UNASSIGNED: Acute aortic dissection remains a serious emergency in the field of cardiovascular medicine and a challenge for cardiothoracic surgeons. In the present study, we seek to compare the outcomes of different surgical techniques in the repair of type A acute aortic dissection.
UNASSIGNED: Between April 2015 and May 2023, 213 patients (82 women, aged: 63.9 ± 13.3 years) with acute aortic dissection (205 type A and 8 non-A-non-B dissections) underwent surgical treatment in our department. A total of 45 patients were treated with the frozen elephant trunk (FET) technique supported by the Thoraflex™ Hybrid prosthesis, 33 received total aortic arch replacement (TAR)-standard or conventional elephant trunk-treatment, and 135 were treated with hemiarch replacement (HR). Aortic arch surgery was performed in most patients under moderate hypothermic (28°C on average) circulatory arrest, with selective antegrade cerebral perfusion through the right axillary artery.
UNASSIGNED: The rates of early mortality were 17.8% (38 perioperative deaths) in the whole population, 8.9% in the FET group of patients, and 33% and 17% in the TAR and HR group of patients, respectively (P-value 0.025). The rate of spinal cord injury was 2.3% (five patients), and a paresis of recurrent laryngeal occurred in 3.7% of patients (seven patients, four were treated with FET). Permanent neurological dysfunction occurred in 27 patients (12.7%). After a mean follow-up of 3 years, the rate of mid-term mortality of discharged patients was 19.4% (34 deaths: 7 FET, 4 TAR, and 23 HR) and the overall mortality rate was 33.8% [72 deaths: 11 FET (24.4%); 15 TAR (45.4%); 46 HR (34.1%)]. A total of 8 patients (17.8%) in whom FET was applied received additional endovascular treatment in the descending aorta.
UNASSIGNED: In our institutional experience, we found that the frozen elephant trunk technique with a high-end Thoraflex Hybrid prosthesis proved its surgical suitability in the treatment of acute aortic dissection with favorable outcomes. The FET technique and our perioperative management led to comparable neurological outcomes and reduced mortality rates in these emergency cases.

UNASSIGNED: Considerable morbidity and death are associated with acute kidney damage (AKI) following total aortic arch replacement (TAAR). The relationship between AKI following TAAR and serum magnesium levels remains unknown. The intention of this research was to access the predictive value of serum magnesium levels on admission to the Cardiovascular Surgical Intensive Care Unit (CSICU) for AKI in patients receiving TAAR.
UNASSIGNED: From May 2018 to January 2020, a prospective, observational study was performed in the Guangdong Provincial People\'s Hospital CSICU. Patients accepting TAAR admitted to the CSICU were studied. The Kidney Disease: Improving Global Outcomes (KDIGO) definition of serum creatinine was used to define AKI, and KDIGO stages two or three were used to characterize severe AKI. Multivariable logistic regression and area under the curve receiver-operator characteristic curve (AUC-ROC) analysis were conducted to assess the predictive capability of the serum magnesium for AKI detection. Finally, the prediction model for AKI was established and internally validated.
UNASSIGNED: Of the 396 enrolled patients, AKI occurred in 315 (79.5%) patients, including 154 (38.8%) patients with severe AKI. Serum magnesium levels were independently related to the postoperative AKI and severe AKI (both, P < 0.001), and AUC-ROCs for predicting AKI and severe AKI were 0.707 and 0.695, respectively. Across increasing quartiles of serum magnesium, the multivariable-adjusted odds ratios (95% confidence intervals) of postoperative AKI were 1.00 (reference), 1.04 (0.50-2.82), 1.20 (0.56-2.56), and 6.19 (2.02-23.91) (P for Trend < 0.001). When serum magnesium was included to a baseline model with established risk factors, AUC-ROC (0.833 vs 0.808, P = 0.050), reclassification (P < 0.001), and discrimination (P = 0.002) were further improved.
UNASSIGNED: Serum magnesium levels on admission are an independent predictor of AKI. In TAAR patients, elevated serum magnesium levels were linked to an increased risk of AKI. In addition, the established risk factor model for AKI can be considerably improved by the addition of serum magnesium in TAAR patients hospitalized in the CSICU.
UNASSIGNED: Značajan morbiditet i smrt su povezani sa akutnim oštećenjem bubrega (AKI) nakon totalne zamene aortnog luka (TAAR). Veza između AKI nakon TAAR-a i nivoa magnezijuma u serumu ostaje nepoznata. Namera ovog istraživanja bila je da se pristupi prediktivnoj vrednosti nivoa magnezijuma u serumu pri prijemu u Jedinicu intenzivne kardiovaskularne hirurgije (CSICU) za AKI kod pacijenata koji primaju TAAR.
UNASSIGNED: Od maja 2018. do januara 2020. sprovedena je prospektivna opservaciona studija u narodnoj bolnici provincije Guangdong CSICU. Proučavani su pacijenti koji prihvataju TAAR primljeni u CSICU. Bolest bubrega: poboljšanje globalnih ishoda (KDIGO) definicija serumskog kreatinina je korišćena za definisanje AKI, a KDIGO faze dva ili tri su korišćene za karakterizaciju teške AKI. Analiza multivarijabilne logističke regresije i površine ispod krive karakteristične krive prijemnik-operater (AUC-ROC) je sprovedena da bi se procenila prediktivna sposobnost serumskog magnezijuma za detekciju AKI. Konačno, model predviđanja za AKI je uspostavljen i interno potvrđen.
UNASSIGNED: Od 396 uključenih pacijenata, AKI se javio kod 315 (79,5%) pacijenata, uključujući 154 (38,8%) pacijenata sa teškim AKI. Nivoi magnezijuma u serumu su bili nezavisno povezani sa postoperativnim AKI i teškim AKI (oba, P < 0,001), a AUC-ROC za predviđanje AKI i teškog AKI su bili 0,707 odnosno 0,695. U rastućim kvartilima serumskog magnezijuma, multivarijabilno prilagođeni odnosi šansi (95% intervala poverenja) postoperativnog AKI su bili 1,00 (referenca), 1,04 (0,50-2,82), 1,20 (0,56-2,56) i 6,19-232. P za Trend < 0,001). Kada je magnezijum u serumu uključen u osnovni model sa utvrđenim faktorima rizika, AUC-ROC (0,833 prema 0,808, P = 0,050), reklasifikacija (P < 0,001) i diskriminacija (P = 0,002) su dodatno poboljšani.
UNASSIGNED: Nivoi magnezijuma u serumu pri prijemu su nezavisni prediktor AKI. Kod pacijenata sa TAAR, povišeni nivoi magnezijuma u serumu bili su povezani sa povećanim rizikom od AKI. Pored toga, uspostavljeni model faktora rizika za AKI može se značajno poboljšati dodatkom serumskog magnezijuma kod pacijenata sa TAAR hospitalizovanim u CSICU.

