PP2A Attenuates Thoracic Aneurysm and Dissection in Mouse Models of Marfan Syndrome.

Background: Recent studies show that hyperactivation of mTOR (mammalian target of rapamycin) signaling plays a causal role in the development of thoracic aortic aneurysm and dissection. Modulation of PP2A (protein phosphatase 2A) activity has been shown to be of significant therapeutic value. In light of the effects that PP2A can exert on the mTOR pathway, we hypothesized that PP2A activation by small-molecule activators of PP2A could mitigate AA progression in Marfan syndrome (MFS).

Malperfusion in Patients with Acute Type A Aortic Dissection: A Nationwide Analysis.

Background: This study describes in detail the clinical burden of malperfusion associated with acute Type A aortic dissection (ATAAD) in a large, national cohort and the effect of treatment strategy on outcomes.

Methods: All patients undergoing repair of ATAAD between 2017 and 2020 in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were studied. Malperfusion was defined using STS definitions based on imaging or surgeon's evaluation.

Valve Sparing Aortic Root Replacement in the Resternotomy Setting.

Objectives: While valve-sparing aortic root replacement (VSRR) has demonstrated satisfactory outcomes, its utility in a reoperative sternotomy setting remains uncertain. This study evaluates the perioperative safety and long-term durability of reoperative sternotomy VSRR.

Methods: All consecutive VSRR at two centers from 2005-2020 were included.

Double Transposition and Physician-Modified Endografting for Complex Arch Aneurysm.

Hybrid repair of complex aortic arch disease typically requires aortic debranching to create a proximal landing zone for completion arch endografting. Despite advances in endograft technology, physician-modified endografting may be required to customize a prosthesis for challenging anatomy. We present a case of a complex distal arch aneurysm after a prior coarctation repair with a pediatric interposition graft several decades earlier, treated with hybrid repair by double transposition for arch debranching and physician-modified arch endografting for complete aneurysm exclusion.

Side- and Disease-Dependent Changes in Human Aortic Valve Cell Population and Transcriptomic Heterogeneity Determined by Single-Cell RNA Sequencing.

Background: Calcific aortic valve disease (CAVD) is a highly prevalent disease, especially in the elderly population, but there are no effective drug therapies other than aortic valve repair or replacement. CAVD develops preferentially on the fibrosa side, while the ventricularis side remains relatively spared through unknown mechanisms. We hypothesized that the fibrosa is prone to the disease due to side-dependent differences in transcriptomic patterns and cell phenotypes.

Reoperation after aortic root replacement and its impact on long-term survival.

Objective: Reoperation after aortic root replacement (ARR) is associated with increased operative risk and complexity. This study evaluated clinical outcomes and reoperation rates in patients undergoing ARR.

Methods: From 2004 to 2021, 2700 adult patients underwent an ARR in a 2-institution database.

Transcatheter electrosurgical aortic septostomy optimizes distal landing zone in chronic dissection.

Objective: Efficacy of thoracic endovascular aortic repair (TEVAR) for chronic type B aortic dissection (CTBAD) is dependent on eliminating retrograde false lumen perfusion and remodeling the aorta. We describe the efficacy of a novel transcatheter electrosurgical technique to fenestrate the dissection flap and create a distal seal zone for TEVAR in CTBAD.

Methods: A retrospective review of the Emory Aortic Database from 2016 to 2023 identified 33 patients who underwent TEVAR with intentional endovascular rupture of the dissection flap (Knickerbocker; KNICK) for CTBAD.

Long-term Results of Valve-Sparing Aortic Root Replacement in Acute Type A Aortic Dissection.

Background: Valve preservation in acute type A aortic dissection (ATAAD) can be accomplished with root repair or replacement. Long-term valve durability with root repair has been established, but limited data exist regarding long-term durability of valve-sparing root replacement (VSRR). In this study, long-term results of VSRR were compared with root repair in ATAAD.

Outcomes of a Novel Single-Branched Aortic Stent Graft for Treatment of Type B Aortic Dissection.

Background: Intervention on type B dissection frequently requires landing the proximal edge of the stent graft between the left common carotid artery and left subclavian artery (LSA). The GORE TAG thoracic branch endoprosthesis is a technology that allows LSA preservation with a single internal branch.

