Fig 3 - available from: Journal of Cardiothoracic Surgery
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Three types of aortic arch. Aortic arch can be divided into three types according to the ratio between diameter of common carotid artery (CCA) to the distance between the horizontal line through the top of arch and the horizontal line through the orifice of innominate artery: a type I, less than 1; b type II, between 1 to 2, and c type III, more than 2
Source publication
Background
Aortic dissection (AD) represents a clinically uncommon aortic pathology which predicts a dismal prognosis if not promptly treated. In acute Debakey type I AD (ADIAD), aortic lesion extends from aortic root to even distal abdominal aorta among which aortic arch and its three main branches still remain a great surgical challenge for repai...
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Altered proteoglycan (PG) and glycosaminoglycan (GAG) distribution within the aortic wall has been implicated in thoracic aortic aneurysm and dissection (TAAD). This review was conducted to identify literature reporting the presence, distribution and role of PGs and GAGs in the normal aorta and differences associated with sporadic TAAD to address t...
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Citations
... However, surgical interventions in cases of aortic and brachial pathology combinations are accompanied by extremely high mortality and neurological complications. Less radical surgical interventions, such as supracoronary ascending aorta prosthetics or the David Bental de Bono procedure, show satisfactory results, especially in acute forms of the disease, but the prognosis for patients with persistent aortic arch and/or main artery dissection remains doubtful [9]. ...
A type A aortic dissection (TAAD) is a dangerous condition requiring emergency surgery. Due to the similarity of the symptoms of cerebral malperfusion in TAAD and the signs of ischemic stroke, a differential diagnosis of these diseases is not always available. Patients with TAAD after cerebral malperfusion can have a neurological deficit. Thrombolysis is performed in this case. It can worsen the patient’s condition and increase the risk of mortality and disability. The aim of the study is to evaluate the new approach to restoring cerebral perfusion during aortic dissection. This approach includes endovascular recanalization and carotid stenting. Methods: Two clinical cases of TAAD complicated by cerebral malperfusion are described. The first patient is 73 years old and was admitted as planned to perform transcatheter aortic valve implantation (TAVI) for grade III aortic stenosis. The patient underwent transcatheter aortic valve implantation (TAVI) on the second day after admission. The second patient is 60 years old and was hospitalized by an ambulance with strong hypertension and ischemia. The surgical correction of aortic dissection was postponed until the neurological status assessment in both patients. Results: The surgery to correct the aorta dissection was deemed inappropriate. The carotid arteries have been reanalyzed, and cerebral perfusion has been restored in a short time in both patients. Conclusion: Acute bilateral internal carotid occlusion is a potentially fatal TAAD outcome. Emergency endovascular recanalization and carotid stenting may be considered one of the few ways to restore cerebral perfusion.
... BAV patients had no significant impairment of the aortic valve [no stage > A for aortic stenosis/regurgitation according to the ACC/AHA guidelines (16)] (P=0.21). Types of the aortic arch according (17). All participants had a left-sided aortic arch and descending thoracic aorta. ...
Background
The rotational direction (RD) of helical blood flow can be classified as either a clockwise (RD⁺) or counter-clockwise (RD⁻) flow. We hypothesized that this simple classification might not be sufficient for analysis in vivo and a simultaneous existence of RD+/− may occur. We utilized volumetric velocity-sensitive cardiovascular magnetic resonance imaging (4D flow MRI) to analyze rotational blood flow in the thoracic aorta.
Methods
Forty volunteers (22 females; mean age, 41±16 years) and seventeen patients with bicuspid aortic valves (BAVs) (9 females; mean age, 42±14 years) were prospectively included. The RDs and the calculation of the rotating blood volumes (RBVs) in the thoracic aorta were performed using a pathline-projection strategy.
Results
We could confirm a mainly clockwise RD in the ascending, descending aorta and in the aortic arch. Furthermore, we found a simultaneous existence of RD⁺/RD⁻. The RD+/−-volume in the ascending aorta was significantly higher in BAV patients, the mean RD⁺/RD⁻ percentage was approximately 80%/20% vs. 60%/40% in volunteers (P<0.01). The maximum RBV always occurred during systole. There was significantly more clockwise than counter-clockwise rotational flow in the ascending aorta (P<0.01) and the aortic arch (P<0.01), but no significant differences in the descending aorta (P=0.48).
