Midterm Outcomes of One-Stage Hybrid Aortic Arch Repair for Stanford Type A Aortic Dissection: A Single Center's Experience.

This study sought to identify the midterm outcomes of one-stage hybrid aortic arch repair (HAAR) in patients with Stanford type A aortic dissection (TAAD). Between January 2010 and December 2015, 75 consecutive patients with TAAD involving the aortic arch who underwent one-stage type Ⅱ HAAR at our institution were identified. During this period, 496 consecutive patients with TAAD underwent traditional total aortic arch replacement (TAR) with frozen elephant trunk. The preoperative, perioperative, and postoperative data of all patients were compared. A propensity score-matching analysis was applied to adjust for baseline risk factors. Five hundred and seventy-one patients were included for analysis (428 men; mean age, 48.9 ± 11.1 years). For all patients, the mean follow-up time was 41.1 ± 22.1 months, in-hospital mortality was 4.7%, and the 5-year survival rate was 89.5%. Midterm outcomes between the propensity-matched groups were compared (59 HAAR vs TAR pairs). HAAR group showed shorter cardiopulmonary bypass time (105-159 minutes vs 158-230 minutes, P < 0.001), aortic cross-clamping time, postoperative ventilation time, and intensive care unit stays (33-108 hours vs 45-131 hours, P = 0.010) than the TAR group. There were no significant differences in in-hospital mortality, rate of stroke and rate of paraplegia between the 2 groups, however, better 5-year survival rate was found in HAAR group (94.9% vs 75.8%, Log-rank P = 0.005). As compared to propensity matched cohort of TAR patients, HAAR shows good midterm outcomes for patients with TAAD. Further randomized study was needed to clarify the optimal management strategy of TAAD.

Higher Mortality in Patients Undergoing Nighttime Surgical Procedures for Acute Type A Aortic Dissection.

BACKGROUND:The aim of this study was to investigate whether nighttime surgical procedures contribute to higher in-hospital mortality in patients with acute type A aortic dissection.METHODS:All patients with acute type A aortic dissection who underwent surgical procedures at Fuwai Hospital in Beijing, China from 2010 to 2015 were included in the present study. Depending on the start and end time of the surgical procedures, patients were divided in daytime and nighttime groups. Propensity-matching analysis was used to compare in-hospital mortality and postoperative complications between these groups.RESULTS:A total of 698 patients with acute type A aortic dissection underwent operation. Of these, 321 (45.98%) patients underwent nighttime surgical procedures, whereas 377 (54.02%) patients underwent daytime procedures. The operation time, cardiopulmonary bypass time, and aortic cross-clamp time showed statistical differences between the two groups (p < 0.01). There was a significant difference between the daytime and nighttime groups in in-hospital mortality (6.42% vs 12.08%; p < 0.05). The nighttime group had a higher incidence rate of reintubation and continuous renal replacement therapy compared with the daytime group (p < 0.05). Furthermore, patients who underwent nighttime operations had significantly higher adjusted in-hospital mortality than patients who underwent daytime operations (odds ratio, 2.13; 95% confidence interval, 1.19 to 3.81; p = 0.01).CONCLUSIONS:Patients with acute type A aortic dissection and certain serious medical conditions were more likely to die in the hospital if they underwent emergency nighttime surgical procedures.

Early Prognosis of Reduction Ascending Aortoplasty in Patients With Aortic Valve Disease: A Single Center's Experience.

BACKGROUND:Dilatation of the ascending aorta tends to develop in individuals with aortic valve disease. Reduction ascending aortoplasty (RAA) is an alternative procedure to ascending aortic replacement. This study was designed to identify the early prognosis of RAA for patients with aortic valve disease and dilatation of the ascending aorta.METHODS:From January 2010 to December 2013, 102 patients with aortic valve disease and ascending aortic dilatation who had undergone aortic valve replacement combined with RAA were enrolled. Fifty-seven patients with bicuspid aortic valve (BAV group) and 45 patients without BAV (non-BAV group) were analyzed. The study endpoints were postoperative death, reoperation, stroke, and aorta-related adverse events.RESULTS:Follow-up data were obtained from all patients. The mean follow-up time was 38.8 ± 13.0 months. More patients with mitral valve disease and tricuspid insufficiency were present in the non-BAV group. More patients with ascending aorta larger than 45 mm were present in the BAV group. Two patients died, and 1 patient experienced a stroke. There were no reoperations or aorta-related adverse events. The mean expansion degree and rate of ascending aorta were 0.39 ± 0.26 cm and 1.3 ± 0.8 mm/year, respectively, in patients with aortic redilatation. Redilatation was observed in the BAV group (37.0 ± 5.0 mm vs 35.5 ± 4.6 mm; p = 0.009), whereas the non-BAV group had no significant change.CONCLUSIONS:Reduction ascending aortoplasty shows good early results in patients with aortic valve disease and dilatation of the ascending aorta. Redilatation tends to happen in patients with BAV, and long-term follow-up is necessary.

