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To retrospectively evaluate early and mid-term results of thoracic endovascular repair (TEVAR) of type B aortic dissection by the second generation of stent graft.From January 2009 to January 2013, 383 acute, 43 sub-acute and 152 chronic patients with type B aortic dissection underwent TEVAR in our aortic center. The mean follow-up period was (27 ± 14) months. All clinical data were analyzed with SPSS 17.0.The 30-day mortality and morbidity were 0.35% and 1.2% respectively. The mid-term mortality and morbidity were 0.35% and 5.5%. Serious complications included retrograde type A dissection (n = 3), new tear at the distal end of stent (n = 26), endoleak (n = 3) and paraplegia (n = 0). The retreatment rate was 5.2% ( 6 patients were transformed to open operation and 24 patients underwent re-intervention).The early and mid-term results of thoracic endovascular repair (TEVAR) of type B aortic dissection by the second generation of stent graft showed lower mortality, no paraplegia and significant reduced endoleaks in comparison with the first generation stent graft. The new distal tear caused by the stent graft became the major complication. The design of the stent graft still need improvement.

Acute type A aortic dissection (AAAD) remains one of the most lethal conditions requiring surgical repair, and is associated with a high rate of postoperative mortality and morbidity. Despite the satisfactory clinical outcomes achieved with the frozen elephant trunk technique so far, controversies still exist regarding the use of this aggressive approach in patients with AAAD. In this study, we seek to analyze the early outcomes of the Sun's procedure, which is an approach integrating total arch replacement using a 4-branched graft with implantation of a special stented graft in the descending aorta, and identify the risk factors for postoperative mortality and morbidity of the Sun's procedure in patients with AAAD.Clinical data of 398 consecutive AAAD patients undergoing the Sun's procedure were analyzed. The associations between 20 preoperative and intraoperative variables and early mortality were assessed by univariate and multivariate analysis.Early mortality occurred in 31 patients (7.8%, 31/398), with leading causes including multi-organ failure in 16 patients (51.6%), permanent neurologic deficit in 6 (19.4%), and low cardiac output syndrome in 4 (12.9%). Permanent neurologic deficit and spinal cord injury occurred, each in 10 patients (2.5%, 10/398). Five significant risk factors for early mortality were identified with multivariate analysis: preexisting cerebrovascular disease [relative risk (RR) 14.76; P0.001], acute heart failure (RR 18.18; P=0.001), spinal cord malperfusion (RR 60.13; P0.002), visceral malperfusion (RR 30.25; P0.001) and cardiopulmonary bypass time190 minutes (RR 3.62; P=0.007).The Sun's procedure has generated a relatively lower mortality rate in 398 patients with AAAD. Patients with preexisting cerebrovascular disease, acute heart failure, spinal cord malperfusion, visceral malperfusion and long cardiopulmonary bypass time are at a higher risk of early mortality.

The Sun's procedure is a surgical technique proposed by Dr. Li-Zhong Sun in 2002 that integrates total aortic arch replacement using a tetrafurcated graft with implantation of a specially designed frozen elephant trunk (Cronus(®)) in the descending aorta. It is used as a treatment option for extensive aortic dissections or aneurysms involving the ascending aorta, aortic arch and the descending aorta. The technical essentials of Sun's procedure include implantation of the special open stented graft into the descending aorta, total arch replacement with a 4-branched vascular graft, right axillary artery cannulation, selective antegrade cerebral perfusion for brain protection, moderate hypothermic circulatory arrest at 25 °C, a special anastomotic sequence for aortic reconstruction (i.e., proximal descending aorta → left carotid artery → ascending aorta → left subclavian artery → innominate artery), and early rewarming and reperfusion after distal anastomosis to minimize cerebral and cardiac ischemia. The core advantage of Sun's procedure lies in the use of a unique stented graft, which has superior technical simplicity, flexibility, inherent mechanical durability and an extra centimeter of attached regular vascular graft at both ends. Since its introduction in 2003, the Sun's procedure has produced satisfactory early and long-term results in over 8,000 patients in China and more than 200 patients in South American countries. In a series of 1,092 patients, the authors have achieved an in-hospital mortality rate of 6.27% (7.98% in emergent or urgent vs. 3.98% in elective cases). Given the accumulating clinical experience and the consequent, continual evolution of surgical indications, the Sun's procedure is becoming increasingly applied/used worldwide as an innovative and imaginative enhancement of surgical options for the dissected (or aneurysmal) ascending aorta, aortic arch and proximal descending aorta, and may become the next standard treatment for type A aortic dissections requiring repair of the aortic arch.

Aortic root aneurysms combined with lesions of the mitral valve requires synchronous operations. The conventional approach is to treat the two lesions through separate aortic and atrial incisions.From May 2009 to August 2012, 28 transaortic mitral valve operations were performed. There were 23 males and five females, the age ranged from 18 to 75 years, mean 41 ± 16 years. The operative procedures included Bentall+MVR in 20 patients, Bentall+MVP in three patients, Bentall+total arch replacement+stent elephant trunk+MVP in one patient, Bentall+total arch replacement+stent elephant trunk+MVR in two patients, Bentall+MVP+CABG in two patients. Follow-up was completed for all patients, with a mean follow-up period of 22 ± 10 months and a maximum of 42 months.Transaortic mitral valve surgery was successful for all patients. There was a reoperation in two patients for bleeding. In the MVP group, there was mild regurgitation in two cases before discharge, without further development during the follow-up. In the MVR group, there was paravalvular leakage in one patient three months later, which required repair. There were no deaths in the hospital and the follow-up period, and no valve-associated complication during the follow-up period. The heart function of all patients during the follow-up period was Level I-II (NYHA).Transaortic mitral valve operation is a feasible surgical approach to treat patients with aortic root aneurysms combined with mitral valve lesions.

