Efficacy and Pitfalls of Transapical Cannulation for the Repair of Acute Type A Aortic Dissection

Matsushita, Akihito; Manabe, Susumu; Tabata, Minoru; Fukui, Toshihiro; Shimokawa, Tomoki; Takanashi, Shuichiro

doi:10.1016/j.athoracsur.2012.02.036

Cited by 29 publications

(27 citation statements)

References 14 publications

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“…Aortic dissection, characterized by delamination of the aortic wall layers, is one of the most common forms of aortic disease (Jondeau and Boileau, 2012; Lu et al, 2012; Matsushita et al, 2012; Takigawa et al, 2012). It usually begins with a tear of the intimal layer in the aending thoracic aorta (ATA), which permits blood to enter the wall, split the media, and create a false lumen that can reenter the true lumen anywhere along the course of the aorta or exit through the adventitia causing frank rupture.…”

Section: Introductionmentioning

confidence: 99%

A mechanistic model on the role of “radially-running” collagen fibers on dissection properties of human ascending thoracic aorta

Pal

Tsamis

Pasta

et al. 2014

Journal of Biomechanics

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Aortic dissection (AoD) is a common condition that often leads to life-threatening cardiovaular emergency. From a biomechanics viewpoint, AoD involves failure of load-bearing microstructural components of the aortic wall, mainly elastin and collagen fibers. Delamination strength of the aortic wall depends on the load-bearing capacity and local micro-architecture of these fibers, which may vary with age, disease and aortic location. Therefore, quantifying the role of fiber micro-architecture on the delamination strength of the aortic wall may lead to improved understanding of AoD. We present an experimentally-driven modeling paradigm towards this goal. Specifically, we utilize collagen fiber microarchitecture, obtained in a parallel study from multi-photon microopy, in a predictive mechanistic framework to characterize the delamination strength. We then validate our model against peel test experiments on human aortic strips and utilize the model to predict the delamination strength of separate aortic strips and compare with experimental findings. We observe that the number density and failure energy of the radially-running collagen fibers control the peel strength. Furthermore, our model suggests that the lower delamination strength previously found for the circumferential direction in human aorta is related to a lower number density of radially-running collagen fibers in that direction. Our model sets the stage for an expanded future study that could predict AoD propagation in patient-specific aortic geometries and better understand factors that may influence propensity for occurrence.

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Section: Introductionmentioning

confidence: 99%

A mechanistic model on the role of “radially-running” collagen fibers on dissection properties of human ascending thoracic aorta

Pal

Tsamis

Pasta

et al. 2014

Journal of Biomechanics

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“…Left ventricular apex is also used: transapical approach. 98,99) Despite a high technical success rate of over 90%, one should pay attention to an entry to the left atrium, or conversion of route may be needed due to mal-perfusion or aortic regurgitation. Rarely, the innominate artery 100) or carotid artery 101) is used for the perfusion route.…”

Section: Perfusion Routementioning

confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

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Despite improved outcomes of acute type A aortic dissection (AAAD), many patients die at the moment of onset, and hospital mortality is still high. This article reviews the latest literature to seek the best possible way to optimize outcomes. Delayed diagnosis is caused by variation in or absence of typical symptoms, especially in patients with neurological symptoms. Misdiagnosis as acute myocardial infarction is another problem. Improved awareness by physicians is needed. On arrival, quick admission to the OR is desirable, followed by assessment with transesophageal echocardiography, and malperfusion already exists or newly develops in the OR; thus, timely diagnosis without delay with multimodality assessment is important. Although endovascular therapy is promising, careful introduction is mandatory so as not to cause complications. While various routes are used for the systemic perfusion, not a single route is perfect, and careful monitoring is essential. Surgical treatment on octogenarians is increasingly performed and produces better outcomes than conservative therapy. Complications are not rare, and consent from the family is essential. Prevention of AAAD is another important issue because more patients die at its onset than in the following treatment. In addition to hereditary diseases, including bicuspid aortic valve disease, the management of blood pressure is important.Keywords: aortic dissection, malperfusion, complication, echocardiography A cute type A aortic dissection (AAAD) not only causes sudden death at the time of onset but leads to various life-threatening complications. In spite of improved diagnostic imaging and surgical strategies, in-hospital mortality is still high, and patients who have survived often suffer from sequelae that make subsequent quality of life poor. This article is aimed to review the latest literature and ideas to seek the best possible way to minimize undesirable results.Various complications of AAAD caused by separation of the aortic wall to outer and inner layers are summarized as three categories: 1) aortic rupture due to disruption of the outer layer; 2) malperfusion caused by the inner layer, that is, the intimal flap; and 3) aortic regurgitation by a deformed aortic valve, leading to acute heart failure. Approximately 20% of patients instantaneously die due to aortic rupture, 1) and 1 to 2% of the remaining patients die every hour unless appropriately treated. 2) Although surgical outcomes are gradually improving, in-hospital mortality of surgical patients (repair on the aortic root to the arch) in 2009 was as high as around 10%, according to the Japanese database. 3) For the further improvement of outcomes, problems should be solved in each of preonset, pre-hospital, and in-hospital stages. In this review, the latter two stages are discussed first, since most of the literature focuses on these stages. After that, the issue of pre-onset stage, i.e., prevention is discussed. DelayeD DiagnosisIn consideration of the natural history of AAAD, the "chain of onset-to-sur...

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“…These consist of a variety of conditions targeting the aorta, with the most common forms being aneurysm [1,2], dissection [3,4], occlusion owing to atherosclerosis [5,6] and a general stiffening of the normally elastic aorta that is thought to be a natural consequence of ageing ( [7][8][9][10][11]; table 1). There are many co-morbid abnormalities that can lead to or be associated with one or more of these conditions, including hypertension [12][13][14], genetic mutations (such as Marfan syndrome (MFS) [15,16]), developmental defects (such as bicuspid aortic valve (BAV) [17 -19]), connective tissue disorders (such as Ehler -Danlos disorder [20,21], scleroderma [22,23], osteogenesis imperfecta [24,25], polycystic kidney disease [26,27] and Turner syndrome [28,29]), as well as injury.…”

Section: Introductionmentioning

confidence: 99%

Elastin and collagen fibre microstructure of the human aorta in ageing and disease: a review

Tsamis

Krawiec

Vorp

2013

J. R. Soc. Interface.

405

300

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Aortic disease is a significant cause of death in developed countries. The most common forms of aortic disease are aneurysm, dissection, atherosclerotic occlusion and ageing-induced stiffening. The microstructure of the aortic tissue has been studied with great interest, because alteration of the quantity and/or architecture of the connective fibres (elastin and collagen) within the aortic wall, which directly imparts elasticity and strength, can lead to the mechanical and functional changes associated with these conditions. This review article summarizes the state of the art with respect to characterization of connective fibre microstructure in the wall of the human aorta in ageing and disease, with emphasis on the ascending thoracic aorta and abdominal aorta where the most common forms of aortic disease tend to occur.

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Efficacy and Pitfalls of Transapical Cannulation for the Repair of Acute Type A Aortic Dissection

Cited by 29 publications

References 14 publications

A mechanistic model on the role of “radially-running” collagen fibers on dissection properties of human ascending thoracic aorta

A mechanistic model on the role of “radially-running” collagen fibers on dissection properties of human ascending thoracic aorta

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Elastin and collagen fibre microstructure of the human aorta in ageing and disease: a review

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