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This article discusses the incidence and mortality rates of malperfusion syndrome in patients with acute Type A aortic dissection after surgical repair. The study, conducted across 18 European centers, included 3,902 patients. It found that 45.62% of patients presented with signs of preoperative malperfusion, with the most common type being cerebral malperfusion. The study also showed that rates of in-hospital mortality increased with the severity of malperfusion. The authors conclude that different levels of the Penn classification can be used as valid predictors of mortality. [Extracted from the article]

This article examines the outcomes of patients with acute type A aortic dissection (ATAD) who underwent surgery after receiving preoperative cardiopulmonary resuscitation (CPR). The study analyzed data from the European registry of type A aortic dissection (ERTAAD) and included 2,266 ATAD patients from 19 European centers. The results showed that patients who required CPR before surgery had higher rates of postoperative complications, including stroke, heart failure, and the need for dialysis. They also had a higher 30-day mortality rate. However, when additional risk factors such as low ejection fraction, advanced age, and myocardial ischemia were present, the analysis did not indicate a significant increase in mortality, suggesting that surgery may still be a viable option for these patients. [Extracted from the article]

This article discusses the potential of long noncoding RNAs (lncRNAs) in understanding thoracic aortic diseases. The researchers identified two lncRNAs, TMEM72-AS1 and LINC00632, that are expressed in vascular smooth muscle cells and differ between dilated and non-dilated areas of the aorta. The expression of these lncRNAs was significantly higher in dilated areas, particularly in tissues from patients with bicuspid aortic valve (BAV) and aortic regurgitation (AI). The findings suggest that these lncRNAs could be potential targets for diagnostic and therapeutic interventions in thoracic aortic diseases. [Extracted from the article]

Background: To avoid extended cardiopulmonary bypass (CPB), moderate temperatures are commonly accepted for hypothermic circulatory arrest (HCA), thereby jeopardizing organ protection. Distal aortic perfusion may be an option, but supportive experimental data is missing. Methods: Eight juvenile pigs (36 ± 2 kg) were cooled to 30°C followed by 60min of HCA with 50 min of lowflow(LF) lower bodyperfusion. Multimodal monitoring was used to measure overall metabolism, hemodynamics andmicrocirculation of the terminal ileum. The animals were observed for four hours following reperfusion. Organs were harvested for histopathological evaluation. Results: During LF perfusion, initially elevated llactate levels decreased subsequently (p < 0.05). Capillary blood flow decreased during cooling to 50% baseline levels (p = 0.03), but remained stable under LF conditions. Parameters indicative of reduced liver and kidney function were slightly elevated at the end of the experiment, but still within normal ranges. Conclusion: Under moderate hypothermia, low flow perfusion seems to provide adequate protection for the lower body organs. Microcirculatory parameters during perfusion as well as lactate levels within normal ranges throughout the experiments further confirm the concept. [ABSTRACT FROM AUTHOR]

Abstract Background To evaluate the impact and safety of different surgical techniques for aortic root replacement (ARR) on early and late morbidity and mortality in septuagenarians undergoing ARR. Methods Ninety-five patients (73.8 ± 3.2 years) were operated and divided into three groups according to the aortic root procedure; MECH-group (n = 51) patients with a mechanical composite graft, BIO-group (n = 22) patients with a customized biological composite graft, and REIMPL-group (n = 22) patients with a valve sparing aortic root reimplantation (David I). In 42.1% (40/95) of these patients the aortic arch was replaced. Follow-up was completed in 95.2% (79/83) of in-hospital survivors. Results Hospital mortality was 12.6% (12/95) in the entire population (MECH. 15.7% (8/51), BIO 19.7% (4/22), REIMPL 0% (0/22); p = 0.004). Two patients died intraoperatively. The most frequent postoperative complications were prolonged mechanical ventilation ((>48 h) in 16.8% (16/93) (MECH. 7% (7/51), BIO 36.4% (8/22), REIMPL 4.5% (1/22); p = 0.013) and rethoracotomy for postoperative bleeding in 12.6% (12/95) (MECH. 12% (6/51), BIO 22.7% (5/22), REIMPL 4.5% (1/22); p = 0.19). Nineteen late deaths (22.9%) (19/83) (MECH 34.8% (15/43), BIO 16.7% (3/18), REIMPL 4.5% (1/22); p = 0.012) occurred during a mean follow-up of 41 ± 42 months (MECH 48 ± 48 months, BIO 25 ± 37 months, REIMPL 40 ± 28 months, p = 0.028). Postoperative NYHA class decreased significantly (p = 0.017) and performance status (p = 0.027) increased for the entire group compared to preoperative values. Conclusion Our data indicate that valve sparing aortic root reimplantation is safe and effective in septuagenarians, and is associated with low early and late morbidity and mortality.