In view of waiting in line, cumbersome procedure problems existed in the new student register system, the article introduced one of the most advanced six sigma DMAIC models. Through the questionnaire survey and positive Likert scales weighted evaluation method to find out the impact of the main factors and new report quality, presents the improved method. The successful application of the DMAIC model is good for the effective implementation in our universities and further enhance the management level and competitiveness of the colleges and universities. DMAIC model may be extended to railway ticketing system, bank, supermarket and so on.

This case report describes a woman at 35 weeks gestation, who presented with an acute type A aortic dissection involving the total aortic arch and descending aorta. She underwent a successful ascending aorta replacement, total arch replacement, and stented elephant trunk implantation at the time of cesarean section with favorable maternal and fetal outcomes. (J Card Surg 2012;27:728-730)

To demonstrate an effective operation of extra-anatomic bypass for complex aortic coarctation in adults.Between July 1997 and October 2010, 51 patients underwent extra-anatomic aortic bypass. There were 39 male and 12 female patients. Mean age was (40 ± 14) years (ranging from 18 to 63 years). Operative technique of extra-anatomic bypass consisted of performing an ascending-to-descending or abdominal or femoral aorta bypass (8, 39 and 4 patients). Concomitant procedures were performed in 38 patients: 10 isolated aortic valve replacements (AVR), 11 aortic root replacements (Bentall), 4 ascending aorta replacements including 3 concomitant AVR, 5 mitral valve replacements including 3 concomitant AVR, 4 ventricular septal defect correcting with AVR, and 4 coronary artery bypass graft.Mean follow-up time was (30 ± 9) months (ranging from 5 to 60 months). Two patients were reoperated for hemorrhage in descending aorta anastomosis, one of whom was dead of multiple organ failure in perioperative period. Upper-extremity blood pressure after coarctation correction with extra-anatomic aortic bypass was significantly improved (10 mmHg, 1 mmHg = 0.133 kPa). Arterial hypertension was well improved, except 10 patients controlled with less drug therapy. All grafts were patent without obstruction or pseudoaneurysm formation in the follow-up period evaluated by vascular ultrasound and computed tomographic angiogram.Extra-anatomic aortic bypass is a safe and effective option for complex aortic coarctation in adults.

Background— Appropriate surgical management of type A dissection is a critical factor for achieving satisfactory outcome, but the choice of optimal procedure is controversial. We retrospectively reviewed our experience with aortic arch replacement for type A dissection involving the arch. Methods and Results— Excluding 14 cases of subtotal or total aortic replacement, 411 of 544 patients with type A dissection (stented elephant trunk=291, conventional surgical repair=120) underwent aortic arch replacement between January 2003 and September 2008. In-hospital mortality was 3.09% (9 of 291) for stented (acute=4.73%, 7 of 148; chronic=1.40%, 2 of 143) and 5.00% (6 of 120) for conventional repairs (acute=6.06%, 4 of 66; chronic=3.70%, 2 of 54). Spinal cord injury was 2.41% (7 of 291) in the stented and 0.83% (1 of 120) in the conventional group. The overall prevalence of stroke was 1.95% (8 of 411) (stented=2.41%, 7 of 291; conventional=0.83, 1 of 120). Secondary intervention was 2.34% (5 of 214) for acute dissection (stented=1 and conventional=4; P =0.031) and 3.05% (6 of 197) for chronic dissection (stented=4 and conventional=2; P =0.661) during follow-up. Obliteration of the false lumen around the stented elephant trunk occurred in 94.2% (130 of 138) of patients with acute dissection and in 92.0% (126 of 137) of patients with chronic dissection. Conclusions— Total arch replacement combined with stented elephant trunk implantation demonstrated the superiority of the combination of the surgical and interventional approaches while avoiding the weaknesses associated with the individual methods. The encouraging surgical results could enable this procedure to become the new “standard” therapy for type A dissection involving repair of the aortic arch.

We get a new proof of a sextuple product identity depending on the Laurent expansion of an analytic function in an annulus. Many identities, including an identity for(q;q)∞4, are obtained from this sextuple product identity.

Intercostal artery aneurysms associated with coarctation of aorta (CoA) are rare and their natural histories are poorly understood. This report describes the surgical correction of this anomaly in an adult without performing extracorporeal circulation. The coarctated segment of aorta and intercostal artery aneurysm were resected, and the continuity of the descending aorta was reestablished with an interposed vascular graft.

To assess the outcome of stented elephant trunk surgery for chronic DebakeyIaortic dissection in Marfan syndrome and hypertension patients by CT.Between 2003 and 2008, 54 patients underwent the modified stented elephant trunk procedure and total arch replacement for chronic DebakeyIaortic dissection. Twenty-two patients were made a diagnosis of Marfan syndrome and the other 32 patients of hypertension. Aortic evolvement was evaluated with CT angiography by calculating the diameter ratios between the stent graft/true lumen and the aorta at the same level.CT study one year after discharge showed no difference in the diameter ratios of the stent and aorta at the carina level between groups (0.84 +/- 0.16 vs 0.80 +/- 0.23, P = 0.472), but had significant difference before and after surgery (0.29 +/- 0.16 vs 0.72 +/- 0.21, Por = 0.001). And significant difference occurred at the different periods after discharge (0.72 +/- 0.21 vs 0.81 +/- 0.20, 0.81 +/- 0.20 vs 0.77 +/- 0.20, Por = 0.001). The residual false lumen in the proximal descending aorta reached complete thrombosis in 59% of Marfan and 78% of hypertension.The modified stented elephant trunk technique is effective for closing the false lumen in the proximal descending aorta of chronic DebakeyIaortic dissection in Marfan syndrome and hypertension patients.

