Surgical Indication for Chronic Aortic Dissection in Descending Thoracic and Thoracoabdominal Aorta

Oda, Tatsuya; Minatoya, Kenji; Sasaki, Hiroaki; Tanaka, Hiroshi; Seike, Yoshimasa; Itonaga, Tatsuya; Inoue, Yosuke; Higashi, Masahiro; Nishimura, Kunihiro; Kobayashi, Junjiro

doi:10.1161/circinterventions.116.004292

Cited by 19 publications

(12 citation statements)

References 21 publications

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“…As is known to all, the normal aortic media comprises of many vascular smooth muscle cells that are regularly arranged and distributed widely, and extracellular matrix that is enriched in elastic fibers. Obviously, SMCs would play an essential role in the development of progression of TAD, which may be involved in the structure and function of aortic tissues [ 19 , 20 ]. In normal human body, contractile phenotype of VSMCs plays an important role in maintenance of the vascular structure and function of the blood vessel wall.…”

Section: Discussionmentioning

confidence: 99%

Hypoxia-inducible factor 1a induces phenotype switch of human aortic vascular smooth muscle cell through PI3K/AKT/AEG-1 signaling

et al. 2017

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To date, hypoxia-inducible factor 1a (HIF-1a) and astrocyte elevated gene-1 (AEG-1) have been involved in the proliferation, migration and morphological changes of vascular smooth muscle cells. However, the potential relationship of HIF-1a-AEG-1 pathway in human aortic smooth muscle cell (HASMC) has not been reported. In the present study, in-vitro assays were utilized to explore the potential impact of HIF-1a-AEG-1 signaling on HASMC phenotype. Here, we found that HIF-1a expression was up-regulated in the media of thoracic aortic dissection tissues as compared with normal aortic tissues, and was associated with increased apoptotic SMCs and decreased AEG-1 expression. Mechanically, hypoxia promoted the expression of HIF-1a by PI3K-AKT pathway in HASMCs; HIF-1a further suppressed the expressions of AEG-1, a-SMA and SM22a, and promoted osteopontin (OPN) expression. Functionally, HIF-1a inhibited the proliferation and migration of HASMCs. However, si-HIF-1a or Akt inhibitor abrogated HIF-1a-mediated related expressions and biological effects above. In conclusion, HIF-1a induces HASMC phenotype switch, and closely related to PI3K/AKT and AEG-1 signaling, which may provide new avenues for the prevention and treatment of aortic dissection diseases.

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Section: Discussionmentioning

confidence: 99%

Hypoxia-inducible factor 1a induces phenotype switch of human aortic vascular smooth muscle cell through PI3K/AKT/AEG-1 signaling

et al. 2017

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“…Still, these remarks are speculative, and the underlying mechanism will need to be fully explored. Furthermore, it remains unclear whether the elevated flow metrics in patients with TAAD will lead to higher rates of aneurysm . Thus, it will be useful to follow patients with rTAAD over time to monitor the effects of elevated flow parameters on aortic size and rate of complications such as aortic aneurysmal degeneration and failure of FL thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Parametric Hemodynamic 4D Flow MRI Maps for the Characterization of Chronic Thoracic Descending Aortic Dissection

