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Surgical Approaches for Complex Thoracic Aortic Diseases
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Surgical Approaches for Complex Thoracic Aortic Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (20 February 2024) | Viewed by 8830

Special Issue Editors

Prof. Dr. Thanos Athanasiou

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Guest Editor
Department of Surgery and Cancer, Imperial College London, London, UK
Interests: cardiac surgery; aortic surgery; clinical research
Special Issues, Collections and Topics in MDPI journals
Dr. Dimitrios E. Magouliotis

E-Mail
Guest Editor
Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
Interests: cardio-thoracic surgery; surgical oncology; bariatric surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Thoracic aortic diseases represent one of the most challenging sequelae for cardiac surgeons and the cause of approximately 10,000 deaths annually in the United States alone. The goal of surgical intervention is to prevent the high morbidity and mortality associated with either acute aortic syndromes or aneurysm rupture. Nonetheless, the design of surgical treatment and the decision making process is even more challenging in complex cases, raising the bar of difficulty for surgical intervention. In the same context, depending on the anatomy, pathology, emergency/severity of the disease, and the patient’s clinical status, there is a wide spectrum of alternative approaches and strategies that are included in the cardiac surgeon’s armamentarium. Meanwhile, the introduction in practice of new instruments and the adoption of hybrid approaches sets a new paradigm shift in aortic surgery. In this rapidly changing landscape, we call all cardiac surgeons with a special interest in aortic surgery to contribute to this Special Issue and bring their own experience regarding the treatment of complex thoracic aortic diseases. Our vision is to provide the best currently available and up-to-date evidence on this important topic, thus providing all the necessary information to cardiac surgeons on core concepts in the surgical management of this challenging group of patients.

Prof. Dr. Thanos Athanasiou
Dr. Dimitrios E. Magouliotis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • aortic surgery
  • thoracic aortic aneurysms
  • TAA
  • acute aortic syndromes
  • aortic dissection
  • intramural hematoma
  • penetrating aortic ulcer

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Published Papers (6 papers)

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Editorial

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3 pages, 156 KiB  
Editorial
Complex Thoracic Aortic Diseases and Surgery: A Quest for the Golden Fleece
by Dimitrios E. Magouliotis and Thanos Athanasiou
J. Clin. Med. 2024, 13(21), 6620; https://doi.org/10.3390/jcm13216620 - 4 Nov 2024
Viewed by 562
Abstract
In Greek mythology, the Golden Fleece, a golden-wooled fleece of a winged ram called Chrysomallos, stood as an eternal symbol of authority and power [...] Full article
(This article belongs to the Special Issue Surgical Approaches for Complex Thoracic Aortic Diseases)