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Comparison of gene expression profiles in aortic dissection and normal human aortic tissues.

The aim of the present study was to compare the gene expression profiles in aortic dissection (AD) and healthy human aortic tissue samples by DNA microarray analysis in order to screen the differential genes. In total, five AD and four healthy aortic specimens were selected; the total RNA was extracted and reverse transcribed into cDNA and in vitro transcribed into aRNA, followed by microarray hybridization for analysis. Thereafter, the transcription levels of six differential genes, myosin light chain kinase (MYLK), polycystin 1, transient receptor potential channel interacting (PKD-1), myosin heavy chain 11 (MYH11), superoxide dismutase 3, extracellular (SOD3), filamin A (FLNA), and transgelin (TAGLN), screened from the expression profiles were quantitatively verified. Compared with the healthy aortic specimens, a total of 1,661 genes in the AD group demonstrated more than 2-fold differential expression, of which 997 genes were upregulated and 664 genes were downregulated. Thereafter, six AD-associated genes that showed downregulation in the microarray assay were selected for quantitatively verifying the gene transcription level using reverse transcription-quantitative polymerase chain reaction (RT-qPCR), which confirmed their downregulation compared with the healthy aortic tissue genes; of the six genes, the expression levels of MYLK, PKD-1, MYH11, SOD3 and TAGLN were significantly downregulated (P<0.05), while the expression of FLNA was not significantly downregulated (P>0.05). Thus, whole genome microarray may be used to screen differentially expressed genes between AD and healthy aortic tissues. When used in combination with RT-qPCR validation, this method may provide novel strategies for investigating AD.

Midterm Outcomes of One-Stage Hybrid Aortic Arch Repair for Stanford Type A Aortic Dissection: A Single Center's Experience.

This study sought to identify the midterm outcomes of one-stage hybrid aortic arch repair (HAAR) in patients with Stanford type A aortic dissection (TAAD). Between January 2010 and December 2015, 75 consecutive patients with TAAD involving the aortic arch who underwent one-stage type Ⅱ HAAR at our institution were identified. During this period, 496 consecutive patients with TAAD underwent traditional total aortic arch replacement (TAR) with frozen elephant trunk. The preoperative, perioperative, and postoperative data of all patients were compared. A propensity score-matching analysis was applied to adjust for baseline risk factors. Five hundred and seventy-one patients were included for analysis (428 men; mean age, 48.9 ± 11.1 years). For all patients, the mean follow-up time was 41.1 ± 22.1 months, in-hospital mortality was 4.7%, and the 5-year survival rate was 89.5%. Midterm outcomes between the propensity-matched groups were compared (59 HAAR vs TAR pairs). HAAR group showed shorter cardiopulmonary bypass time (105-159 minutes vs 158-230 minutes, P < 0.001), aortic cross-clamping time, postoperative ventilation time, and intensive care unit stays (33-108 hours vs 45-131 hours, P = 0.010) than the TAR group. There were no significant differences in in-hospital mortality, rate of stroke and rate of paraplegia between the 2 groups, however, better 5-year survival rate was found in HAAR group (94.9% vs 75.8%, Log-rank P = 0.005). As compared to propensity matched cohort of TAR patients, HAAR shows good midterm outcomes for patients with TAAD. Further randomized study was needed to clarify the optimal management strategy of TAAD.

Higher Mortality in Patients Undergoing Nighttime Surgical Procedures for Acute Type A Aortic Dissection.