To explore the experiences of aortic valve preservation and root reconstruction in patients with Marfan syndrome.From July 2003 to Dec 2007, 22 patients with Marfan syndrome were treated by aortic valve preservation and root reconstruction. There were 12 male and 10 female, the age ranged from 10 to 57 years old with a mean of (28 +/- 10) years. The operation procedures included reimplantation technique in 9 patients, remodeling technique in 8 patients, and patch technique in 2 patients. In addition, reimplantation technique + total aorta replacement in 1 patient, remodeling technique + "aortic arch replacement + stent-elephant trunk" in 1 patient, patch technique + "aortic arch replacement + stent-elephant trunk" in 1 patient. The patients were followed-up by 17 to 64 months with a mean of (46 +/- 16) months.No in-hospital and follow-up period death occurred. There was one reexploration for bleeding 1 d postoperative. No valve-related complication occurred during the follow-up. At the end of follow-up, no aortic regurgitation was demonstrate in 16 patients, but mild regurgitation in 4 patients, moderate regurgitation in 1 patient and severe regurgitation in 1 patient. Two patients with moderate and severe aortic regurgitation need reoperation 1 year postoperative.The early and mid-term results of aortic valve preservation and root reconstruction operations in Marfan syndrome were favorable.

To summarize the experience of the application of stented elephant trunk procedure in the treatment of the patients with complicated Stanford type B aortic Dissection.Between January 2004 and March 2009, 33 patients (27 male and 6 female) underwent stented elephant trunk implantation in the descending aorta for complicated type B dissection. Right auxiliary artery cannulation was routinely used for cardiopulmonary bypass and selected cerebral perfusion. The stented elephant trunk was implanted through the aortic arch under hypothermic circulatory arrest. Complications were recorded to evaluate the immediate and mid-term results.Cardiopulmonary bypass time was 174 +/- 29 min, and average selective cerebral perfusion and lower body arrest time was 24 +/- 9 min. The in-hospital mortality was 6.0% (2/33). No paraplegia was observed after surgery. During follow-up CT-scans thrombus formation was observed within the descending aortic false lumen excluded by the stented graft in the acute and chronic aortic dissections. There was one death during follow-up.The stented elephant trunk procedure could be an effective treatment for complicated type B dissection; it also could close the false lumen of the descending aorta and in preventing expansion of the descending aorta.

Objective: The objective is to present a method for maintaining the spinal cord blood supply and our midterm results for using a tetrafurcate graft in extensive thoracoabdominal aortic aneurysm (TAAA) repair.Methods: From August 2003 to October 2007, we used a tetrafurcate graft to perform repairs to TAAAs of Crawford extent II in 63 consecutive patients. The mean age of this group of patients was 39.98 10.62 years, and 46 (73%) of them were male. All of the procedures were performed under profound hypothermia with a short interval of circulatory arrest. T6 to T12 intercostal arteries were reconstructed as a "neo-intercostal artery" (N-IA) and were connected to an 8-mm sidearm of the graft to maintain the spinal cord blood supply. Visceral arteries were joined into a patch and were anastomosed to the end of the main graft. The left renal artery was anastomosed to an 8-mm sidearm or joined to the patch. The other 10-mm sidearms were anastomosed to iliac arteries.Results: With 100% follow-up, the early-mortality rate was 7.94%. The incidence of cerebral complications was 9.52%. Temporary paraplegia was observed in 2 patients, and paraparesis occurred in 1 patient. Pulmonary complication was the most common morbidity in this group (25.40%). Two patients with Marfan syndrome had N-IA artery pseudoaneurysms during follow-up. The mean survival time of this group was 50.64 2.13 months, with survival rates of 92.06% after 1 year, 88.38% after 2 years, and 86.11% after 3 years.Conclusion: The N-IA may play an important role in spinal cord protection, and N-IA pseudoaneurysm should be avoided in Marfan syndrome patients. The use of a tetrafurcate graft is a reliable method for TAAA repair, with satisfactory midterm results.

This cross-sectional, retrospective study was designed to evaluate the current clinical applications and acute hepatotoxicity of intravenous amiodarone administration at a hospital in China. Clinical data were collected from 1214 patients receiving intravenous amiodarone treatment between October 2003 and September 2005. Baseline patient characteristics, drug indications, administration records and acute hepatotoxicity associated with the drug were examined. Amiodarone was used primarily in arrhythmic patients with obvious cardiac dysfunction. Atrial fibrillation and ventricular arrhythmia were the two most commonly treated dysfunctions. Incorrect indications and administration methods were also noted. Hepatotoxicity occurred in 12.6% of the patients, but was mild in most cases. Males showed a higher incidence of hepatotoxicity than females. The use of amiodarone was considered to be reasonable and standardized, but there was still considerable room for improvement, particularly in the standardization of administration guidelines. Intravenous amiodarone can cause hepatotoxicity and hepatic function tests should be performed soon after giving amiodarone intravenously.