Conclusions
A simultaneous occurrence of RD⁺/RD⁻ indicates that a simple categorization in either of both is insufficient to describe blood flow in vivo. Rotational flow in the ascending aorta and in the aortic arch differs significantly from flow in the descending aorta. BAV patients show significantly more clockwise rotating volume in the ascending aorta compared to healthy volunteers.
... Acute Debakey Type I Aortic Dissection (ADTIAD) is widely accepted as an urgent and catastrophic aortic pathology in which aortic lesion extends from aortic root, aortic arch to even distal abdominal aorta (1). Several decades have witnessed the fantastic breakthroughs of surgical strategy, cardiopulmonary bypass (CPB), anesthesia, and intensive care in the treatment of ADTIAD (2). Although the short-and long-term outcomes of ADTIAD are currently favorable worldwide, the postoperative complications are still enormous medical challenges for cardiovascular surgeons (3). ...
Background: The post-operative acute kidney injury (AKI) represents a common complication in the Acute Debakey Type I Aortic Dissection (ADTIAD) and predicts a poorer prognosis. The clinical evidence is scarce supporting the predictive value of the pre-operative lymphocyte-to-monocyte ratio (LMR) in post-operative AKI in ADTIAD.
Methods: In this retrospective cohort study, 190 consecutive patients with ADTIAD enrolled for surgical treatment between January 1, 2013, and December 31, 2018. The diagnosis of AKI followed the Kidney Disease: Improving Global Outcomes guidelines (KDIGO). Pre-operative LMR and other possible risk factors were analyzed for their prognostic value in the post-operative AKI in ADTIAD.
Results: The subjects were assigned to the low-LMR and high-LMR groups according to the median value of pre-operative LMR. For post-operative AKI, the incidence and the severity in the low-LMR group were statistically different from that of the high-LMR group. Besides, the lower LMR was statistically associated with the more extended ICU stay and intubation time and higher incidences of ischemic stroke and in-hospital mortality. Additionally, in the multivariable analysis, the pre-operative LMR was an independent predictor for post-operative AKI in ADTIAD. A predictive model for post-operative AKI in ADTIAD was established incorporating LMR.
Conclusions: LMR is an independent prognostic indicator incorporated into the predictive model with other risk factors to predict the post-operative AKI in ADTIAD.
... Three (3) different angles, namely aortic valve angle, LVOT-root angle and root-aorta angle (aortic angle) along with asymmetry index (AI) were measured ( Figure 3). An additional note was made of the type of aortic arch [19]. An orthogonal diameter .40 ...
... The terminology for BAV classification was based on Sievers' classification [7]. Aortic arch types were classified according to the difference between the takeoff of left subclavian artery versus the innominate artery [19]. We classified the aortic dilatation into five types as shown in Figure 4, a slight variation of the original subtypes described by Fazel [8]. ...
Background
Bicuspid aortic valves (BAV) and related aortopathy remain an intriguing topic. Not all BAVs get diseased and around 40% would develop aortic dilatation in their lifetime. If haemodynamic theory is to be believed, then leaflet fusion pattern should have an impact. This study sought to compare the association of aortic morphologies and rate of growth in a set of 102 BAV acropathies operated at a single centre, based on the fusion patterns.
Methods
Data on aortic valve replacements over a 10-year period was analysed from a prospectively maintained database. Of the 198 BAV undergoing surgery, 102 had aortic dilatation above 40 mm on echocardiogram. These underwent computed tomography (CT) aortograms and were followed up as a part of a database. The impact of leaflet fusion patterns on aortic dilatation pattern and rate was analysed.
Results
Of the 102, two patients had type 0 pathology and one had left-noncoronary (LN) leaflet fusion. Seventy-four (74) had type 1A or left-right (RL) fusion and 25 had type 1B right-noncoronary (RN) fusion. RL fusion had more males, were taller, bigger and had more proportion of aortic stenosis (AS). Aortic diameters, angles and growth rates at root, ascending/descending aorta and arch were not different. Regression analyses for size or growth did not show any significant impact of fusion pattern.
Conclusions
Left-right fusion pattern comprised three-quarters of BAV in this cohort and these patients were bigger, taller and had a greater proportion of males with increased rate of aortic stenosis. Despite these differences, there was no significant impact of fusion pattern on aortic size or rate of growth.
