Surgery versus surveillance: A quality-of-life analysis of patients with moderately dilated aortic root or ascending aorta.

Objectives: The impact of diagnosis and management of ascending thoracic aortic aneurysm (ATAA) on patients' quality of life (QoL) is not well characterized. This study aims to compare QoL with surgery versus surveillance in patients with moderate ATAAs.

Methods: Treatment In Thoracic Aortic aNeurysm: Surgery versus Surveillance is a multicentre randomized trial for patients with ATAA between 5.

Intra-aortic balloon pump can be used after acute type A aortic dissection repair.

Objectives: We analyzed our data to evaluate the safety and feasibility of intraoperative extracorporeal membrane oxygenation and intra-aortic balloon pump use in acute type A aortic dissection repair.

Methods: Between December 1999-December 2020, we identified patients who received intraoperative extracorporeal membrane oxygenation and/or intra-aortic balloon pump support to wean off cardiopulmonary bypass were retrospectively reviewed.

Results: A total of 690 patients who underwent acute type A dissection repair.

Lifelong aortic risk in Turner syndrome: Unexpected aortic events in asymptomatic patients.

Individuals with Turner syndrome (TS) face a high relative risk of acute aortic dissection compared with the general population. Dissection risk is greatest in those who have congenital heart disease, thoracic aortic aneurysms, or hypertension. This case report features two adult patients with TS who presented with asymptomatic thoracic aortic pathologies that were identified on routine surveillance imaging.

Outcomes of routine surveillance of grade 1 blunt traumatic aortic injury.

Background: Blunt traumatic aortic injury (BTAI) can present with a wide range of severity from mild intimal injuries (grade 1) to rupture (grade 4). Although there is consensus that patients with grade 3 and 4 injuries should undergo immediate thoracic endovascular aortic repair (TEVAR), the optimal treatment strategy for milder injuries is less clear owing to the lack of data regarding the natural history of these injuries. Grade 1 injuries are typically treated with anti-impulse therapy and surveillance imaging.

Complications of cerebrospinal fluid drainage after open descending thoracic and thoracoabdominal aortic aneurysm repair.

Objective: This study aimed to review a 10-year experience, identify cerebrospinal fluid drainage (CSFD)-related complications, and evaluate its usefulness in spinal cord protection.

Methods: This retrospective study reviewed all open descending thoracic aneurysm and thoracoabdominal aortic aneurysm (DTA/TAAA) repairs performed at our institution between January 2013 and September 2024. The analysis focused on patients who underwent CSFD for preoperative spinal cord protection.

Impact of new classification from the Society for Vascular Surgery and Society of Thoracic Surgeons on acute Stanford type A aortic dissection.

Objectives: The Stanford classification categorizes aortic dissection based on ascending aortic involvement, whereas the newer Society for Vascular Surgery/Society of Thoracic Surgeons (SVS/STS) classification emphasizes tear location. Thus, traditional Stanford type A dissection may be an SVS/STS type A dissection or SVS/STS type B0 dissection. We evaluated the impact of SVS/STS classification on perioperative characteristics and outcomes after acute Stanford type A dissection repair.

Aortic Root Reconstruction With Pledgeted Sutures in Patients With Acute Type A Aortic Dissection.

Background: The aortic root is invariably dissected in patients with acute type A aortic dissection (ATAD). We have used an aortic root reconstruction technique using pledgeted sutures to reattach the dissected wall without surgical glue. We reviewed our 2-decade experience to evaluate the results of aortic root reconstruction with pledgeted sutures in ATAD.

Outcomes of Redo Total Arch Replacement After Limited Arch Repair for Acute Type A Aortic Dissection.

Background: Despite the life-saving nature of emergency surgery for acute type A aortic dissection (ATAD), debate persists on whether limited or extended arch repair is preferable. This study evaluates outcomes of redo total arch replacement after initial, limited arch repair for ATAD.

Methods: We retrospectively reviewed all patients who underwent ascending and arch repair from September 1999 to December 2024.

Cardiac Tamponade Complicating Type A Acute Aortic Dissection: Insights From 25 Years of Registry Research.

Background: Cardiac tamponade (TMP) is a catastrophic complication of type A acute aortic dissection (TAAAD), increasing the risk of morbidity and mortality.

Objectives: The present study aimed to assess the characteristics, management, and outcomes of TAAAD patients with preoperative TMP enrolled in the International Registry of Acute Aortic Dissection database from 1996 to 2022.

Methods: Data from 63 aortic centers were analyzed and TAAAD patients with and without preoperative TMP were compared.

Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection: Results From the ROADMAP Validation Study.

Background: Risk stratification is highly desirable in patients with uncomplicated Stanford type B aortic dissection but inadequately supported by evidence. We sought to validate externally a published prediction model for late adverse events (LAEs), consisting of 1 clinical (connective tissue disease) and 4 imaging variables: maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and number of identifiable intercostal arteries.

Methods: We assembled a retrospective multicenter cohort (ROADMAP [Registry of Aortic Diseases to Model Adverse Events and Progression]) of 401 patients with uncomplicated Stanford type B aortic dissection presenting to 1 of 8 aortic centers between 2001 and 2013, followed until 2020.

Malperfusion in Patients With Acute Type A Aortic Dissection: A Nationwide Analysis.

Background: This study describes in detail the clinical burden of malperfusion associated with acute type A aortic dissection (ATAAD) in a large, national cohort and the effect of treatment strategy on outcomes.

