Computed tomography angiography findings predict the risk factors for preoperative acute ischaemic stroke in patients with acute type A aortic dissection

2020 ◽  
Vol 57 (5) ◽  
pp. 912-919 ◽  
Author(s):  
Hongliang Zhao ◽  
Wanling Ma ◽  
Didi Wen ◽  
Weixun Duan ◽  
Minwen Zheng
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Aortic Valve ◽  
False Lumen ◽  
Ascending Aorta ◽  
Acute Type ◽  
Aortic Valve Insufficiency ◽  
True Lumen ◽  
Type A Aortic Dissection ◽  
Valve Insufficiency

Abstract OBJECTIVES Acute ischaemic stroke (AIS) is a highly dreaded complication of acute type A aortic dissection (ATAAD). Knowledge about independent predictors of preoperative AIS in patients with ATAAD remains unclear. The aim of this study was to identify the risk factors for preoperative AIS in patients with ATAAD by computed tomography angiography (CTA) findings. METHODS Between October 2014 and March 2017, 281 (217 male; mean age, 50 years) patients with ATAAD underwent aortic CTA and diffusion-weighted magnetic resonance imaging of the brain was used to confirm the results. The clinical data and CTA findings were evaluated retrospectively. Patients were divided into 2 groups depending on the presence or absence of preoperative AIS. RESULTS Preoperative AIS was detected in 103 (36.7%) of the patients with ATAAD. Univariable analysis of the clinical characteristics and CTA findings revealed that age, aortic valve insufficiency (moderate or severe), the ratio of the diameter of the true lumen of the ascending aorta to the diameter of the involved ascending aorta, intimal flap plaque, dissection of the common carotid artery (CCA), the lower density of the unilateral internal carotid artery, the CCA originating from the false lumen and dissection of the subclavian artery were implicated in patients with ATAAD with AIS. Multivariable analysis further showed that aortic valve insufficiency (moderate or severe) [odds ratio (OR) 2.033, 95% confidence interval (CI) 1.052–3.931; P = 0.035], 2 CTA findings including the ratio of the diameters (OR 0.074, 95% CI 0.011–0.516; P = 0.009) and dissection of the CCA (OR 2.422, 95% CI 1.389–4.224; P = 0.002) were independent risk predictors for preoperative AIS in patients with ATAAD. The lower density in the false lumen, the same enhancement in the true and false lumen with re-entry and the stenosis of the true lumen without re-entry significantly increased the risk of preoperative AIS in CCA dissection. CONCLUSIONS Aortic valve insufficiency (moderate or severe), the ratio of the diameters of the true and false lumens and CCA dissection are independent predictors of preoperative AIS in patients with ATAAD. The specific carotid and aortic CTA findings may help to predict the risk factors for preoperative AIS in patients with ATAAD. Clinical registration number 20120216-4.

scholarly journals Observe the Unexpected: A Strange History of Bioprosthesis in a Patient in Dialytic Treatment

2021 ◽  
pp. 1-3
Author(s):  
Andrea Mazza ◽  
Andrea Mazza ◽  
Piergiorgio Bruno ◽  
Mauro Iafrancesco ◽  
Federico Cammertoni ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Valve ◽  
Renal Dialysis ◽  
Acute Chest Pain ◽  
Acute Type ◽  
Aortic Valve Insufficiency ◽  
Type A Aortic Dissection ◽  
Valve Insufficiency ◽  
History Of ◽  
Dialytic Treatment

A 73-year-old male with a history of right nephrectomy due to cancer in 1996 was referred to our hospital for dyspnea and acute chest pain. In May 2007, the Shelhigh® No-React® valved bioconduit was implanted using the Bentall-De Bono procedure due to the finding of severe aortic valve insufficiency and acute type A aortic dissection. Nine months after discharge, he was placed on chronic renal dialysis. The patient’s condition was followed carefully after being placed on dialysis, and now, thirteen years later the implanted aortic valve is still moving freely without signs of calcification.