... The mean age of patients in our study was 53.8±11.5 years. Consistent with other studies from China, our patients were relatively younger than those reported from western countries (19,(21)(22)(23). In decision making, age of the patient was an important concern. ...
Background:
Acute type A aortic dissection with arch involvement is a life-threatening condition, which requires immediate surgical attention. Emergent total arch replacement and root reconstruction is a technically demanding operation with varying outcomes based on surgeon experience. The human factors in total arch replacement in the emergent setting have never been systematically investigated. The ability of surgeons with low volumes to achieve acceptable results in their start-up period is not known.
Methods:
From January 2013 to December 2016, patients with acute type A aortic dissection who underwent emergent total arch replacement with three surgeons were enrolled. Basic characteristics, procedural and postoperative outcomes were collected. The time of critical surgical steps and operative mortality were calculated using descriptive statistics and cumulative SUM (CUSUM) analysis.
Results:
A total of 300 patients (age 53.8±11.5 years, female 63, 21.0%) with acute type A aortic dissection underwent emergent total arch replacement. A total of 219 patients (73.0%) had root reinforcement, 295 patients (98.3%) underwent frozen elephant trunk repair. Mean circulatory arrest and cross-clamp times were 29.8±9.8 and 112.3±32.1 min, respectively. The operative mortality was 6.7%, the stroke rate was 4.0%. The mean length of postoperative ICU and hospital stays were 8.4±10.6 and 18.0±12.2 days, respectively. By CUSUM depictions, surgeons appeared to have different learning curves with regards to operative time. By CUSUM failure analysis on operative mortality, two newly appointed surgeons in their start-up period stayed in an acceptable range, while one senior surgeon with higher volumes experienced superior outcomes and better performance.
Conclusions:
Although emergent total arch replacement for acute type A dissection is a complex scenario, surgeons well-trained in adult cardiac surgery are able to achieve acceptable results in their start-up period.
... De hecho, el grupo de la Universidad de Calgary en Canadá, tras una revisión sistemática y un metaanálisis, propone una clasificación en cuatro grupos para facilitar la comparación de resultados a corto y a largo plazo de las diferentes técnicas quirúrgicas de la reparación del arco aórtico 100 . El Canadian Thoracic Aortic Collaborate (CTAC) recomienda sustitución del arco cuando su diámetro es > 45 mm en pacientes jóvenes con trastornos del tejido conectivo 101 . ...
Resumen
La patología de la aorta supone un reto para la medicina. Tanto a nivel diagnóstico, como terapéutico, el volumen de variables implicado ha hecho que dicha patología sea abordada por una ingente cantidad de especialistas. El manejo quirúrgico de dichas patologías implica un esfuerzo extraordinario por parte de muchos profesionales, dada la complejidad técnica y tecnológica empleada. A lo largo de estos años, dichos esfuerzos están dando sus frutos en forma de mejoras de resultados, gracias a un abordaje sistemático y protocolizado en el seno de un grupo de expertos (Comités de aorta o ``Aortic team'') en el que se han de implicar cardiólogos, cirujanos cardíacos, cirujanos vasculares, anestesiólogos y radiólogos, principalmente.
En este documento, consensuado entre los grupos de trabajo de Aorta de las sociedades españolas de Anestesiología (SEDAR) y Cirugía Torácica-cardiovascular (SECTCV) se busca difundir los modos de trabajo más consensuados entre los centros de mayor actividad del país por parte de ambas especialidades, en lo que al tratamiento quirúrgico se refiere de la patología de aorta ascendente y arco aórtico se refiere, así como del tratamiento de la disección aguda de aorta.
Somos conscientes de la evolución constante de la terapéutica, lo cual sin duda puede hacer cuestionables algunas opiniones aquí expresadas y que sin duda irán modificándose en futuras ediciones.
Este documento aspira a ser una herramienta de trabajo para los diferentes profesionales implicados en el tratamiento de la patología aórtica.
... The estimated rate of temporary and permanent brain damage after aortic arch surgery is 19-28% and 4-28%, respectively (1). Delayed awakening often results in prolonged mechanical ventilation and stay in the intensive care unit (2,3). However, the rate of delayed awakening after aortic arch surgery is not clear (2,3). ...
