Improved Prognosis of Thoracic Aortic Aneurysms: a Population- Based Study

Clouse, W. Darrin; Hallett, John W.; Schaff, Hartzell V.; Gayari, Michelle M.; Ilstrup, Duane M.; Melton, Joseph

doi:10.1097/00132586-199908000-00011

Cited by 133 publications

(160 citation statements)

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“…7) The most common cause of thoracic aortic aneurysms is degenerative and its incidence is increasing and is 10.4 cases/100,000 person-years. 8) Despite the fact that rupture risk of an aneurysm is in direct proportion to the increase in the size of the aneurysm, the rupture risk in saccular aneurysms is independent from the size of the aneurysm. Both in the studies conducted and in European and American cardiology and cardiovascular surgery, thoracic, and aortic disease guidelines, endovascular repair is strongly recommended when descendent saccular aortic aneurysm is appropriate.…”

Section: Discussionmentioning

confidence: 99%

Simultaneously Successful Transfemoral Aortic Valve Implantation and Endovascular Repair of Thoracic Aortic Saccular Aneurysm

et al. 2014

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SummaryThe prevalence of aortic stenosis (AS) increases in the elderly. They present high surgical risk due to comorbid factors that increase with age. Transcatheter aortic valve implantation (TAVI) is an effective method in patients who present with severe aortic stenosis with a higher surgical risk or who cannot undergo surgical aortic valve replacement (s-AVR). In our case, the presence of saccular thoracic aortic aneurysm with severe AS, which is a vital co-morbidity, requires the treatment of both. The rise in systolic pressure following the TAVI procedure increases the saccular thoracic aneurysm rupture risk and this is why the timing and method of the two treatments become crucial. In this case, which is as far as we know the first and only report in the literature, both TAVI and endovascular thoracic aortic saccular aneurysm repair were applied simultaneously and successfully to the patient via the same transfemoral route. After 1 month, the patient had good functional capacity and there were no complications in control tomography and echocardiography. In this way, we attempted to emphasize with a multidisciplinary study that the patients be assessed carefully before the procedure, and found that even in patients with common peripheral vascular diseases, a transfemoral route could be used together with the proper methods, and that both procedures could be performed simultaneously. (Int Heart J 2014; 55: 459-462) Key words: Transcatheter aortic valve implantation, TEVAR, Aortic aneurysm T he prevalence of aortic stenosis (AS) has increased with the increase in life expectancy. As a result, severe comorbid factors can occur in advanced ages. The surgical replacement of a stenotic aortic valve (s-AVR) can be performed with low operative mortality rates in the absence of serious comorbid conditions. The patients undergoing s-AVR tend to have greater life expectancy and progress in their symptoms. However, 30% of the patients cannot undergo s-AVR due to left ventricular dysfunction, advanced age, and comorbid conditions. 1,2) Performed for the first time on a patient in 2002, transcatheter aortic valve implantation (TAVI) has become the leading treatment option for high risk and inoperable patient groups. One of the comorbid factors that increases the risk in patients is aortic aneurysm. The rupture risk will be increased with the increase in systolic pressure due to the aortic stenosis being treated. Hence, the timing and method of both treatments are of great importance in our high-risk case which was complicated by a thoracic aortic saccular aneurysm and serious aortic stenosis. In this study, thanks to our unique case in the literature, we managed to show that transfemoral aortic valve implantation and endovascular aneurysm repair could be performed simultaneously and successfully using the same femoral route by evaluating them in a detailed multidisciplinary way. Case ReportAn 83 year-old male patient with a history of coronary artery bypass grafting (CABG) and a permanent pacemaker (VVI-R type) follo...

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Section: Discussionmentioning

confidence: 99%

Simultaneously Successful Transfemoral Aortic Valve Implantation and Endovascular Repair of Thoracic Aortic Saccular Aneurysm

et al. 2014

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“…AscAA is an uncommon but highly lethal condition (Clouse et al 1998). In contrast to aneurysms of the descending aorta, AscAAs are not commonly due to atherosclerosis (Lilly 1997).…”

Section: Discussionmentioning

confidence: 99%

Increased Epicardial Adipose Tissue Thickness Is Correlated with Ascending Aortic Diameter

Çanğa

Kocaman

Çetin

et al. 2012

Tohoku J. Exp. Med.

