EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ

Czerny, Martin; Grabenwöger, Martin; Berger, Tim; Aboyans, Victor; Della Corte, Alessandro; Chen, Edward P; Desai, Nimesh D; Dumfarth, Julia; Elefteriades, John A; Etz, Christian D; Kim, Karen M; Kreibich, Maximilian; Lescan, Mario; Di Marco, Luca; Martens, Andreas; Mestres, Carlos A; Milojevic, Milan; Nienaber, Christoph A; Piffaretti, Gabriele; Preventza, Ourania; Quintana, Eduard; Rylski, Bartosz; Schlett, Christopher L; Schoenhoff, Florian; Trimarchi, Santi; Tsagakis, Konstantinos; ,; Siepe, Matthias; Estrera, Anthony L; Bavaria, Joseph E; Pacini, Davide; Okita, Yutaka; Evangelista, Arturo; Harrington, Katherine B; Kachroo, Puja; Hughes, G Chad

doi:10.1093/ejcts/ezad426

Cited by 72 publications

(10 citation statements)

References 918 publications

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“…Root dilatation and supracoronary disease of the ascending aorta are more commonly correlated to genetically driven pathology than to the distal thoracic or thoracoabdominal aorta. Also, it is known that the morphology of aneurysms of the ascending aorta differs markedly from that of aneurysms of the descending aorta (which are more related to atherosclerosis) [15]. Sixty-two percent of the patients showed histopathological signs of aortic connective tissue disease, mostly media degeneration and changes in the elastic fibers, in 80.9% each.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Value of Histological Examination for the Prediction of Genetic Thoracic Proximal Aortopathies

Mahlmann,

Rodionov,

Behrendt

et al. 2024

JCM

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Background: Heritable connective tissue disorders are often accompanied by an increased risk for thoracic aortic aneurysm and dissection (TAAD). Profound knowledge of the underlying pathology may have an impact on individual treatment, systematic follow-up, and early detection by the screening of offspring. The aim of this study, based in a single high-volume tertiary center, was an analysis of the diagnostic validity of histopathologic findings in patients with TAAD due to these findings’ accuracy in diagnosing heritable connective tissue disorders. Methods: Therefore, genetic testing by next-generation sequencing (NGS) was performed to evaluate the correlations. In total, 65 patients with TAAD undergoing surgical treatment before the age of 60 years or with age up to 80 years if they had offspring at the time of the procedure were included in the analysis. Results: In our cohort, no certain correlation of histological findings to the results of genetic diagnostics in patients with clinically relevant aortic pathology could be shown. Patients with histopathologic findings for heritable connective tissue disorder and a positive gene variant were 11.6 years younger than patients without mutation and without histological evidence for connective tissue disorder. Conclusions: Genetic clarification is useful to define the specific genotype of the disease of the aortic wall in the case of non-specific histological characteristics.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Value of Histological Examination for the Prediction of Genetic Thoracic Proximal Aortopathies

Mahlmann,

Rodionov,

Behrendt

et al. 2024

JCM

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“…Aortic dissection is defined as an intimal tear propagating the blood flow into the media, resulting in the separation of the aortic wall layers by an intimal flap. The propagation of this process forms a true and a false lumen, with or without communicating re-entries ( 11 ). In accordance with contemporary guidelines, aortic intramural hematoma is characterized by a localized hemorrhage within the aortic wall of >5 mm and may occur with or without intimal disruption ( 11 ).…”

Section: Methodsmentioning

confidence: 99%

Clinical outcomes of the type II hybrid procedure for the repair of extensive aortic arch pathology