Reported outcomes after aortic valve resuspension for acute type A aortic dissection: a systematic review and meta-analysis

2019 ◽  
Vol 29 (3) ◽  
pp. 331-338
Author(s):  
Shuang-Kun Chen ◽  
Zhi-Huang Qiu ◽  
Guan-Hua Fang ◽  
Xi-Jie Wu ◽  
Liang-Wan Chen
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Meta Analysis ◽  
Type A ◽  
Acute Type ◽  
Aortic Valve Insufficiency ◽  
Type A Aortic Dissection ◽  
Valve Insufficiency

AbstractIn the majority of patients presenting with acute type A aortic dissection (AAD) complicated by aortic valve insufficiency, the aortic valve (AV) can be preserved by AV resuspension. A meta-analysis was performed to investigate the outcomes following AV resuspension for AAD. A systematic literature search for publications reporting outcomes after AV resuspension in AAD published between January 1998 and June 2018 was conducted. Early outcome events and linearized occurrence rates for late outcome events were derived. The retrieval process yielded 18 unique studies involving 3295 patients with a total of 17 532 patient-years (pt-yrs). Pooled early mortality was 15.5% [95% confidence interval (95% CI) 11.5–19.4%, I2 = 91.9%], and the linearized late mortality rate was 3.21%/pt-yrs (95% CI 2.49–3.77, I2 = 29%). The linearized occurrence rates for aortic root reintervention was 1.4%/pt-yrs (95% CI 0.88–1.79, I2 = 48%); for recurrent significant aortic valve insufficiency (>2+), it was 1.12%/pt-yrs (95% CI 0.79–1.45, I2 = 68%); and for endocarditis, it was 0.01%/pt-yrs (95% CI 0–0.04, I2 = 7%). The composite rate of thromboembolism and bleeding was 1.41%/pt-yrs (95% CI 0.18–2.63, I2 = 82%). A more recent surgical period was associated with a decreased hazard of reoperation on the aortic root (P < 0.001). Requirement of AV resuspension alone in AAD is a risk factor for mortality. The long-term durability of AV resuspension is excellent, with low rates of endocarditis and thromboembolism and bleeding. Root reoperation hazard has become acceptable in recent years. Preoperative aortic valve insufficiency grade exceeding 2+ is a predictor for root reoperation.

scholarly journals AVIATOR: An open international registry to evaluate medical and surgical outcomes of aortic valve insufficiency and ascending aorta aneurysm

2019 ◽  
Vol 157 (6) ◽  
pp. 2202-2211.e7 ◽  
Author(s):  
Frederiek de Heer ◽  
Jolanda Kluin ◽  
Gebrine Elkhoury ◽  
Guillaume Jondeau ◽  
Maurice Enriquez-Sarano ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Surgical Outcomes ◽  
Ascending Aorta ◽  
Aortic Valve Insufficiency ◽  
Aorta Aneurysm ◽  
International Registry ◽  
Valve Insufficiency

scholarly journals Early Results of the PETTICOAT Technique for the Management of Acute Type A Aortic Dissection

Aorta ◽  
2017 ◽  
Vol 05 (04) ◽  
pp. 124-128 ◽  
Author(s):  
Vamshi Krishna Kotha ◽  
Zlatko Pozeg ◽  
Eric Herget ◽  
Michael Moon ◽  
Jehangir Appoo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Ischemia ◽  
False Lumen ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Acute Type ◽  
Bare Metal ◽  
True Lumen ◽  
Descending Aorta ◽  
Type A Aortic Dissection

AbstractConventional surgical techniques for acute Type A aortic dissection (ATAAD) generally fail to address residual dissection in the descending aorta. The persistence of a false lumen is associated with visceral malperfusion in the acute setting and adverse aortic remodeling in the chronic setting. Hybrid aortic arch repair techniques may improve perioperative and long-term mortality by expanding the true lumen and obliterating the false lumen. However, there is a limit to the extent of aortic coverage due to the concomitant risk of spinal cord ischemia. In Type B dissection, the PETTICOAT (Provisional Extension To Induce Complete Attachment) technique, which entails stent graft coverage of the primary intimal tear followed by bare metal stent placement distally, may improve true lumen caliber and promote false lumen thrombosis without increasing the risk of spinal cord ischemia, as intercostal branches remain perfused through the bare metal stents. The technique of hybrid arch with surgical creation of a Dacron landing zone covering a stent graft in the proximal descending aorta and bare metal stents in the thoraco-abdominal aorta is a promising concept in the treatment of ATAAD.