To summarize the experience of one-stage total and subtotal aortic replacement for aneurysm evolving the entire aorta and show the midterm results of the operation.From February 2004 to July 2008, 22 patients (17 men and 5 women, age ranged from 19 to 47 years old) underwent one-stage total or subtotal aortic replacement under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion. Seven patients received subtotal aortic replacement (from the aortic valve to the abdominal aorta). Fifteen patients underwent total aortic replacement (from the aortic valve to the aortic bifurcation). Patients were opened with a mid-sternotomy and a thoracoabdominal incision. First, the ascending aorta was replaced; following which the aortic arch was reconstructed. Finally, the thoracoabdominal aorta was fully replaced.Thirty-day mortality was 4.5% (1/22). One patient died of multiple organ failure 11 days postoperatively. Two patients had cerebral infarction secondary to embolism. Spinal neurological deficits didn't occur. Twenty-one patients survived the operation and were followed up for 3 to 56 months (35.0 +/- 16.9 months). There was no late death. One patient received aortic valve replacement due to aortic valve regurgitation one year after David and total aortic replacement.One-stage total and subtotal aortic replacement is an effective operation for aneurysm evolving the whole length of the aorta with acceptable mortality and morbidity. Midterm follow-up showed satisfactory results.

Background A conventional single-stage procedure, staged procedures, or debranching of the supraaortic vessels, followed by immediate transfemoral stenting of the aortic arch, have been introduced to treat chronic type B dissection with aortic arch involvement. The best method for surgical repair of chronic type B dissection with aortic arch involvement alone or concomitant with proximal aortic lesions is not known. Methods Between October 2003 and December 2008, 19 patients underwent total arch replacement combined with stented elephant trunk implantation under hypothermic cardiopulmonary bypass and selective cerebral perfusion through a median sternotomy. Thirteen patients had proximal aortic lesions. Postoperative computed tomography was used to evaluate thrombosis and absorption of the false lumen. Results Concomitant proximal aortic lesions were repaired in all patients. Thirty-day mortality was 5.26% (1/19). There was one late death at a mean follow-up of 36 ± 12 months. There was no spinal cord injury or visceral malperfusion. One patient with Marfan syndrome with chronic dissection underwent thoracoabdominal aortic replacement 6 months later. Obliteration of the false lumen around the stented elephant trunk was observed in 16 patients (94.1%, 16/17) during follow-up. Conclusions This technique is safe, effective, and economical. Replacement of aortic arch dissection and thrombosis of the dissected descending aorta was achieved simultaneously. Concomitant proximal aortic lesions were repaired. Favorable surgical outcomes and postoperative results using this technique were obtained in patients with chronic type B dissection with aortic arch involvement alone or concomitant with proximal aortic lesions.

Objectives: The treatment of Stanford type B aortic dissections involving the arch or associated with proximal aortic aneurysms remains a surgical challenge. We report our results with total arch replacement with the stented elephant trunk (SET) procedure for these complicated Stanford type B aortic dissections. Methods: Between December 2003 and June 2008, 31 patients were admitted for complicated type B dissection (12 acute, 19 chronic). The mean age at operation was 44.3 ± 10.6 years (range: 22-68 years). The surgeries were performed by using total arch replacement combined with SET implantation. Enhanced computed tomography (CT) was performed before discharge as well as 3 months and annually to evaluate the condition of the graft and the residual false lumen. Results: The procedure was successful in all but two patients; two patients died of multiple organ failure following surgery. No paraplegia was observed after surgery. Follow-up was completed in 27 of 29 patients and the mean follow-up period was 18.4 ± 12.3 months (range: 6-54 months). During follow-up CT scans, thrombus formation was observed in the descending aortic false lumen excluded by the stented graft in most patients. One patient died during follow-up while two patients with Marfan syndrome underwent successful operations for replacement of the remaining descending and abdominal aorta. Conclusion: Total arch replacement with the SET procedure has emerged as a viable option for complicated type B dissections and is associated with low morbidity and mortality. At mid-term follow-up, most patients have either thrombosed or have had no further increase in the false lumen of the descending aorta.

Objective In patients with acute type A dissection, it is controversial whether to use a more aggressive strategy with extended aortic replacement to improve long-term outcome or to use a conventional strategy with limited ascending aortic or hemiarch replacement to circumvent a life-threatening situation. Methods Between April 2003 and June 2007, 107 patients (17 women, 90 men; mean age, 45 ± 11 years; range, 17–78 years) with acute type A dissection underwent total arch replacement combined with stented elephant trunk implantation under hypothermic cardiopulmonary bypass and selective cerebral perfusion. Computed tomography was performed to evaluate the residual false lumen in the descending aorta during follow-up. Results Thirty-day mortality was 3.74% (4/107 patients), and in-hospital mortality was 4.67% (5/107 patients). Spinal cord injury was observed in 3 patients (1 patient with left lower-extremity paraparesis and 2 patients with paraplegia). Cerebral infarction was observed in 3 patients, ventilator support exceeding 5 days was required in 9 patients, and rebleeding was observed in 4 patients. During a mean follow-up of 35 ± 14 months, 3 patients died and 3 patients were lost to follow-up. On postoperative computed tomography, complete thrombus formation was observed around the stented elephant trunk in 95% of patients (95/100) and at the diaphragmatic level in 69% of patients (69/100). Conclusion Low morbidity and mortality were achieved using total arch replacement combined with stented elephant trunk implantation. These encouraging surgical results and postoperative outcomes favor this more aggressive procedure for acute type A dissection.