Xue,

Lou,

Wang

et al. 2024

J Thorac Dis

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Background Type II hybrid arch repair (HAR) has been used for the repair of extensive aortic arch pathology. The aim of this study was to retrospectively analyze single-stage hybrid treatment involving replacement of the ascending aorta, arch debranching, and zone 0 stent graft deployment. Methods We retrospectively analyzed clinical data from 41 patients with acute and chronic aortic disease who underwent a type II hybrid arch procedure at Beijing Anzhen Hospital and Beijing Chaoyang Hospital from January 2020 to August 2022. The femoral arteries and right axillary arteries were used as cannulation sites to decrease the risk of malperfusion. During surgery, the nasopharyngeal temperature was lowered to 30 ℃. Demographic, perioperative, and late results data were retrieved and analyzed. Results The mean age of the patients was 54.9±11.1 years, and 31 patients (75.6%) were men. In all cases, zone 0 stent graft deployment was successful, with no in-hospital mortality. The median follow-up time was 10.5 [interquartile range (IQR), 4.8–17.6] months, and the survival rate was 94.9% during follow-up. Complications included cerebral infarction (3 patients, 7.3%) and renal failure requiring dialysis (3 patients, 7.3%). There were no occurrences of paraplegia, and no stent-related complications occurred during the follow-up period. Conclusions The single-stage hybrid arch procedure achieved satisfactory early results and represents a less invasive approach for treating complex diffuse aortic disease that affects the arch. This strategy is an important technical advance in the treatment of high-risk patients with extensive aortic arch pathology.

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“…The aortic diameter is the principal decision-making criterion for surgical intervention within the Multidisciplinary Aortic Team. According to the latest clinical guidelines (EACTS/STS) for aortic diseases published in 2024, surgical replacement of the aorta is recommended when the aortic diameter is greater than 5.5 cm [ 37 ]. In high-risk patients with the presence of connective tissue disorders (e.g., Marfan or Loeys-Dietz), earlier intervention is recommended (≥ 4.5 cm).…”

Section: Challenges In Clinical Managementmentioning

confidence: 99%

“…On the contrary, ATAA severity has been indicated to be worse in women compared to men with faster aneurysm growth [ 32 ] and increased in-hospital mortality rates [ 134 ]. The estimated incidence of ATAA ranges from 5–10 per 100,000 individuals/year [ 37 , 156 ], with a currently increasing trend [ 107 ]. Compared to abdominal aortic aneurysm (AAA), ATAA exhibits different flow patterns [ 176 ], regional variations [ 185 ], and developmental origins [ 193 ].…”

Section: Introductionmentioning

confidence: 99%

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Unveiling cellular and molecular aspects of ascending thoracic aortic aneurysms and dissections

Ganizada,

Veltrop,

Akbulut

et al. 2024

Basic Res Cardiol

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Ascending thoracic aortic aneurysm (ATAA) remains a significant medical concern, with its asymptomatic nature posing diagnostic and monitoring challenges, thereby increasing the risk of aortic wall dissection and rupture. Current management of aortic repair relies on an aortic diameter threshold. However, this approach underestimates the complexity of aortic wall disease due to important knowledge gaps in understanding its underlying pathologic mechanisms.Since traditional risk factors cannot explain the initiation and progression of ATAA leading to dissection, local vascular factors such as extracellular matrix (ECM) and vascular smooth muscle cells (VSMCs) might harbor targets for early diagnosis and intervention. Derived from diverse embryonic lineages, VSMCs exhibit varied responses to genetic abnormalities that regulate their contractility. The transition of VSMCs into different phenotypes is an adaptive response to stress stimuli such as hemodynamic changes resulting from cardiovascular disease, aging, lifestyle, and genetic predisposition. Upon longer exposure to stress stimuli, VSMC phenotypic switching can instigate pathologic remodeling that contributes to the pathogenesis of ATAA.This review aims to illuminate the current understanding of cellular and molecular characteristics associated with ATAA and dissection, emphasizing the need for a more nuanced comprehension of the impaired ECM–VSMC network.

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EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ

Cited by 72 publications

References 918 publications

Evaluation of the Value of Histological Examination for the Prediction of Genetic Thoracic Proximal Aortopathies

Evaluation of the Value of Histological Examination for the Prediction of Genetic Thoracic Proximal Aortopathies

Clinical outcomes of the type II hybrid procedure for the repair of extensive aortic arch pathology

Unveiling cellular and molecular aspects of ascending thoracic aortic aneurysms and dissections

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