Methods: All patients undergoing repair of ATAAD between 2017 and 2020 in The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were studied. Malperfusion was defined using STS definitions on the basis of imaging or the surgeon's evaluation.

Cardiomegaly Status After Open Repair of an Arch Aneurysm.

This report describes a patient with a thoracic aortic aneurysm who presented with chest pain and dyspnea. Preoperative studies revealed a massive cardiomediastinal silhouette. Within hours after the operation, a profound reduction in cardiomegaly was observed.

Outcomes after open repair of aortic aneurysms and dissections in cannabis consumers.

Objective: To investigate the influence of cannabis consumption on the mid- and long-term surgical outcomes of patients with aortic aneurysms or dissections.

Methods: All individuals aged 18 years and older with more than 6 months of cannabis use at the time of surgical repair for cardiovascular disease (aortic aneurysms or aortic dissection) between 2007 and 2023 were eligible. Patients were stratified into 2 groups based on their preoperative history of cannabis use: cannabis users and noncannabis users.

Case studies in heritable vascular disease: Proceedings of the UTHealth Houston Multidisciplinary Aortic Conference.

Heritable thoracic aortic disease is caused by dominantly inherited mutations in more than a dozen genes, including mutations that cause Loeys-Dietz syndrome. McGovern Medical School at UTHealth Houston convenes a regular conference that includes cardiothoracic and vascular surgeons, cardiologists, geneticists, radiologists, and pathologists to formulate multidisciplinary approaches for the management of complex heritable thoracic aortic disease cases. In this report, we highlight the unique management of individuals with distinct presentations of Loeys-Dietz syndrome owing to mutations.

Routine intercostal artery reattachment strategy reduces delayed and permanent spinal cord injury after open descending thoracic and thoracoabdominal aortic aneurysm repair.

Objective: During open descending thoracic and thoracoabdominal aortic aneurysm (DTAA/TAAA) repair, we used a routine T8-T12 intercostal artery (ICA) reattachment strategy from July 2004 to June 2009 and after 2017, we used a selective ICA reattachment strategy (reattaching T8-T12 ICAs only when neuromonitor signals were lost) from July 2009 to 2016. This study reviewed our nearly 2-decade experience to assess the impact of 2 ICA reattachment strategies on spinal cord injury (SCI).

Methods: All open DTAA/TAAA repairs performed from July 2004 to June 2022 were included, except for cases without intraoperative cerebral spinal fluid drainage.

Morphology of true lumen and surgical outcomes of acute type A aortic dissection repair with superior mesenteric artery malperfusion.

Background: Acute type A aortic dissection (ATAD) can cause visceral malperfusion. Central aortic repair may resolve malperfusion, but some require further intervention. This study aimed to review outcomes after ATAD presenting with visceral malperfusion and to evaluate the predictive value of true lumen (TL) morphologies in preoperative computed tomography scan for persistent superior mesenteric artery (SMA) ischemia after central repair.

Open Thoracoabdominal Aortic Aneurysm Repair.

Operative techniques and perioperative management for thoracoabdominal aortic aneurysm (TAAA) have been modified and refined, but the morbidity and mortality remain high. Major challenges in open TAAA repair are prevention of ischemic insults to multiple organs, especially the spinal cord, and minimizing bleeding. The purpose of this narrative review is to provide currently available techniques and management strategies for open TAAA repair that optimize outcomes.

Repair of thoracic aortic aneurysm with bilateral aberrant subclavian artery.

We present a rare anatomical configuration of a 19-year-old woman, characterized by descending thoracic aortic aneurysm with right aberrant subclavian arteries with a Kommerell's diverticulum in a left aortic arch. The complexity of this vascular anomaly was accompanied by an anomalous origin of left subclavian artery. The patient underwent a single-stage open surgical repair via left thoracotomy under deep hypothermic circulatory arrest.

Open repair with latissimus muscle flap coverage for treatment of infected thoracic endovascular aneurysm repair.

A male patient, 70 years of age, was evaluated for an infected thoracic endovascular aneurysm repair (TEVAR). After presenting with persistent fever, a positron emission tomography scan found an infected aortic stent graft. The patient underwent open repair with explantation of the infected TEVAR, extensive periaortic debridement, graft replacement with a Dacron graft, and complete coverage with a latissimus dorsi muscle flap.

Insights From the Histopathologic Analysis of Acquired and Genetic Thoracic Aortic Aneurysms and Dissections.

Objective: The purpose of this study was to apply contemporary consensus criteria developed by the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology to the evaluation of aortic pathology, with the expectation that the additional pathologic information may enhance the understanding and management of aortic diseases.

Methods: A scoring system was applied to ascending aortic specimens from 42 patients with heritable thoracic aortic disease and known genetic variations and from 86 patients from a single year, including patients with known genetic variations (n = 12) and patients with sporadic disease (n = 74).

Results: The various types of lesions of medial degeneration and the overall severity of medial degeneration overlapped considerably between those patients with heritable disease and those with sporadic disease; however, patients with heritable thoracic aortic disease had significantly more overall medial degeneration (P = .

Outcomes of cardiothoracic surgery in women with Turner syndrome.

Background: To describe short- and mid-term surgical outcomes of patients with Turner syndrome (TS) after cardiovascular interventions.

Methods: All individuals >12 years of age at the time of surgical repair for cardiovascular disease (valve or coarctation repairs, aortic disease, aortic dissection) from 2002 to 2022 were eligible. The primary endpoint was complications or death within 30 days of intervention.