Objective Surgical treatment of chronic Stanford type A aortic dissection using total arch replacement combined with stented elephant trunk implantation is controversial owing to the visceral arteries and intercostal arteries originating from the false lumen. Methods Eighty-nine patients (mean age, 45.67 ± 10.18 years; range, 21–68 years) with chronic type A dissection underwent total arch replacement combined with stented elephant trunk implantation between April 2003 and March 2007. Careful assessment of the visceral arteries and location of entry and re-entry was done before surgery. Postoperative patency of the visceral arteries and diameter of the aortic artery and the residual false lumen were evaluated by computed tomography. Results One (1.12%) hospital death and 2 (2.25%) late deaths occurred at a mean follow-up of 28.5 months (range, 8–52 months). Visceral malperfusion was not observed. Two patients had spinal cord injury and recovered during follow-up. One patient had a transient neurologic deficit and recovered completely before discharge. One patient underwent thoracoabdominal aortic replacement for aneurysmal dilatation of the residual descending aorta 3 months after the operation. Thrombus obliteration of the false lumen at the distal edge of the stented elephant trunk and at the diaphragmatic level was 94.2% (81/86) and 61.6% (53/86), respectively. Conclusions Satisfactory results with low morbidity and mortality were obtained. No visceral malperfusion and a low risk of postoperative spinal cord injury favor this technique in patients with chronic type A dissection.

Ciliary neurotrophic factor (CNTF) can lead to weight loss by up-regulating energy metabolism and the expression of UCP-1 in mitochondria. To investigate the up-stream regulators of the expression of UCP-1, recombinant human CNTF (rhCNTF) (0.1, 0.3, 0.9 mg/kg/day s.c.) administered to KK-Ay mice for 30 days resulting in reductions in body weight and perirenal fat mass. In brown adipose tissues, the gene expressions of nuclear respiratory factor (NRF)-1, mitochondrial transcription factor A (TFam) and uncoupling protein (UCP)-1 were found up-regulated by rhCNTF. To the best of our knowledge, these effects represent new insights on the mechanisms of action of weight loss by rhCNTF. In addition, we also found that rhCNTF increased the activity of mitochondrial complex IV. The stimulation of NRF-1, TFam, UCP-1 and the enhanced activity of mitochondrial complex IV may be associated with remedying obesity. The result indicates that rhCNTF can enhance the expressions of NRF-1 and TFam, both of which can up-regulate the expression of UCP-1.

To investigate the association of matrix metalloproteinase 9 (MMP-9) gene -1562C/T polymorphism with the pathogenesis and site involved range of aortic dissection in Chinese population.142 hypertensive patients with aortic dissection and 130 hypertensive patients without aortic dissection were enrolled. Genomic DNAs were extracted from peripheral blood leucocytes. MMP-9 gene -1562C/T polymorphism was determined with PCR-RFLP. MMP-9 gene -1562C/T genotype and allele frequency were compared between hypertensive patients with aortic dissection and without. In addition, associations of MMP-9 gene -1562C/T polymorphism with clinical aspects were analyzed in hypertensive patients with aortic dissection.There was a significant difference in the T allele frequency of the C-1562T MMP-9 polymorphism between the two groups, with more T allele (17.6%) observed in hypertensive patients with aortic dissection as compared with these without (11.2%) (P = 0.033). The genotype distribution for the MMP-9 -1562C/T polymorphism in hypertensive patients with aortic dissection (-1562CC: 69.0%; -1562 CT: 26.8%; -1562TT: 4.2%) and those without (-1562CC: 79.2%; -1562CT: 19.2%; -1562TT: 1.6%; P = 0.118) showed no remarkable difference, but hypertensive patients with aortic dissection possessing T allele showed a higher odds ratio for involving ascending aorta (OR = 2.063, 95% CI = 0.998 - 4.264, P = 0.049) as compared with those without T allele.The T variant of MMP-9 gene -1562C/T polymorphism was significantly associated with aortic dissection in hypertensive patients and may represent an important genetic component contributing to aortic dissection susceptibility. Furthermore, hypertensive patients with aortic dissection possessing MMP-9 gene -1562T allele are more prone to involvement of ascending aorta.

To summarize the experience in one-stage total thoracoabdominal aorta replacement with four branch vessel prosthesis under deep hypothermic cardiopulmonary bypass and subsection circulatory arrest.From August 2003 to May 2005 38 patients with thoracoabdominal aortic disease, including severe extensive thoracoabdominal aorta of Crawford II type (n = 4), chronic Stanford type B dissecting aneurysm (n = 24), chronic Stanford type A dissecting aneurysm (n = 5), and Marfan's syndrome with chronic Stanford type B dissecting aneurysm (n = 5), 25 males and 13 females, aged 40 +/- 9 (22-58), underwent one-stage total thoracoabdominal aorta replacement with four branch vessel prosthesis under deep hypothermic cardiopulmonary bypass and subsection circulatory arrest.Two patients died during the early post-operational period with a mortality of 5.26%. Four patients showed cerebral complications with an incidence of 10.5% and were cured after hydration therapy. Acute kidney dysfunction occurred in 2 patients and was cured by hemodialysis.With simplified operational procedure, one-stage total thoracoabdominal aorta replacement with four branch vessel prosthesis under deep hypothermic cardiopulmonary bypass and subsection circulatory arrest significantly shortens the ischemic time of brain, spinal cord, and other major organs and has an excellent effect.