OBJECTIVE: Outcomes after hemiarch repair for acute DeBakey Type I aortic dissection remain unfavorable, with high rates of major adverse events and negative aortic remodeling. The PERSEVERE study evaluates safety and effectiveness of the AMDS Hybrid prosthesis, a novel bare metal stent, in patients presenting with pre-operative malperfusion.
METHODS: PERSEVERE is a prospective, single arm, investigational study conducted at 26 sites in the United States. Ninety-three patients underwent acute DeBakey Type I aortic dissection repair with AMDS implantation. The 30-day primary endpoints are composite rate of 4 major adverse events and rate of distal anastomotic new entry tears. The secondary endpoints include aortic remodeling.
RESULTS: Clinical malperfusion was documented in 76 patients (82%), with the remaining having only radiographic malperfusion. Median follow-in 93 patients was 5.6 months. Within 30-days, there were 9 deaths (9.7%), 11 patients (11.8%) with new disabling stroke, 18 patients (19.4%) with new onset renal failure requiring ≥ 1 dialysis treatment, and no myocardial infarction. The composite rate of major adverse events (28%) was less than the reference cohort (58%). There were no distal anastomotic new entry tears. Technical success was achieved in 99% of patients. Early remodeling indicated total aortic diameter stability, true lumen expansion, and false lumen reduction in the treated aortic segment.
CONCLUSIONS: Early results show significant reduction in major adverse events and distal anastomotic new entry tears, successfully meeting both primary endpoints. The technical success rate was high. AMDS can be used safely in patients with acute DeBakey type I dissection with malperfusion.