BACKGROUND:The aim of this study was to investigate whether nighttime surgical procedures contribute to higher in-hospital mortality in patients with acute type A aortic dissection.METHODS:All patients with acute type A aortic dissection who underwent surgical procedures at Fuwai Hospital in Beijing, China from 2010 to 2015 were included in the present study. Depending on the start and end time of the surgical procedures, patients were divided in daytime and nighttime groups. Propensity-matching analysis was used to compare in-hospital mortality and postoperative complications between these groups.RESULTS:A total of 698 patients with acute type A aortic dissection underwent operation. Of these, 321 (45.98%) patients underwent nighttime surgical procedures, whereas 377 (54.02%) patients underwent daytime procedures. The operation time, cardiopulmonary bypass time, and aortic cross-clamp time showed statistical differences between the two groups (p < 0.01). There was a significant difference between the daytime and nighttime groups in in-hospital mortality (6.42% vs 12.08%; p < 0.05). The nighttime group had a higher incidence rate of reintubation and continuous renal replacement therapy compared with the daytime group (p < 0.05). Furthermore, patients who underwent nighttime operations had significantly higher adjusted in-hospital mortality than patients who underwent daytime operations (odds ratio, 2.13; 95% confidence interval, 1.19 to 3.81; p = 0.01).CONCLUSIONS:Patients with acute type A aortic dissection and certain serious medical conditions were more likely to die in the hospital if they underwent emergency nighttime surgical procedures.

Early Prognosis of Reduction Ascending Aortoplasty in Patients With Aortic Valve Disease: A Single Center's Experience.

BACKGROUND:Dilatation of the ascending aorta tends to develop in individuals with aortic valve disease. Reduction ascending aortoplasty (RAA) is an alternative procedure to ascending aortic replacement. This study was designed to identify the early prognosis of RAA for patients with aortic valve disease and dilatation of the ascending aorta.METHODS:From January 2010 to December 2013, 102 patients with aortic valve disease and ascending aortic dilatation who had undergone aortic valve replacement combined with RAA were enrolled. Fifty-seven patients with bicuspid aortic valve (BAV group) and 45 patients without BAV (non-BAV group) were analyzed. The study endpoints were postoperative death, reoperation, stroke, and aorta-related adverse events.RESULTS:Follow-up data were obtained from all patients. The mean follow-up time was 38.8 ± 13.0 months. More patients with mitral valve disease and tricuspid insufficiency were present in the non-BAV group. More patients with ascending aorta larger than 45 mm were present in the BAV group. Two patients died, and 1 patient experienced a stroke. There were no reoperations or aorta-related adverse events. The mean expansion degree and rate of ascending aorta were 0.39 ± 0.26 cm and 1.3 ± 0.8 mm/year, respectively, in patients with aortic redilatation. Redilatation was observed in the BAV group (37.0 ± 5.0 mm vs 35.5 ± 4.6 mm; p = 0.009), whereas the non-BAV group had no significant change.CONCLUSIONS:Reduction ascending aortoplasty shows good early results in patients with aortic valve disease and dilatation of the ascending aorta. Redilatation tends to happen in patients with BAV, and long-term follow-up is necessary.

Reply.

Comparison of gene expression profiles in aortic dissection and normal human aortic tissues.

The aim of the present study was to compare the gene expression profiles in aortic dissection (AD) and healthy human aortic tissue samples by DNA microarray analysis in order to screen the differential genes. In total, five AD and four healthy aortic specimens were selected; the total RNA was extracted and reverse transcribed into cDNA and in vitro transcribed into aRNA, followed by microarray hybridization for analysis. Thereafter, the transcription levels of six differential genes, myosin light chain kinase (MYLK), polycystin 1, transient receptor potential channel interacting (PKD-1), myosin heavy chain 11 (MYH11), superoxide dismutase 3, extracellular (SOD3), filamin A (FLNA), and transgelin (TAGLN), screened from the expression profiles were quantitatively verified. Compared with the healthy aortic specimens, a total of 1,661 genes in the AD group demonstrated more than 2-fold differential expression, of which 997 genes were upregulated and 664 genes were downregulated. Thereafter, six AD-associated genes that showed downregulation in the microarray assay were selected for quantitatively verifying the gene transcription level using reverse transcription-quantitative polymerase chain reaction (RT-qPCR), which confirmed their downregulation compared with the healthy aortic tissue genes; of the six genes, the expression levels of MYLK, PKD-1, MYH11, SOD3 and TAGLN were significantly downregulated (P<0.05), while the expression of FLNA was not significantly downregulated (P>0.05). Thus, whole genome microarray may be used to screen differentially expressed genes between AD and healthy aortic tissues. When used in combination with RT-qPCR validation, this method may provide novel strategies for investigating AD.