To summarized the experience of simultaneous aortic operation and coronary artery bypass.Between November 1997 and September 2004, thirty-six patients who underwent combined aortic operation and coronary artery bypass graft (CABG) were reviewed with a mean age of (57 +/- 12) years (range 31 to 75). Nineteen patients were suffered from aortic dissection. There were 17 patients of aortic aneurysm, 5 aortic root aneurysm, 5 ascending aortic aneurysm, 4 aortic arch aneurysm, 3 abdominal aneurysm. Preoperational coronary angiography was performed in 1 of 10 acute type A dissection patients. The coronary arteries were involved by dissection in 7 acute type A dissection patients. The artherosclerosis of coronary artery was found during operation in 2 patients. Among 7 patients with chronic type A aortic dissection, coronary angiography was performed in 2, coronary artery was involved by dissection in 2 and coronary arterosclaerosis was founded in 3. There were 2 patients with acute or chronic type B aortic dissection. The stenosis of coronary artery was confirmed by preoperative angiography in the patients with aortic aneurysm. There were 57 coronary bypass grafts, 6 of them were artery grafts, and others were venous grafts.The mean cardiopulmonary bypass time was (157 +/- 54) min, and the mean aortic cross clamp time was (98 +/- 31) min. Five patients with type A aortic dissection died postoperatively, 3 from heart failure leading to multi organ system failure, 1 from cerebral hernia and one from ischemia of intestinal tract. Postoperative complication included reoperation for hemorrhage in 1 patient, respiratory failure in 1 patient.Type A aortic dissection with coronary involvement or arterosclaerosis is associated with high mortality rate. Coronary artery angiography should be performed in the elder than 50 years patient with aortic aneurysm. Combined aortic aneurysm operation and CABG is a safe procedure.

To review the results of the valve-sparing operation (David procedure) in patients with aortic root disease.Twenty-nine patients with aortic root disease, 20 males and 9 females, aged 39 +/- 17 (10-64), 10 being of heart functional class I, 15 of class II, and 4 of class III, and 15 with gentle, 9 with moderate, and 5 with severe aortic insufficiency underwent David procedure, one undergoing the aortic valve-sparing reimplantation (David I), 25 undergoing aortic valve-sparing remodeling (David II), and 3 undergoing a new modified aortic valve-sparing operation. After the operation the patients were followed up for 29 +/- 15 months (5-74 months).No intra-operative death was found. The mean extracorporeal circulation time was 126 min +/- 25 min, and the aortic crossclamp time was 87 min +/- 22 min. All patients recovered to heart functional class I. Post-operatively 11 patients showed no normal, eight gently and two moderate aortic regurgitation.The valve-sparing operation is an ideal operation to the aortic root aneurysm with more or less normal aortic leaflets and valvular ring normal.

To summarize the experience of the application of total and subtotal aortic replacement on the one stage in the treatment of the patients with extensive aortic aneurysm and chronic Stanford type A dissecting aneurysm.From February to November 2004, 8 patients (7 male and 1 female; ranging from 23 to 47 years old) underwent one-stage total or subtotal aortic replacement under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion. Two patients received subtotal aortic replacement (from the aortic valve to the abdominal aorta). Six patients underwent total aortic replacement (from the aortic valve to the aortic bifurcation), of which 3 patients had aortic valve replacement. Patients were with mid-sternotomy and thoracoabdominal incision. The ascending aorta was firstly replaced, following which the aortic arch was reconstructed. Finally, the thoracoabdominal aorta was fully replaced.There was no operative or early postoperative death. One patient had cerebral infarction secondary to embolism. Spinal neurological deficits didn't occur. All 8 patients were alive and had good functional status 2 to 12 months after operation.The patients performed with one-stage total and subtotal aortic replacement achieves good results. It can eliminate the risk of remnant aneurysm rupture in staged total aortic replacement.

To review the experience of various positions aortic replacement by four branch prosthesis vessel.From August 2003 to May 2005, we finished aortic procedures with four branch prosthesis vessel for 142 patients, aged (44 +/- 12) (22-78) years, weighted (72 +/- 20) kg (49-130 kg). We performed ascending aorta and total aortic arch replacement for 85 cases during right axillary artery cannulation for cardiopulmonary bypass and selected antegrade cerebral perfusion. 38 patients underwent one-stage total thoracoabdominal aortic replacement during deep hypothermic bypass and subsection circulatory arrest. 8 patients underwent one-stage total or subtotal aortic replacement during deep hypothermic bypass and selected antegrade cerebral perfusion and subsection circulatory arrest. We performed totally aortic arch replacement without utilizing cardiopulmonary bypass and hypothermic for 11 cases.The mortality was 4.2%. Cerebral complications occurred in 16 (11.3%). 2 patients suffered from permanence spinal cord dysfunction. 4 patients suffered from temporary spinal cord dysfunction.The four branch vessel prosthesis can be used on aortic surgery dexterously. The approach may shorten she time of aortic arrest and arterial construction.