暂无摘要。

UNASSIGNED: Abnormal inter arm systolic blood pressure, inter leg systolic blood pressure and ankle brachial index (ABI) are related to vascular diseases. Our aim was to evaluate the correlation of inter arm systolic blood pressure difference (IASBPD), inter leg systolic blood pressure difference (ILSBPD), and ABI with acute aortic dissection (AAD) and their role in predicting AAD.
UNASSIGNED: In this prospective case-control study, 180 patients with AAD admitted to the emergency department were prospectively and consecutively collected in Tongji Hospital from October 2019 to December 2020. 180 healthy people matched by sex, age and BMI served as control group. All participants were adults over 18 years of age who underwent four-limb blood pressure measurements. IASBPD, ILSBPD and ABI were compared between the two groups and their associations with AAD were analyzed.
UNASSIGNED: A total of 360 patients (180 cases and 180 controls) were analyzed. In case group IASBPD was larger [(15.23 ± 16.15) mm Hg vs. (4.19 ± 3.63) mm Hg] and ILSBPD was larger (13.00 mm Hg vs. 5.70 mm Hg). ABI was smaller [(0.98 ± 0.24) vs. (1.12 ± 0.09)], and the difference was statistically significant (all p < 0.05). According to the receiver operating characteristic curve (ROC), IASBPD ≥ 10 mm Hg (Sen 61.7%, Spe 88.9%), ILSBPD ≥ 13 mm Hg (Sen 50.6%, Spe 80.6%) and ABI ≤ 0.9 (Sen 53.3%, Spe 87.2%), showed significant correlation with AAD (all p < 0.001).
UNASSIGNED: Compared with healthy people, IASBPD and ILSBPD levels were higher and ABI levels were lower in patients with AAD. IASBPD ≥ 10 mm Hg and ILSBPD ≥ 13 mm Hg can be used as indicators for early screening of AAD, and IASBPD ≥ 10 mm Hg has better predictive value for the occurrence of AAD. In patients with typical chest pain, attention needs to be paid to measuring blood pressure in the extremities.

OBJECTIVE: This study aimed to explore the effectiveness of a multidisciplinary cooperative first aid model in the process of establishing a chest pain center specializing in acute aortic dissection (AD).
METHODS: A quality improvement report.
METHODS: A total of 142 patients with acute aortic dissection treated before and after the optimization of the chest pain center process in our hospital were included. According to their admission time: the group before the optimization process was designated as the control group (66 cases) and the group after the optimization process was the intervention group (76 cases). The control group received conventional emergency treatment, while the intervention group received treatment through a multidisciplinary cooperative first aid model. The treatment times for both groups were compared: the time from first medical contact(FMC) to completion of an electrocardiogram (ECG), the diagnosis time, and the time spent in the emergency department.
RESULTS: The research findings revealed that the intervention group had significantly shorter times for FMC-to-ECG, diagnosis time, and emergency stay compared to the control group (P < 0.001).
CONCLUSIONS: Our findings indicate that by optimizing the multidisciplinary cooperative first aid model and procedures, the treatment of patients has indeed been effectively ensured, achieving safety outcomes.
CONCLUSIONS: For chest pain centers, we suggest that to use multidisciplinary cooperative first aid model to get repaid and definite diagnosis of various causes of chest pain. A bedside transthoracic echocardiography is recommended to use in order to identify AD before proceeding with further treatment.

BACKGROUND: The presentation of acute aortic dissection can pose a challenge for emergency physicians, as it may occur without pain. Atypical presentations can lead to significant delays in diagnosis and increased mortality rates.
METHODS: Our case illustrates that isolated painless syncope can be a rare presenting symptom of acute aortic dissection type A. What is unique about our case is the limited extension of the dissection tear and the availability of Holter monitoring during the syncopal episode.
CONCLUSIONS: This constellation provides insight into the pathophysiological mechanism of the syncope in this patient. Mechanisms of syncope related to acute aortic dissection are diverse. We show that vasovagal activation not related to pain can be the underlying mechanism of syncope in acute aortic dissection type A. Although excessive vasovagal tone in the setting of aortic dissection has been hypothesized in the past, it has never been as clearly illustrated as in the present case. This also highlights the challenge in risk stratification of syncope in the emergency department.

UNASSIGNED: Acute Type A Aortic Dissection (AAAD) is one of the most life-threatening diseases, often associated with transient hyperglycemia induced by acute physiological stress. The impact of stress-induced hyperglycemia on the prognosis of ST-segment elevation myocardial infarction has been reported. However, the relationship between stress-induced hyperglycemia and the prognosis of AAAD patients remains uncertain.
UNASSIGNED: The clinical data of 456 patients with acute type A aortic dissection were retrospectively reviewed. Patients were divided into two groups based on their admission blood glucose. Cox model regression analysis was performed to assess the relationship between stress-induced hyperglycemia and the 30-day and 1-year mortality rates of these patients.
UNASSIGNED: Among the 456 patients, 149 cases (32.7%) had AAAD combined with stress-induced hyperglycemia (SIH). The results of the multifactor regression analysis of the Cox model indicated that hyperglycemia (RR = 1.505, 95% CI: 1.046-2.165, p = 0.028), aortic coarctation involving renal arteries (RR = 3.330, 95% CI: 2.237-4.957, p < 0.001), aortic coarctation involving superior mesenteric arteries (RR = 1.611, 95% CI: 1.056-2.455, p = 0.027), and aortic coarctation involving iliac arteries (RR = 2.034, 95% CI: 1.364-3.035, p = 0.001) were independent influences on 1-year postoperative mortality in AAAD patients.
UNASSIGNED: The current findings indicate that stress-induced hyperglycemia measured on admission is strongly associated with 1-year mortality in patients with AAAD. Furthermore, stress-induced hyperglycemia may be related to the severity of the condition in patients with AAAD.