scholarly journals Aortic Geometric Alteration Associated With Acute Type B Aortic Dissection: Angulation, Tortuosity, and Arch Type

2021 ◽  
Vol 12 ◽  
Author(s):  
Likun Sun ◽  
Jiehua Li ◽  
Lunchang Wang ◽  
Quanming Li ◽  
Hao He ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
False Lumen ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
True Lumen ◽  
Factors Associated ◽  
Geometric Factors

Background: Acute type B aortic dissection is a highly serious aortic pathology. Aortic geometric parameters may be useful variables related to the occurrence of acute type B aortic dissection (aTBAD). The aim of the study is to delineate the alteration in aortic geometric parameters and analyze the specific geometric factors associated with aTBAD.Methods: The propensity score matching method was applied to control confounding factors. The aortic diameter, length, angulation, tortuosity, and type of aortic arch of the aTBAD and control group were retrospectively analyzed via three-dimensional computed tomography imaging created by the 3mensio software (version 10.0, Maastricht, The Netherlands). The geometric variables of true lumen and false lumen in the descending aorta were measured to estimate the severity of aortic dissection. Multivariable logistic regression models were used to investigate the significant and specific factors associated with aTBAD occurrence. The area under the receiver operating characteristic curve (AUC) was used to estimate the performance of the model.Results: After propensity score matching, 168 matched pairs of patients were selected. The ascending aorta and aortic arch diameters were dilated, and the ascending aorta and total aorta lengths were elongated in aTBAD group significantly (P &lt; 0.001). The ascending aorta and aortic arch angulations in the aTBAD group were sharper than those of the controls (P = 0.01, P &lt; 0.001, respectively). The aortic arch and total aorta tortuosities were significantly higher in the aTBAD group (P = 0.001, P &lt; 0.001, respectively). There were more type III arch patients in the aTBAD group than the controls (67.9 vs. 22.6%). The true lumen angulation was sharper than that in the false lumen (P &lt; 0.01). The true lumen tortuosity was significantly lower than that in the false lumen (P &lt; 0.001). The multivariable models identified that aortic arch angulation, tortuosity, and type III arch were independent and specific geometric factors associated with aTBAD occurrence. The AUC of the multivariable models 1, 2, 3 were 0.945, 0.953, and 0.96, respectively.Conclusions: The sharper angulation and higher tortuosity of aortic arch and type III arch were the geometric factors associated with aTBAD in addition to the ascending aorta elongation and aortic arch dilation. The angulation and tortuosity of the true and false lumens may carry significant clinical implications for the treatment and prognosis of aTBAD.

scholarly journals Endovascular fenestration of aortic dissection membrane after failed frozen elephant trunk procedure

2019 ◽  
Author(s):  
Jan Raupach ◽  
Vendelin Chovanec ◽  
Veronika Kozakova ◽  
Jan Vojacek
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
True Lumen ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Elephant Trunk Procedure ◽  
Frozen Elephant Trunk Technique

Abstract We report a case of a 51-year-old male with complicated acute type A aortic dissection who initially underwent a supracoronary and aortic arch replacement using frozen elephant trunk technique. False-lumen perfusion was revealed later which resulted in the collapse of the true lumen. Endovascular fenestration of the dissection flap was performed. True-lumen reperfusion with false-lumen regression was achieved. Endovascular fenestration using a re-entry catheter represents an efficient and safe treatment approach for this rare but serious complication.

Subcapsular hepatic hematoma as a complicating cardiac surgery

2021 ◽  
pp. 021849232110691
Author(s):  
Shintaro Takago ◽  
Satoru Nishida ◽  
Yukihiro Noda ◽  
Toru Yamamoto
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Aortic Valve ◽  
Ascending Aorta ◽  
Aortic Valve Insufficiency ◽  
Ascending Aortic Aneurysm ◽  
Hepatic Hematoma ◽  
Valve Insufficiency ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

An 80-year-old woman was hospitalized for aortic valve insufficiency, paroxysmal atrial fibrillation, and ascending aortic aneurysm. She underwent aortic valve replacement, pulmonary vein isolation, left atrium appendectomy, and ascending aorta replacement. She developed a subcapsular hepatic hematoma during the surgery. The patient was managed conservatively and discharged successfully.

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