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Epicardial adipose tissue (EAT), localized beneath the visceral pericardium, is a metabolically active endocrine and paracrine organ with possible interactions within the heart. Recent studies identified possible roles of uric acid (UA)-induced oxidative stress and increased inflammatory status in the pathogenesis of ascending aortic dilatation. The aim of this study was to investigate whether EAT is an independent factor for ascending aortic dilatation. The patients were evaluated by a complete transthoracic echocardiographic examination including measurements of EAT and aortic dimensions. Serum levels of UA and C-reactive protein and EAT thicknesses were compared in 38 patients with dilated ascending aorta (DAA) (the diameter ≥ 37 mm) vs. 107 subjects with normal aortic diameter (AD) of < 37 mm. EAT thickness was significantly higher in DAA group compared to normal AD group (8.3 ± 2.7 vs. 5.4 ± 2.2 mm, p < 0.001) as well as age (53 ± 10 vs. 48 ± 9 years, p = 0.004), the presence of hypertension (54% vs. 30%, p = 0.009) and UA levels (6.0 ± 1.4 vs. 5.2 ± 1.1 mg/dL, p < 0.001). There was a strong correlation between EAT thickness and ascending aortic diameter (r = 0.521, p < 0.001). In multiple logistic regression analysis, EAT thickness (OR: 1.429, p = 0.006), body mass index (OR: 1.169, p = 0.014) and UA levels (OR: 1.727, p = 0.023) were independently correlated to ascending aortic dilatation. We therefore propose that increased EAT thickness is an independent predictor of ascending aortic dilation.

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“…1,2) Although elective surgical repair is an effective approach to prevent death from ruptured TAA, it still carries a relatively high mortality rate despite improvements in techniques. Thus, new strategies for the clinical management of TAAs are being pursued, however, little is known about the mechanisms responsible for aneurysmal formation and progression except that matrix metalloproteinases (MMPs), which are required for the breakdown of matrix proteins, have attracted interest as causative molecules of TAAs and abdominal aortic aneurysms (AAA).…”

Section: Taketani Et Almentioning

confidence: 99%

Altered Patterns of Gene Expression Specific to Thoracic Aortic Aneurysms: Microarray Analysis of Surgically Resected Specimens

et al. 2005

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SUMMARYChanges in the expression levels of several genes have been described in aortic aneurysm specimens, however, the spectrum of diverse molecular alterations remains to be elucidated. We attempted to identify key molecules that modulate the pathogenesis of aortic aneurysm, using a complimentary DNA microarray carrying approximately 13,000 human genes.Segments of thoracic aortic aneurysms (TAA) and adjacent normal thoracic aortic tissues without aneurysmal changes (NTA) were obtained from 20 patients undergoing graft surgery. RNA obtained from five pairs of TAA and NTA samples was compared to determine aneurysm-specific alterations using microarray. Further, the expression levels of several genes of interest were verified in the remaining specimens by real-time reverse transcription-polymerase chain reaction (RT-PCR).In microarray assays, several types of the matrix metalloproteinases were upregulated as reported previously. Also, 220 genes suggested to be involved in protein degradation, inflammation, apoptosis, stress response, intracellular signaling, and other processes were significantly upregulated. Many of these genes have not been previously implicated in cardiovascular disease. The real time RT-PCR independently confirmed that the expression levels of MMP-2, MMP-9, ADAMTS-1, and caspase 4 were consistently increased in TAA.The results indicate that many genes are involved in a complicated manner in the pathogenesis of TAA. Investigation of these genes will help clarify the pathogenesis of this disease, and may lead to the discovery of novel therapeutic targets. (Int Heart J 2005; 46: 265-277)

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Improved Prognosis of Thoracic Aortic Aneurysms: a Population- Based Study

Cited by 133 publications

References 0 publications

Simultaneously Successful Transfemoral Aortic Valve Implantation and Endovascular Repair of Thoracic Aortic Saccular Aneurysm

Simultaneously Successful Transfemoral Aortic Valve Implantation and Endovascular Repair of Thoracic Aortic Saccular Aneurysm

Increased Epicardial Adipose Tissue Thickness Is Correlated with Ascending Aortic Diameter

Altered Patterns of Gene Expression Specific to Thoracic Aortic Aneurysms: Microarray Analysis of Surgically Resected Specimens

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