for reconstruction of the LSCA, which is associated with bleeding events. However, the fenestrated FET technique confers a risk of endoleakage from the fenestration site. We report our unique novel technique in which the proximal side of the hybrid stent graft is cut into V-shape around the subclavian artery and sutured continuously around the orifice of the subclavian artery during aortic stump fixation. [ABSTRACT FROM AUTHOR]

Vascular surgery is a relatively new surgical sub-speciality in the UK, with treatment of abdominal aortic aneurysms forming a substantial proportion of the emergency and elective caseload. This article summarises the guidance from the National Institute of Health and Care Excellence and the European Society for Vascular Surgery that outlines the epidemiology, diagnosis and management of abdominal aortic aneurysms. This is important for both vascular and non-vascular trainees to understand because of the critical nature of the disease, which can cause catastrophic haemorrhage, limb loss and mortality. However, if discovered in time, abdominal aortic aneurysms are a very treatable condition. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether hybrid repair has supremacy over conventional open repair in aortic arch diseases. Methods: A comprehensive search was undertaken in two major databases (PubMed and MEDLINE) to identify all studies comparing the two surgical techniques in five years, up to December 2018, that met the established criteria in this study. The search returned 310 papers, and 305 were selected after removing duplicates. The abstracts of the remaining articles were assessed, resulting in 15 studies that went to full-text analysis. After application of the inclusion and exclusion criteria, 8 papers remained for the final revision. Results: Eight studies met the criteria, with the inclusion of 1,837 patients. From a short-term perspective, hybrid repair and conventional open repair had similar outcomes in terms of postoperative mortality and acute neurological events. Hybrid repair was associated with less respiratory complications and risk of new intervention, as well as reduced hospital length of stay. Conventional open repair showed better mid- and long-term outcomes. Conclusion: Hybrid repair should be used in selected patients, with a high risk or very high-risk profile for conventional surgery. Finally, since most of the current data were obtained from limited to large samples, with narrow follow-up and had great heterogeneity, the best approach to the aortic arch is still variable. Therefore, the decision of the approach should be individualized and evaluated by the whole Heart Team, considering the expertise of the surgical team. [ABSTRACT FROM AUTHOR]

Copyright of Zdravotnícke Študie is the property of Catholic University in Ruzomberok and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abdominal aortic aneurysm (AAA) rupture is a common cause of death in adults. Current AAA treatment is by open surgical or endovascular aneurysm repair. Rodent model and human epidemiology, and genetic and observational studies over the last few decades have highlighted the potential of a number of drug therapies, including medications that lower blood pressure, correct dyslipidaemia, or inhibit thrombosis, inflammation or matrix remodelling, as approaches to managing small AAA. This review summarizes prior AAA pathogenesis data from animal and human studies aimed at identifying targets for the development of drug therapies. The review also systematically assesses past randomized placebo-controlled drug trials in patients with small AAAs. Eleven previously published randomized-controlled clinical trials testing different drug therapies aimed at slowing AAA progression were identified. Five of the trials tested antibiotics and three trials assessed medications that lower blood pressure. Meta-analyses of these trials suggested that neither of these approaches limit AAA growth. Allocation to blood pressure-lowering medication was associated with a small reduction in AAA rupture or repair, compared to placebo (relative risk 0.94, 95% confidence intervals 0.89, 1.00, P = 0.047). Three further trials assessed the effect of a mast cell inhibitor, fibrate or platelet aggregation inhibition and reported no effect on AAA growth or clinical events. Past trials were noted to have a number of design issues, particularly small sample sizes and limited follow-up. Much larger trials are needed to properly test potential therapeutic approaches if a convincingly effective medical therapy for AAA is to be identified. [ABSTRACT FROM AUTHOR]