UNASSIGNED: Acute aortic dissection (AAD) often leads to out-of-hospital cardiac arrest (OHCA) and death before hospital arrival.
UNASSIGNED: The purpose of this study was to investigate differences in AAD incidence by sex.
UNASSIGNED: A population-based study in a city with 121,180 residents was conducted using postmortem computed tomography data to identify patients with AAD who died before hospital arrival in 2008-2020. The incidence rate ratio and odds ratio were estimated using Poisson regression and univariable logistic regression, respectively.
UNASSIGNED: A total of 266 patients with incident AAD were enrolled: 84 patients with OHCA, 137 women [n = 137], and 164 patients with type A AAD. The crude and age-adjusted incidence of AAD was 16.2 and 14.3/100,000 person-years, respectively. The incidence of AAD was comparable by sex (men, 16.7/100,000 person-years; women, 15.7/100,000 person-years; incidence rate ratio: 0.94; 95% CI: 0.74-1.20; P = 0.64). Compared with men with AAD, women with AAD were older (77 ± 11 years vs 70 ± 14 years; P < 0.001), and a higher proportion had type A AAD (76% vs 47%; P < 0.001). Women with AAD had higher prehospital mortality than men with AAD (37% vs 21%; P = 0.004; OR: 2.24; 95% CI: 1.30-3.87; P = 0.004). Among 1,373 patients with OHCA, the proportion of women with AAD was significantly higher than the proportion of men with AAD (11% vs 3.9%; P < 0.001; OR: 2.90; 95% CI: 1.86-4.53; P < 0.001). AAD was most common in women aged 60 to 69 years (16.4%).
UNASSIGNED: Women had a higher incidence of AAD presenting as prehospital death than men.

UNASSIGNED: The treatment of acute type B aortic dissection (ATBAD) is currently a challenge for vascular surgeons, because of the early morbidity and mortality rates and the high risk of late aortic events up to 50% at 5 years. This study presents the initial outcomes of ATBAD treatment using optimal medical therapy alone or combined with proximal entry tear stent-graft coverage. Additionally, it provides an analysis of the evolution of the aortic diameter and its clinical consequences during the chronic phase in each group.
UNASSIGNED: Conducted as a retrospective, single-center study, we enrolled all consecutive ATBAD patients (n=130) treated between 2008 and 2020. The primary analysis studies the entire patient cohort based on their initial management approach, namely, medical treatment alone for uncomplicated ATBAD (n=67) or combined with stent-graft entry tear coverage (n=63). We also conducted a subgroup analysis to investigate factors associated with disease progression in the medical management group.
UNASSIGNED: Median follow-up was 29.5 months. During this time aneurysmal evolution was observed in: 42.4% of cases in the medical group compared with 21.8% in the stent-graft group, primarily affecting the thoracic aorta. The stent-graft group exhibited significant aortic remodeling, with a decrease in false lumen (FL) and thoracic aortic diameters. Initial aortic diameter ≥40 mm and FL ≥22 mm were independent risk factors for aneurysmal degeneration. Five-year survival was consistent at 76.1% in both groups.
UNASSIGNED: This study confirms the safety and efficacy of stent-graft entry tear coverage for ATBAD. Initial thoracic endovascular aortic repair (TEVAR) appears to reduce late aortic events by promoting aortic remodeling. Considering TEVAR\'s safety and potential to prevent late aortic complications, it may be considered for uncomplicated ATBAD patients with an initial aortic diameter ≥40 mm or an FL ≥22 mm.
CONCLUSIONS: This study validates the efficacy and safety of using endovascular stent grafts to seal the proximal entry tear in cases of acute type B aortic dissections, compared to optimal medical therapy. Aortic remodelling significantly benefits from endovascular stent graft coverage of the proximal entry tear. Given the heightened risk of late aortic events observed in the medical therapy cohort, there appears to be a necessity for including endovascular interventions in the management of uncomplicated acute type B aortic dissections, particularly when aortic diameter is ≥40 mm and false lumen diameter is ≥22 mm.