To determine the indication, optimal operative procedures, plan and the estimation of the prognosis depending on the subtype of aortic dissection defined by the extension and extent of dissection.The outcome of 708 patients with aortic dissection between January 1994 and December 2004 was analyzed. Among them 477 patients suffered from Stanford type A aortic dissection were treated. Type A dissection can be classified into 3 subtypes based on the pathological change of the aortic root. Type A1 (No pathological change type): 212 patients underwent ascending aorta replacements; Type A2 (mild pathological change type): 63 patients underwent ascending aortic replacement with concomitant aortic valve and valsalva sinus plasty and David procedure was performed in 9 patients; Type A3 (severe pathological change type): 193 patients underwent Bentall procedure. The method of aortic arch repair was determined by the pathological type of distal aorta. Total aortic arch replacement was performed in 78 patients with complex type (type C). There hundred and ninety-nine patients with simple type (type S) underwent partial aortic arch replacement. 231 patients suffered from Stanford type B aortic dissection. Type B dissection can be classified into 3 subtypes based on dilated extension of proximal descending aorta. Type B1 (no dilation was confined in the proximal of thoracic descending aorta): endoluminal stent graft repair was performed in 103 patients. Replacement of the partial proximal thoracic descending aorta and replacement combined with stented elephant trunk procedure were performed in 32 and 12 patients respectively; Type B2 (aneurysm in thoracic descending aorta): 32 patients underwent the part proximal thoracic descending aorta replacement combined with aorta plasty. 21 patients underwent the replacement of entire thoracic descending aorta; Type B3 (aneurysm in thoracic descending and abdominal aorta): thoracoabdominal aortic replacement was operated in 31 patients with deep hypothermia circulatory arrest; Type BC (complex type): 44 patients were performed the operation with the use of deep hypothermia circulatory arrest because their left subclavian arteries or distal aortic arch were affected by the dissection; Type BS (simple type): 103 patients were underwent endoluminal stent graft repair. In the 60 patients, the operations were performed by using the technique which preserved blood was transfused back by pump via the femoral artery. Femoro-femoral bypass was performed in 24 patients.Type A: the operative mortality was 4.6% (27/477), and the hospital morbidity was 14.5% (69/477). Type B: the hospital mortality of endoluminal stent graft repair was 1.9% (2/103). 9.7% (10/103) had mild leakage from proximal communications. The morbidity was 2.9% (3/103) in stent group. The mortality was 3.1% (4/128), and the hospital morbidity was 18.8% (24/128) in the operative group.The subtype of aortic dissection is much useful in determining the optimal procedure, operative indication and plan, estimating the prognosis.

To summarize operational effect with surgical treatment of aortic regurgitation caused by Behcet's disease and discuss relevant surgical techniques for treatment of these conditions.Eight patients with aortic regurgitation secondary to Behcet's disease and received surgery between April 1997 and August 2003 were retrospetively analyzed. Among them, two patients had their aortic valves replaced in other hospital before admitted to our hospital where one undertook aortic valve replacement (AVR), and the other undertook aortic root replacement (ARR). In six patients who were initially treated in our hospital, the surgical procedures for aortic regurgitation included AVR in three patients and ARR operation in other three patients in whom Bentall-type operation was conducted in two patients and Cabrol-type operation in one.One patient died during hospital stay. The follow-up periods ranged from 3 months to 36 months. In five patients with prosthetic valve detachment or suture detachment, redo homograft replacement was required in one patient and redo AVR in 3, one patient had redo AVR twice, and the remaining one patient had no surgery at present. Three patients primarily operated by ARR operation have no complications.The rate of prosthetic valve detachment is high in patients with Behcet's disease. ARR should be a first-line therapy for operation promised these patients.

To introduce the experience of diagnosis and surgical treatment of Williams syndrome combined with cardiovascular disease.Between October 1996 and June 2003, 8 patients of Williams syndrome with cardiovascular disease were admitted in Fuwai hospital. Seven patients underwent surgical correction. One didn't undergo surgical procedure. There were 6 male and 2 female ranging from 1.5 to 12.0 years old (medium age 6.4). Three had localized type supravalvular aortic stenosis and 5 diffused type supravalvular aortic stenosis. In them, 2 patients were combined with peripheral pulmonary stenosis. Single patch aortoplasty were performed in 6 cases, and inverted bifurcated patch aortoplasty in one patient.One patient died and one patient suffered renal insufficiency. In the early postoperative period, the mean speed of flow was reduced to 1.7 m/s from 4.6 m/s, and the mean systolic pressure gradient was reduced from 91 mm Hg to 18 mm Hg. Six patients were followed up 16 to 91 months. There were 5 cases in NYHA function class I, and one in class II.Satisfied result can be achieved in surgical treatment of Williams syndrome with supravalvular aortic stenosis, but it is not in combined with peripheral pulmonary stenosis.

To improve the long term outcomes of the surgery for Stanford type A aortic dissection, we performed ascending aorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta for acute and chronic type A aortic dissection.From April 2003 to March 2004, 40 consecutive patients with acute or chronic Stanford type A aortic dissection underwent this procedure. Right axillary artery cannulation was routinely used for cardiopulmonary bypass and selected cerebral perfusion. The stented elephant trunk was implanted through the aortic arch under hypothermic circulatory arrest. The stented elephant trunk was a 10 cm long self expandable graft. Enhanced electric beam computed tomography (EBCT) was performed in each patient before discharge, three month after surgery, and once each year after discharge to evaluate the postoperative time course of the residual false lumen.Cardiopulmonary bypass time was (166 +/- 38) min, average cross clamp time was (107 +/- 28) min, and average selective cerebral perfusion and lower body arrest time was (30 +/- 15) min. The in-hospital mortality was 5% (2/40). One patient died of multi-organ failure postoperatively and another died of cerebral infarction 2 month after surgery. One suffered from spinal cord injury perioperatively. There was no late death during follow up.Ascending aorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is an effective way in closing the residual false lumen of the descending aorta and might contribute to the better long term outcomes of type A aortic dissection. Our half mortality of 2 patients suffering acute renal failure suggests that this group may be candidates for medical or delayed surgical intervention. Conversely, our 5% mortality rate for those renal intact patients warrant aggressive and expeditious surgical treatment.