Jarvis

Pruijssen

Son

et al. 2019

Magnetic Resonance Imaging

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Background: Systematic evaluation of complex flow in the true lumen and false lumen (TL, FL) is needed to better understand which patients with chronic descending aortic dissection (DAD) are predisposed to complications. Purpose: To develop quantitative hemodynamic maps from 4D flow MRI for evaluating TL and FL flow characteristics. Study Type: Retrospective. Population: In all, 20 DAD patients (age = 60 AE 11 years; 12 male) (six medically managed type B AD [TBAD], 14 repaired type A AD [rTAAD] now with ascending aortic graft [AAo] or elephant trunk [ET1] repair) and 21 age-matched controls (age = 59 AE 10 years; 13 male) were included. Field Strength/Sequence: 1.5T, 3T, 4D flow MRI. Assessment: 4D flow MRI was acquired in all subjects. Data analysis included 3D segmentation of TL and FL and voxelwise calculation of forward flow, reverse flow, flow stasis, and kinetic energy as quantitative hemodynamics maps. Statistical Tests: Analysis of variance (ANOVA) or Kruskal-Wallis tests were performed for comparing subject groups. Correlation and Bland-Altman analysis was performed for the interobserver study. Results: Patients with rTAAD presented with elevated TL reverse flow (AAo repair: P = 0.004, ET1: P = 0.018) and increased TL kinetic energy (AAo repair: P = 0.0002, ET1: P = 0.011) compared to controls. In addition, TL kinetic energy was increased vs. patients with TBAD (AAo repair: P = 0.021, ET1: P = 0.048). rTAAD was associated with higher FL kinetic energy and lower FL stasis compared to patients with TBAD (AAo repair: P = 0.002, ET1: P = 0.024 and AAo repair: P = 0.003, ET1: P = 0.048, respectively). Data Conclusion: Quantitative maps from 4D flow MRI demonstrated global and regional hemodynamic differences between DAD patients and controls. Patients with rTAAD vs. TBAD had significantly altered regional TL and FL hemodynamics. These findings indicate the potential of 4D flow MRI-derived hemodynamic maps to help better evaluate patients with DAD.

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“…The random intercept for each institution allowed us to include unmeasured processes for the outcome specific to each institute. Considering that the association between the physician volume in each institute and the 30-day inhospital mortality was not linear, we used a systematic search for the best-fitting linear spline function or fractional polynomial function for physician volume using the MVRS command in Stata 12, 13 (for other details, refer to the Supplementary Material). All analyses were performed using STATA version 15 (StataCorp, College Station, TX, USA).…”

Section: Discussionmentioning

confidence: 99%

Impact of Physician Volume and Specialty on In-Hospital Mortality of Ischemic and Hemorrhagic Stroke

Nishimura

Ogasawara

Kitazono

et al. 2021

Circ J

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on behalf of the J-ASPECT Study Collaborators Background: The degree of association between mortality and case volume/physician volume is well known for many surgical procedures and medical conditions. However, the link between physician volume and death rate in patients hospitalized for stroke remains unclear. This study analyzed the correlation between in-hospital stroke mortality and physician volume per hospital, considering board certification status. Methods and Results:For this retrospective registry-based cohort study, data were obtained from the Japanese nationwide registry on patients hospitalized for ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) between 2010 and 2016. The number of stroke care physicians and relevant board-certified physicians was also obtained. Odd ratios (ORs) of 30-day in-hospital mortality were estimated after adjusting for institutional and patient differences using generalized mixed logistic regression. From 295,150 (ischemic stroke), 98,657 (ICH), and 36,174 (SAH) patients, 30-day in-hospital mortality rates were 4.4%, 16.0%, and 26.6%, respectively. There was a correlation between case volume and physician volume. A higher number of stroke care physicians was associated with a reduction in 30-day mortality after adjusting for stroke case volume and comorbidities for all stroke types (all P for trend<0.05).Conclusions: An increased number of stroke care physicians was associated with reduced in-hospital mortality for all types of stroke. The volume threshold of board-certified physicians depends on the specialty and stroke type.

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Surgical Indication for Chronic Aortic Dissection in Descending Thoracic and Thoracoabdominal Aorta

Cited by 19 publications

References 21 publications

Hypoxia-inducible factor 1a induces phenotype switch of human aortic vascular smooth muscle cell through PI3K/AKT/AEG-1 signaling

Hypoxia-inducible factor 1a induces phenotype switch of human aortic vascular smooth muscle cell through PI3K/AKT/AEG-1 signaling

Parametric Hemodynamic 4D Flow MRI Maps for the Characterization of Chronic Thoracic Descending Aortic Dissection

Impact of Physician Volume and Specialty on In-Hospital Mortality of Ischemic and Hemorrhagic Stroke

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