Introduction: Recently, the clinical significance of mild paravalvular aortic regurgitation (PAR) has been evaluated and suggested that it can be predictor of clinical outcomes. In our study, we aimed to investigate the interaction of aortic pulse wave velocity (PWV) and mild PAR and their effects on the functional status of patients after transcatheter aortic valve implantation (TAVI). Methods: A total of 109 consecutive patients with symptomatic severe aortic stenosis were enrolled prospectively. After TAVI procedure, they were divided in to three groups according to PAR and PWV measurements. Patients without PAR were defined as the NonePAR group (n=60), patients with mild PAR and normal PWV were defined as the MildPAR-nPWV group (n=23), and patients with mild PAR and high PWV were defined as the MildPAR-hPWV group (n=26). Results: Compared with other groups, the MildPAR-hPWV group was older (P<0.001), hypertensive (P=0.015), and had a higher pulse pressure (P=0.018). In addition to PWV, this group had lower aortic regurgitation index (ARI) (P=0.010) and higher rate of New York Heart Association (NYHA) class II (at least) patients (P<0.001) in 30-day follow-up period. On multivariate regression analysis, the MildPARhPWV group (odds ratio=1.364, 95% confidence interval 1.221-1.843; P=0.011) as well as N-terminal-pro-brain natriuretic peptide levels and ARI were independently related with 30-day functional NYHA classification. However, NonePAR or MildPAR-nPWV group was not an independent predictor of early functional status. Conclusion: It was concluded that high PWV may adversely affect early functional status in patients with mild PAR in contrast to normal values following TAVI. [ABSTRACT FROM AUTHOR]

Background Measuring transcranial motor evoked potentials (EPs) and somatosensory EPs is a well-established method to assess spinal cord function during thoracic endovascular aortic repair (TEVAR). Functional occlusion of one or both internal iliac arteries by large bore sheaths during TEVAR can cause unilateral intermittently EP loss. Methods Between 2006 and 2016, 194 patients underwent TEVAR entailing EP monitoring. The ISIS IOM System (Inomed Medizintechnik GmbH, Emmendingen, Germany) was employed in all patients. EPs were recorded after inducing anesthesia, during the procedure, and before discontinuing anesthesia. Results We observed a unilateral intermittently EP decrease or loss in 12 (6.2%) patients. Most events were ipsilateral (9 of 12). The underlying pathologies were descending aortic aneurysm in six patients and type B dissection in six patients. An evoked-potential decrease or loss was always associated with the insertion of large bore stent-graft-introducing sheaths. The median duration of the unilaterally EP decrease or loss was 16 (10; 31) minutes (range, 2–77 minutes) with baseline values re-established at the end of the procedure after sheath removal in all cases. No patient developed irreversible symptomatic spinal cord ischemia. Conclusion A functional occlusion of internal iliac arteries via large bore TEVAR-introducing sheaths is associated with a unilateral intermittent decrease in or loss of EPs returning to baseline after sheath removal. This observation highlights the importance of the internal iliac arteries as one of the major spinal cord's blood supply territories, and may serve as a stimulus to reduce the duration of sheath indwelling to a minimum. [ABSTRACT FROM AUTHOR]

Background: Experimental evidence indicates that oral L-citrulline (L-Cit) may reduce resting blood pressure (BP) as well as BP responses to exercise and cold exposure (non-resting). However, results from human intervention trials are inconsistent. This study aims to summarize the clinical evidence regarding the effects of L-Cit supplementation on brachial systolic blood pressure (SBP), brachial diastolic blood pressure (DBP), in addition to aortic SBP and aortic DBP at rest and non-resting conditions. Methods: Multiple databases including PubMed, Embase, Cochrane library, Web of Science, and Clinical Trials were searched systematically. Randomized controlled trials of human participants were quantitatively meta-analyzed. Results: Fourteen trials contained in eight studies were available for quantitative syntheses for brachial BP. Results showed that L-Cit supplementation significantly reduced both brachial SBP (− 4.490 mmHg, 95% CI: − 7.332 to − 1.648, P = 0.002) and brachial DBP (− 3.629 mmHg, 95% CI: − 5.825 to − 1.434, P = 0.001). Nine of the trials were meta-analyzed for aortic BP which showed that L-Cit intervention significantly reduced aortic SBP (− 6.763 mmHg, 95% CI: − 10.991 to − 2.534, P = 0.002), but not aortic DBP (− 3.396 mmHg, 95% CI: − 7.418 to 0.627, P = 0.098). The observed reducing effects of L-Cit appeared stronger for non-resting than for resting brachial SBP (P for difference = 0.044). Conclusion: L-Cit supplementation significantly decreased non-resting brachial and aortic SBP. Brachial DBP was significantly lowered by L-Cit regardless of resting status. Given the relatively small number of available trials in the stratified analyses and the potential limitations of these trials, the present findings should be interpreted cautiously and need to be confirmed in future well-designed trials with a larger sample size. [ABSTRACT FROM AUTHOR]

