scholarly journals Restoration of malperfusion during repair of thoracic aortic dissection

2021 ◽  
Author(s):  
Jeffrey Shuhaiber ◽  
Volodymyr Labinskyy
Keyword(s):  
Physical Activity ◽  
Aortic Dissection ◽  
Operating Room ◽  
Lower Extremities ◽  
Type A ◽  
Contralateral Limb ◽  
Thoracic Aortic Dissection ◽  
Intense Physical Activity

A 46- year old male, during intense physical activity, sustained malperfusion of the lower extremities from Type A thoracic aortic dissection. We took him to the operating room. emergently and perfusing both lower extremities using a modified straight graft with side to side anastomosis to one limb and end to side anastomoses to the inflow perfusion and contralateral limb. The patient was successfully discharged and remained to be doing well. for four years.

scholarly journals Altered DNA methylation pattern reveals epigenetic regulation of Hox genes in thoracic aortic dissection and serves as a biomarker in disease diagnosis

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Peiru Liu ◽  
Jing Zhang ◽  
Duo Du ◽  
Dandan Zhang ◽  
Zelin Jin ◽  
...  
Keyword(s):  
Dna Methylation ◽  
Aortic Dissection ◽  
Epigenetic Regulation ◽  
Heart Development ◽  
Type A ◽  
Methylation Pattern ◽  
Healthy Controls ◽  
Global Methylation ◽  
Thoracic Aortic Dissection

Abstract Background Thoracic aortic dissection (TAD) is a severe disease with limited understandings in its pathogenesis. Altered DNA methylation has been revealed to be involved in many diseases etiology. Few studies have examined the role of DNA methylation in the development of TAD. This study explored alterations of the DNA methylation landscape in TAD and examined the potential role of cell-free DNA (cfDNA) methylation as a biomarker in TAD diagnosis. Results Ascending aortic tissues from TAD patients (Stanford type A; n = 6) and healthy controls (n = 6) were first examined via whole-genome bisulfite sequencing (WGBS). While no obvious global methylation shift was observed, numerous differentially methylated regions (DMRs) were identified, with associated genes enriched in the areas of vasculature and heart development. We further confirmed the methylation and expression changes in homeobox (Hox) clusters with 10 independent samples using bisulfite pyrosequencing and quantitative real-time PCR (qPCR). Among these, HOXA5, HOXB6 and HOXC6 were significantly down-regulated in TAD samples relative to controls. To evaluate cfDNA methylation pattern as a biomarker in TAD diagnosis, cfDNA from TAD patients (Stanford type A; n = 7) and healthy controls (n = 4) were examined by WGBS. A prediction model was built using DMRs identified previously from aortic tissues on methylation data from cfDNA. Both high sensitivity (86%) and specificity (75%) were achieved in patient classification (AUC = 0.96). Conclusions These findings showed an altered epigenetic regulation in TAD patients. This altered epigenetic regulation and subsequent altered expression of genes associated with vasculature and heart development, such as Hox family genes, may contribute to the loss of aortic integrity and TAD pathogenesis. Additionally, the cfDNA methylation in TAD was highly disease specific, which can be used as a non-invasive biomarker for disease prediction.

Surgical Correction of Ascending Type A Thoracic Aortic Dissection: Simultaneous Endoluminal Exclusion of the Arch and Distal Aorta

2005 ◽  
Vol 12 (6) ◽  
pp. 660-666 ◽  
Author(s):  
Edward B. Diethrich ◽  
Marwan Ghazoul ◽  
Grayson H. Wheatley ◽  
Jeffrey Alpern ◽  
Julio Rodriguez-Lopez ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Surgical Correction ◽  
Thoracic Aortic Dissection

Risk factors predictive of unfavorable distal aortic remodeling after surgical repair of type A thoracic aortic dissection

2020 ◽  
Vol 61 (3) ◽  
Author(s):  
Robert Rhee ◽  
Aashish Gupta ◽  
Suttatip Vechvitvarakul ◽  
Mohammed Hoque ◽  
Maryanne Ruggiero ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Surgical Repair ◽  
Type A ◽  
Thoracic Aortic Dissection ◽  
Aortic Remodeling

Abstract 17497: Management of Acute Type A Aortic Dissection in an Hybrid Operating Room: - Feasibility and Added Value of Preoperative Angiography and Intravascular Ultrasound

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Rolf A Janosi ◽  
Konstantinos Tsagakis ◽  
Philipp Kahlert ◽  
Eva Kottenberg ◽  
Riccardo Gorla ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Operating Room ◽  
Intravascular Ultrasound ◽  
Type A ◽  
Time Interval ◽  
Acute Type ◽  
Hybrid Operating Room ◽  
Type A Aortic Dissection ◽  
The Impact

Introduction: Acute type A aortic dissection (ATAAD) is rapidly lethal and requires comprehensive tactics and decision making. To refine our respective approach we retrospectively analyzed our patients undergoing urgent surgery in our hybrid operating room over a 10 year period for the impact of immediate preoperative coronary angiography (CA), aortography, and/or intravascular ultrasound (IVUS) for the detection of coronary artery disease (CAD) and/or arterial malperfusion. Methods: 136 patients (mean age: 60.6 y ± 13; 63% male, March 2004-February 2014) underwent preoperative CA with or without IVUS. We assessed the time interval from preoperative CA to surgery and the impact for concomitant coronary artery bypass grafting (CABG) or endovascular interventions. Results: The delay to proceed with surgery due to preoperative catheterization averaged 32 min ± 26 (Fig. 1) in the setting of the hybrid OR. CA revealed CAD in 47/136 (35%) patients, with CABG consequently performed in 38 (28%). In 12 (9%) patients, CABG was necessary due to ostium obstruction by the dissection. 30-day mortality more than doubled in patients with concomitant CAD (27.7% vs. 11.2%, respectively, p<0.01). However in patients with confirmed CAD, mortality was less 19% (6/31), in those undergoing CABG, compared to 44% (7/16) for isolated aortic repair (p=0.08). Conclusions: In a hybrid operating room setting, preoperative coronary and aortic angiography do not unduly delay surgery, facilitate diagnosis of coronary malperfusion, and allowing concomitant CABG in as much as 28% of patients.

Direct Admission to the Operating Room: An Efficient Strategy for Patients With Diagnosed or Highly Suspected Acute Type A Aortic Dissection

2011 ◽  
Vol 27 (6) ◽  
pp. 685-691 ◽  
Author(s):  
Olivier Chavanon ◽  
Jean-Philippe Baguet ◽  
Pierre Albaladéjo ◽  
Dominique Blin ◽  
Gerald Vanzetto
Keyword(s):  
Aortic Dissection ◽  
Operating Room ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Efficient Strategy ◽  
Direct Admission

Aortic root replacement in a patient with previous coronary artery bypass

2021 ◽  
pp. 021849232199738
Author(s):  
Juan F Parra ◽  
Eric E Vinck ◽  
Jessica N González ◽  
Hernando Santos
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Type A ◽  
Composite Graft ◽  
Acute Type ◽  
Thoracic Aortic Dissection ◽  
Threatening Condition ◽  
Life Threatening

Acute type A thoracic aortic dissection is a life-threatening condition that requires rapid diagnosis and prompt surgical intervention. Prior cardiac surgery is recognized as a predisposing risk factor. Here, we report a rare case and successful surgical repair of a late presenting acute type A thoracic aortic dissection four years after a three-vessel coronary artery bypass grafting. Resection of the aortic valve and aneurysmal tissue was required, reconstruction was done with a composite graft, and the native coronary ostia and aorto-saphenous buttons were preserved.

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