... Delayed awakening often results in prolonged mechanical ventilation and stay in the intensive care unit (2,3). However, the rate of delayed awakening after aortic arch surgery is not clear (2,3). In the current retrospective analysis, we collected the clinical data of all patients undergoing aortic arch surgery under deep hypothermic circulatory arrest (DHCA) in combination with selective antegrade cerebral perfusion (SACP) during a period from September 2015 to September 2017, and examined potential risk factors for delayed awakening. ...
... A variety of factors have been associated with delayed awakening after surgeries under DHCA + SACP. Reported intraoperative factors include: (I) atherosclerotic plaque falling during the operation or small emboli occurring during CPB, (II) cerebrovascular contraction and reduced cerebral blood flow resulting from reperfusion injury and inflammatory reaction, (III) long circulatory arrest time, (IV) uneven cooling, and (V) pre-existing diseases (1,2,4). Postoperative factors associated with delayed awakening include high fever, hypoxemia, and intracranial hypertension (5,6). ...
Background:
To determine the risk factors of delayed awakening following aortic arch surgery under deep hypothermic circulatory arrest (DHCA) in combination with selective antegrade cerebral perfusion (SACP).
Methods:
We retrospectively analyzed the clinical data of all patients who underwent aortic arch surgery under DHCA + SACP between September 2015 and September 2017 in our hospital. Delayed awakening was defined as recovery of consciousness later than 24 hours after the surgery. Risk factors of delayed awakening were evaluated using multivariate logistic regression analysis.
Results:
A total of 168 subjects were included. In-hospital mortality of the overall sample was 19.05% (n=32). Delayed awakening occurred in 76 (45.23%) subjects. Subjects with delayed awakening had older age, hypertension, higher rate of emergency surgery and blood transfusion, and longer cardiopulmonary bypass (CPB) time and myocardial blocking time. Multivariate regression analysis showed emergency surgery (P=0.005) and CPB time >240 min (P<0.001) as risk factors for delayed awakening, even after adjusting potential confounders, including age, hypertension, aortic cross-clamp time and blood transfusion.
Conclusions:
In patients undergoing aortic arch surgery under DHCA + SACP, emergency surgery and CPB time >240 min are risk factors for delayed awakening.
... М. Kato и соавт. [6] путем стентирования нисходящего отдела грудной аорты после классической операции «хобот слона». Успех данной методики способствовал созданию новых моделей гибридных протезов («E-vita open plus», «Thoraflex», «Gianturco-Z-stent» и др.) [7]. ...
... Однак на сьогоднішній день, за даними вітчизняної та зарубіжної літератури, відсутня загальновизнана оптимальна хірургічна тактика ведення хворих із даною патологією. Зараз застосовується декілька варіантів хірургічних операцій при лікуванні розшарування аорти типу А, проте чіткі критерії проведення різних видів операцій не прописані ні у вітчизняній, ні в закордонній літературі [1,7,10,12]. ...
Розшарування аорти першого типу – складна проблема сучасної кардіохірургії. З моменту першого досвіду хірургічного лікування розшарування аорти в 1955 році (DeBakey) минуло більше шістдесяти років. У статті описані особливості лікування пацієнтів із гострим розшаруванням висхідної аорти без глибокої гіпотермії з 2012 по 2018 рік у ДУ «ІЗНХ імені В. Т. Зайцева НАМН».
Cardiac troponin serum concentration is the primary marker used for the diagnosis of acute coronary syndrome. Moreover, the measurement of cardiac troponin concentration is important for risk stratification in patients with pulmonary embolism. The cardiac troponin level is also a general marker of myocardial damage, regardless of etiology. The purpose of this study is to conduct a literature review and present the most important information regarding the current state of knowledge on the cardiac troponin serum concentration in patients with chronic cardiovascular disease (CVD), as well as on the relationships between cardiac troponin serum concentration and features of subclinical cardiovascular dysfunction. According to research conducted to date, patients with CVDs, such as chronic coronary syndrome, chronic lower extremities' ischemia, and cer-ebrovascular disease, are characterized by higher cardiac troponin concentrations than people without a CVD. Moreover, the literature data indicate that the concentration of cardiac troponin is correlated with markers of subclinical dysfunction of the cardiovascular system, such as the intima-media thickness, pulse wave velocity, ankle-brachial index, coronary artery calcium index (the Agatston score), and flow-mediated dilation. However, further research is needed in various patient subpopulations and in different clinical contexts.