Aortic dissections and ruptures are life-threatening injuries that must be immediately treated. Our national radiology practice receives dozens of these cases each month, but no automated process is currently available to check for critical pathologies before the images are opened by a radiologist. In this project, we developed a convolutional neural network model trained on aortic dissection and rupture data to assess the likelihood of these pathologies being present in prospective patients. This aortic injury model was used for study prioritization over the course of 4 weeks and model results were compared with clinicians' reports to determine accuracy metrics. The model obtained a sensitivity and specificity of 87.8% and 96.0% for aortic dissection and 100% and 96.0% for aortic rupture. We observed a median reduction of 395 s in the time between study intake and radiologist review for studies that were prioritized by this model. False-positive and false-negative data were also collected for retraining to provide further improvements in subsequent versions of the model. The methodology described here can be applied to a number of modalities and pathologies moving forward. [ABSTRACT FROM AUTHOR]

Introduction: Cor-Knot automated fastener has been used as an adjunct in heart valve surgery to eliminate the need for manual tying during valve implantation. Although reduced operative time and facilitation for minimally invasive surgery are clear benefits, whether their use translates to improved patient outcome remains debatable. This study aims to review the safety and efficacy of automated fasteners in heart valve surgeries.Method: Specific searches were conducted via online medical databases (Pubmed, Embase, Ovid) between 1950 and June 2019. Longitudinal studies were included that provided operative parameters.Results: The initial literature search identified 3773 articles, but only eight met the inclusion criteria and were used for analysis: four studies related to aortic valve replacement (AVR), four related to mitral valve (MV) intervention (total n = 810). The meta-analysis revealed the significantly shorter aortic cross-clamp time in the Cor-knot group compared to manual tying, both in AVR and MV surgeries (P < .05). Cardiopulmonary bypass time was significantly shorter in the Cor-knot group when analyzing studies in MV surgery (weighted mean difference [WMD]: 110.0; 95% confidence interval: 12.3-207.7; P = .027) The use of Cor-Knot did not increase the risk of permanent pacemaker implantation, paravalvular leak, and 30-day mortality. The majority of studies reported no change in the length of intensive unit care and total hospital stay.Conclusion: We confirmed that the majority of existing literatures indicated the safety and intraoperative efficacy with automated fastener application. Nevertheless, there is currently no evidence to support automated fastened sutures can translate its intraoperative advantages to improved patient outcome. [ABSTRACT FROM AUTHOR]

This article discusses the need for standardization of nomenclature when measuring and reporting ascending aortic morphology. The current international guidelines only consider ascending aortic diameter as a risk factor for type A aortic dissection. The authors analyze previous publications on the bending of blood around a curved aorta, but note that different measurements and nomenclatures are used, and there is a lack of cross-referencing. They also mention the importance of considering confounding factors and suggest that the International Registry of Aortic Disease should start recording aortic curvature variables in addition to diameter. [Extracted from the article]

Introduction: Abdominal endovascular aneurysm repair is a minimally invasive alternative to major open surgery for the repair of abdominal aortic aneurysms that results in reduced recovery times and early survival rates. Methods: The TriVascular Ovation® Abdominal Stent Graft System is a low-profile endovascular device with active fixation used for endovascular aneurysm repair. The stent graft is designed to reline the diseased vasculature, providing an endovascular blood conduit for isolating the aneurysm from the high-pressure flow of blood, thereby reducing the risk of rupture. The stent graft is a modular configuration comprised of an aortic body section, iliac limbs, and iliac extensions as required. Results and Conclusion: We present a case of symptomatic aortic body graft stenosis in the unsupported segment below the O-rings, 26 months after the treatment of abdominal aortic aneurysm with Ovation® Abdominal Stent Graft System. The successful repair was performed by ballooning the stenotic area which resulted in complete resolution of the symptoms. [ABSTRACT FROM AUTHOR]