2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease

Isselbacher, Eric M.; Preventza, Ourania; Black, James H.; Augoustides, John; Beck, Adam W.; Bolen, Michael A.; Braverman, Alan C.; Bray, Bruce E.; Brown-Zimmerman, Maya M.; Chen, Edward P.; Collins, Tyrone J.; DeAnda, Abe; Fanola, Christina; Girardi, Leonard N.; Hicks, Caitlin W.; Hui, Dawn S.; Jones, W. Schuyler; Kalahasti, Vidyasagar; Kim, Karen M.; Milewicz, Dianna M.; Oderich, Gustavo S.; Ogbechie, Laura; Promes, Susan B.; Ross, Elsie Gyang; Schermerhorn, Marc L.; Times, Sabrina Singleton; Tseng, Elaine E.; Wang, Grace J.; Woo, Y. Joseph

doi:10.1016/j.jacc.2022.08.004

Cited by 254 publications

(193 citation statements)

References 1,088 publications

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“…Patients for whom the surgeon judged there was an indication for aortic root surgery at diameters below conventional thresholds may have additional risk factors, yet we did not have data on clinical decision-making available. 1 The median aortic root diameter of 49 mm in our selected population of patients with…”

Section: Discussionmentioning

confidence: 99%

Matched comparison between external aortic root support and valve-sparing root replacement

Hoof

Lamberigts

Noé

et al. 2023

Heart

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ObjectivesDifferences in indication and technique make a randomised comparison between valve-sparing root replacement (VSRR) and personalised external aortic root support (PEARS) challenging. We performed a propensity score (PS)-matched comparison of PEARS and VSRR for syndromic root aneurysm.MethodsPatients in the PEARS 200 Database and Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (undergoing VSRR) with connective tissue disease operated electively for root aneurysm <60 mm with aortic regurgitation (AR) <1/4 were included. Using a PS analysis, 80 patients in each cohort were matched. Survival, freedom from reintervention and from AR ≥2/4 were estimated using a Kaplan-Meier analysis.ResultsMedian follow-up was 25 and 55 months for 159 PEARS and 142 VSRR patients. Seven (4.4%) patients undergoing PEARS required an intervention for coronary injury or impingement, resulting in one death (0.6%). After VSRR, there were no early deaths, 10 (7%) reinterventions for bleeding and 1 coronary intervention. Survival for matched cohorts at 5 years was similar (PEARS 98% vs VSRR 99%, p=0.99). There was no difference in freedom from valve or ascending aortic/arch reintervention between matched groups. Freedom from AR ≥2/4 at 5 years in the matched cohorts was 97% for PEARS vs 92% for VSRR (p=0.55). There were no type A dissections.ConclusionsVSRR and PEARS offer favourable mid-term survival, freedom from reintervention and preservation of valve function. Both treatments deserve their place in the surgical repertoire, depending on a patient’s disease stage. This study is limited by its retrospective nature and different follow-ups in both cohorts.

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Section: Discussionmentioning

confidence: 99%

Matched comparison between external aortic root support and valve-sparing root replacement

Hoof

Lamberigts

Noé

et al. 2023

Heart

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“…Most cases of thoracic aortic dilatation are caused by degenerative atherosclerotic processes, although, especially in younger patients, many forms of syndromic and familial aorta pathology are increasingly being recognized [ 54 ]. Because of the increase in blood pressure during diving and heavy diving equipment, diving is not recommended in patients with a moderate (aorta size ≥ 45 mm, z-score > 4) or severe aortic dilatation.…”

Section: Specific Conditionsmentioning

confidence: 99%

SCUBA Diving in Adult Congenital Heart Disease

Kauling

Rienks

Cuypers

et al. 2023

JCDD

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Conventionally, scuba diving has been discouraged for adult patients with congenital heart disease (ACHD). This restrictive sports advice is based on expert opinion in the absence of high-quality diving-specific studies. However, as survival and quality of life in congenital heart disease (CHD) patients have dramatically improved in the last decades, a critical appraisal whether such restrictive sports advice is still applicable is warranted. In this review, the cardiovascular effects of diving are described and a framework for the work-up for ACHD patients wishing to engage in scuba diving is provided. In addition, diving recommendations for specific CHD diagnostic groups are proposed.

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“…where E(t) is the time-varying function (mmHg/ml), P sv (t) is the time function of ventricular pressure (mmHg), V sv (t) is a time function of ventricular volume (ml), and V 0 is the ventricular reference volume (ml), which is the theoretical volume relative to ventricular zero pressure. Boston (17) proposed a mathematical fit to determine the function of ventricular systole according to equation (2):…”

Section: Mathematical Modeling For 0d Modelmentioning

confidence: 99%

“…For advanced and/or rapid-growing aneurysms, prompt surgical or endovascular interventions are indicated, among which endovascular aortic aneurysm repair (EVAR) is widely accepted as the firstline treatment option for anatomically feasible cases (2).…”

Section: Introductionmentioning

confidence: 99%

Effects of cardiac function alterations on the risk of postoperative thrombotic complications in patients receiving endovascular aortic repair

Sun

et al. 2022

Preprint

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Chronic heart disease (CHD) is a common comorbidity of patients receiving endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA). The ventricular systolic function determines the hemodynamic environments in aorta, and thus regulating the formation of postoperative thrombus. However, the explicit relationship between ventricular systolic function and EVAR complication of thrombotic events is unknown. Here, we proposed a three-dimensional numerical model coupled with the lumped-elements heart model, which is capable of simulating thrombus formation in diverse systolic functions. The computational results show that that thrombus tended to occur at the interior side of the aorta arch and iliac branches, which is consistent with the post-operative imaging follow-up. In addition, we found that both an increase in maximum ventricular contractile force and a decrease in minimum ventricular contractile force inhibit thrombus formation, whereas the effect of heart rate on thrombus formation is not significant. In conclusion, changes in ventricular systolic function may alter the risk of thrombotic events after EVAR repair, which could provide insight into the selection of adjuvant therapy strategies for AAA patients with CHD.

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2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease

Cited by 254 publications

References 1,088 publications

Matched comparison between external aortic root support and valve-sparing root replacement

Matched comparison between external aortic root support and valve-sparing root replacement

SCUBA Diving in Adult Congenital Heart Disease

Effects of cardiac function alterations on the risk of postoperative thrombotic complications in patients receiving endovascular aortic repair

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