Methods: This study was a prospective nonrandomized single-arm clinical trial of patients with type B aortic dissection who were treated with the single-branched device.

Aggressive Treatment Strategy at Index Thoracic Endovascular Aortic Surgery is Associated with Reduced Need for Short-Term Reintervention in Patients with Aortic Dissection.

Introduction: Thoracic endovascular aortic surgery (TEVAR) is the modern standard of treatment for patients with Type B aortic dissection, however it is unclear how the initial length of treated aorta affects long-term outcomes. This study aims to elucidate risk factors for secondary intervention after TEVAR for aortic dissection, focusing on length of aortic treatment at index operation.

Methods: A retrospective multihospital chart review was completed for patients treated between 2011 and 2022 who underwent TEVAR for aortic dissection with at least 1 year of post-TEVAR imaging and follow-up.

Early trajectories of virological and immunological biomarkers and clinical outcomes in patients admitted to hospital for COVID-19: an international, prospective cohort study.

Background: Serial measurement of virological and immunological biomarkers in patients admitted to hospital with COVID-19 can give valuable insight into the pathogenic roles of viral replication and immune dysregulation. We aimed to characterise biomarker trajectories and their associations with clinical outcomes.

Methods: In this international, prospective cohort study, patients admitted to hospital with COVID-19 and enrolled in the Therapeutics for Inpatients with COVID-19 platform trial within the Accelerating COVID-19 Therapeutic Interventions and Vaccines programme between Aug 5, 2020 and Sept 30, 2021 were included.

Long-term outcomes after aortic root replacement for bicuspid aortic valve-associated aneurysm.

Objective: Patients with congenital bicuspid aortic valve often require root replacement. This study aims to describe their long-term rates of mortality and reoperation.

Methods: This is a multicenter retrospective study of 747 patients with bicuspid aortic valve who underwent aortic root replacement for aortic aneurysm between 2004 and 2020.

Supravalvular Aortic Stenosis in Homozygous Familial Hypercholesterolemia: Contemporary Management.

We report a case of a patient diagnosed with homozygous familial hypercholesterolemia and progressive supravalvular aortic stenosis. Treatment with long-term low-density lipoprotein apheresis and management with novel lipid-lowering agents including an angiopoetin-like protein inhibitor led to significant low-density lipoprotein reduction. The case highlights the challenges in managing the manifestations of homozygous familial hypercholesterolemia.

Long-term outcomes after recurrent acute thoracic aortic dissection: Insights from the International Registry of Aortic Dissection.

Objective: With an aging population and advancements in imaging, recurrence of thoracic aortic dissection is becoming more common.

Methods: All patients enrolled in the International Registry of Aortic Dissection from 1996 to 2023 with type A and type B acute aortic dissection were identified. Among them, initial dissection and recurrent dissection were discerned.

The role of anatomic shape features in the prognosis of uncomplicated type B aortic dissection initially treated with optimal medical therapy.

Objective: Currently, the long-term outcomes of uncomplicated type B aortic dissection (TBAD) patients managed with optimal medical therapy (OMT) remain poor. Aortic expansion is a major factor that determines patient long-term survival. The objective of this study was to investigate the association between anatomic shape features and (i) OMT outcome; (ii) aortic growth rate for TBAD patients initially treated with OMT.

Acute Type B Intramural Hematoma: Novel Insights in the Endovascular Era.

Background: The pathophysiology and behavior of acute type B intramural hematoma (TBIMH) is poorly understood. The purpose of this study is to characterize the pathophysiology, fate, and outcomes of TBIMH in the endovascular era.

Methods: A retrospective analysis of a US Aortic Database identified 70 patients with TBIMH from 2008 to 2022.

True redo-aortic root replacement versus root replacement after any previous surgery.

Objective: The impact of previous aortic root replacement (True-Redo) versus any previous operation (Any-Redo) on outcomes after reoperative aortic root replacement (redo-ROOT) is largely unknown. In this first multi-institutional study, the clinical impact True-Redo versus Any-Redo in the setting of redo-ROOT was reviewed.

Methods: From 2004 to 2021, 822 patients underwent redo-ROOT at 2 major academic centers: 638 Any-Redo and 184 True-Redo.