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Background: Prosthetic valve detachment after aortic valve replacement and pseudoaneurysm formation are the most important postoperative complications in patients with Takayasu arteritis with aortic regurgitation. We reviewed our experience of surgical treatment of aortic regurgitation in patients with Takayasu disease.Methods: Between November 1997 and September 2011, 11 patients (4 women and 7 men) with Takayasu arteritis with aortic regurgitation underwent surgical treatment. The age of the patients ranged from 26 to 56 years (mean, 40 � 9 years). Primary isolated aortic valve replacement was performed in 1 patient, David procedure in 1 patient, Wheat procedure in 1 patient, Bentall procedure in 2 patients, and Cabrol procedure in 6 patients (including 2 patients who underwent primary aortic valve replacement in other hospitals before being admitted to our surgical team).Results: There was no in-hospital death. All patients had an uneventful recovery during the postoperative course and were discharged. Prosthetic valve detachment, pseudoaneurysm formation at the suture line, and dilatation of the ascending aorta were not found in patients with composite aortic root replacement during a mean follow-up of 98 � 45 months. One patient died during follow-up.Conclusion: Valve detachment after composite aortic root replacement was not observed in patients with Takayasu disease with aortic regurgitation. Satisfactory surgical outcomes were obtained using composite aortic root replacement. However, close follow-up was needed to assess the effectiveness of the Cabrol procedure in patients with Takayasu disease with aortic regurgitation.

Background: Stent grafting is a very important treatment for type B dissection. Some patients are unsuitable for endograft repair because of inadequate proximal and/or distal fixation zones. We reviewed our experience of proximal descending thoracic replacement combined with short-stented elephant trunk implantation for type B dissection for patients without adequate fixation zones for endografts.Methods: Twenty-one patients with type B dissection (10 acute, 11 chronic) underwent this procedure between August 2003 and December 2007. After replacement of the proximal descending thoracic aorta, a short-stented elephant trunk was implanted into the residual descending thoracic aorta. The residual false lumen was evaluated post-operatively using computed tomography (CT) scans.Results: There were no in-hospital deaths. One death was observed during a mean follow-up of 69 � 15 months. One patient with preoperative shock suffered paraparesis but recovered postoperatively. One patient had paraplegia and was lost to follow-up. Cerebral hemorrhage was observed in 1 patient, but he recovered. Thrombus obliteration of the false lumen around the stented elephant trunk was observed in 19 patients (95%) and at the diaphragmatic level in 17 patients (85%) during follow-up.Conclusion: Replacement of the proximal descending thoracic aorta combined with short-stented elephant trunk implantation was a suitable alternative for type B dissection for patients without adequate fixation zones for endografts (particularly for young subjects). This procedure allowed enlargement of the true lumen, re-establishment of the true lumen, induction of thrombosis of the false lumen, and shrinkage of the aorta. Injury to the spinal cord, however, was an intractable problem.

Objectives To eliminate the residual false lumen in the descending thoracic aorta and improve long-term outcomes of surgical intervention for Stanford type A aortic dissection, we performed the skeletonized "elephant trunk" procedure in the ascending aorta and aortic arch replacement combined with transaortic stented graft implantation into the descending aorta for both acute and chronic type A aortic dissection, and the short-term results were compared. Methods Between April 2003 and November 2004, 60 consecutive patients (mean age, 53 ± 16.7; approximate range, 28-78 years) with acute (n = 36) or chronic (n = 24) type A aortic dissection underwent this procedure. Right axillary artery cannulation was used for cardiopulmonary bypass and selected cerebral perfusion. The stented graft, a 10-cm-long woven Dacron graft with a self-expandable stent, was implanted through the aortic arch during hypothermic circulatory arrest. Enhanced electric beam computed tomography was performed in each patient before discharge, 3 months after the operation, and once each year thereafter to evaluate the postoperative time course of the residual false lumen. Results Cardiopulmonary bypass time was 166 ± 38 minutes, and average selective cerebral perfusion and lower body arrest time was 30 ± 15 minutes. The in-hospital mortality was 3.3% (2/60). Thrombus obliteration of the residual false lumen in the descending thoracic aorta was observed in 92% and 85% of the acute and chronic aortic dissections, respectively, 3 months postoperatively. There was no late death during follow-up. Conclusions The skeletonized elephant trunk procedure is an effective way of closing the residual false lumen of the descending aorta and might contribute to better long-term outcomes for both acute and chronic type A aortic dissection.

Objective The optimal surgical repair for patients with Marfan syndrome with type A dissection involving the aortic arch is controversial. We retrospectively reviewed our experience of total arch replacement combined with stented elephant trunk implantation for patients with Marfan syndrome with type A dissection. Methods Between April 2003 and September 2008, 44 patients with Marfan syndrome (acute = 19, chronic = 25) with type A dissection underwent this procedure. Postoperative computed tomography was used to evaluate thrombosis and absorption of the residual false lumen. Results In-hospital mortality was 4.55% (2/44) (acute = 0%, 0/19; chronic = 8.00%, 2/25) and follow-up death rate was 4.76% (2/42) (acute = 5.26%, 1/19; chronic = 4.35%, 1/23) during a mean follow-up of 38 ± 17 months. One patient (5.26%, 1/19) with chronic dissection underwent thoracoabdominal aortic replacement 7 months after surgery. Injury to the spinal cord and visceral ischemia were not observed during follow-up. Obliteration of the false lumen around the stented elephant trunk was observed in 76.2% of patients (32/42) (acute = 84.2%, 16/19; chronic = 69.6%, 16/23) as demonstrated by postoperative computed tomography. The distal end of the stent-graft entering the false lumen was observed in 4 patients (21.1%, 4/19) with acute dissection. Conclusions The procedure was a suitable alternative to patients with Marfan syndrome with chronic type A dissection. However, more attention should be paid to patients with Marfan syndrome with acute dissection caused by the fragile dissecting membrane. If this procedure was adopted in patients with Marfan syndrome with acute type A dissection, an entry adjacent to the distal end of the surgical stent-graft, a small true lumen, or an extremely tortuous morphology of the false lumen aorta should be excluded.