Research

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14 pages, 1616 KiB  
Article
Paradoxical Changes: EMMPRIN Tissue and Plasma Levels in Marfan Syndrome-Related Thoracic Aortic Aneurysms
by Kyle C. Alexander, Carlton W. Anderson, Chris B. Agala, Panagiotis Tasoudis, Elizabeth N. Collins, Yiwen Ding, John W. Blackwell, Danielle E. Willcox, Behzad S. Farivar, Melina R. Kibbe, John S. Ikonomidis and Adam W. Akerman
J. Clin. Med. 2024, 13(6), 1548; https://doi.org/10.3390/jcm13061548 - 8 Mar 2024
Viewed by 1183
Abstract
Background: Thoracic aortic aneurysms (TAAs) associated with Marfan syndrome (MFS) are unique in that extracellular matrix metalloproteinase inducer (EMMPRIN) levels do not behave the way they do in other cardiovascular pathologies. EMMPRIN is shed into the circulation through the secretion of extracellular vesicles. [...] Read more.
Background: Thoracic aortic aneurysms (TAAs) associated with Marfan syndrome (MFS) are unique in that extracellular matrix metalloproteinase inducer (EMMPRIN) levels do not behave the way they do in other cardiovascular pathologies. EMMPRIN is shed into the circulation through the secretion of extracellular vesicles. This has been demonstrated to be dependent upon the Membrane Type-1 MMP (MT1-MMP). We investigated this relationship in MFS TAA tissue and plasma to discern why unique profiles may exist. Methods: Protein targets were measured in aortic tissue and plasma from MFS patients with TAAs and were compared to healthy controls. The abundance and location of MT1-MMP was modified in aortic fibroblasts and secreted EMMPRIN was measured in conditioned culture media. Results: EMMPRIN levels were elevated in MFS TAA tissue but reduced in plasma, compared to the controls. Tissue EMMPRIN elevation did not induce MMP-3, MMP-8, or TIMP-1 expression, while MT1-MMP and TIMP-2 were elevated. MMP-2 and MMP-9 were reduced in TAA tissue but increased in plasma. In aortic fibroblasts, EMMPRIN secretion required the internalization of MT1-MMP. Conclusions: In MFS, impaired EMMPRIN secretion likely contributes to higher tissue levels, influenced by MT1-MMP cellular localization. Low EMMPRIN levels, in conjunction with other MMP analytes, distinguished MFS TAAs from controls, suggesting diagnostic potential. Full article
(This article belongs to the Special Issue Surgical Approaches for Complex Thoracic Aortic Diseases)
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17 pages, 915 KiB  
Article
Endovascular Treatment of Type A Aortic Dissection: A Systematic Review and Meta-Analysis Using Reconstructed Time-to-Event Data
by Konstantinos S. Mylonas, Ioannis Zoupas, Panagiotis T. Tasoudis, Evangelos Vitkos, George T. Stavridis and Dimitrios V. Avgerinos
J. Clin. Med. 2023, 12(22), 7051; https://doi.org/10.3390/jcm12227051 - 12 Nov 2023
Cited by 4 | Viewed by 1427
Abstract
Objective: The undisputed gold standard of treatment for type A aortic dissections (TAAD) is open surgery. Anecdotal reports have assessed thoracic endovascular aortic repair (TEVAR) as a last resort for highly selected candidates. The present study aims to evaluate endovascular outcomes in TAAD [...] Read more.
Objective: The undisputed gold standard of treatment for type A aortic dissections (TAAD) is open surgery. Anecdotal reports have assessed thoracic endovascular aortic repair (TEVAR) as a last resort for highly selected candidates. The present study aims to evaluate endovascular outcomes in TAAD patients who are unsuitable for open surgery whilst having TEVAR-compatible aortic anatomy. Methods: A PRISMA-compliant systematic search of the PubMed, Scopus, and Cochrane databases was performed up to 19 May 2022. Time-to-event data were reconstructed using Kaplan–Meier curves from the source literature. Results: In 20 eligible studies, 311 patients underwent TEVAR for acute, subacute, or chronic TAAD. Mean age at the time of the operation was 60.70 ± 8.00 years and 75.48% (95% Confidence Interval [CI], 60.33–88.46%) of the included patients were males. Mean operative time was 169.40 ± 30.70 min. Overall, 0.44% (95% CI, 0.00–4.83%) of the cases were converted to salvage open surgery. Technical failure, stroke, and endoleaks occurred in 0.22%, 0.1%, and 8.52% of the cohort, respectively. Thirty-day postoperative complication rate was 7.08% (95% CI, 1.52–14.97%), whereas late complications developed in 16.89% (95% CI, 7.75–27.88%) of the patients. One-, three-, and five-year survival rates were estimated at 87.15%, 82.52% and 82.31%, respectively. Reintervention was required in 8.38% of the cohort over a mean follow-up of 32.40 ± 24.40 months. Conclusions: TEVAR seems to be feasible in highly selected patients with TAAD who cannot tolerate open surgery. Overcoming technical limitations and acquiring long-term data are warranted to safely define the place of endovascular treatment in the armamentarium of TAAD repair. Full article
(This article belongs to the Special Issue Surgical Approaches for Complex Thoracic Aortic Diseases)
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16 pages, 15548 KiB  
Article
Sizing the Frozen Elephant Trunk Based on Aortic Pathology and the Importance of Pre-Operative Imaging
by Marinos Koulouroudias, Konstantinos Velissarios, John Kokotsakis, Dimitrios E. Magouliotis, Pantelis Tsipas, Arian Arjomandi Rad, Alessandro Viviano, Antonios Kourliouros and Thanos Athanasiou
J. Clin. Med. 2023, 12(21), 6836; https://doi.org/10.3390/jcm12216836 - 29 Oct 2023
Cited by 2 | Viewed by 2019
Abstract
The frozen elephant trunk is a formidable tool for the aortovascular surgeon. An appreciation of how to size the graft in different pathologies is key in achieving optimal results. Herein, we demonstrate worked examples of how imaging can be used to plan for [...] Read more.
The frozen elephant trunk is a formidable tool for the aortovascular surgeon. An appreciation of how to size the graft in different pathologies is key in achieving optimal results. Herein, we demonstrate worked examples of how imaging can be used to plan for a frozen elephant trunk and discuss the nuisances and uncertainties of sizing using three index cases: Type A aortic dissection, distal thoracic aortic aneurysm and chronic dissection. Full article
(This article belongs to the Special Issue Surgical Approaches for Complex Thoracic Aortic Diseases)
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12 pages, 2167 KiB  
Article
Assessment of the Effectiveness of Zone 1-Landing Hybrid TEVAR by Comparing Its Outcomes with Those of Zone 2-Landing Hybrid TEVAR
by Tomoaki Kudo, Toru Kuratani, Yoshiki Sawa and Shigeru Miyagawa
J. Clin. Med. 2023, 12(16), 5326; https://doi.org/10.3390/jcm12165326 - 16 Aug 2023
Viewed by 1335
Abstract
Background: Hybrid thoracic endovascular aortic repair (TEVAR) without median sternotomy is increasingly being performed in high-risk patients with aortic arch disease. The outcomes of hybrid TEVAR were reported to be worse with a more proximal landing zone. This study aims to clarify the [...] Read more.
Background: Hybrid thoracic endovascular aortic repair (TEVAR) without median sternotomy is increasingly being performed in high-risk patients with aortic arch disease. The outcomes of hybrid TEVAR were reported to be worse with a more proximal landing zone. This study aims to clarify the effectiveness of zone 1-landing hybrid TEVAR by comparing the outcomes of zone 2-landing hybrid TEVAR. Methods: From April 2008 to October 2020, 213 patients (zone 1: zone 1-landing hybrid TEVAR, n = 82, 38.5%; zone 2: zone 2-landing hybrid TEVAR, n = 131, 61.5%) were enrolled (median age, 72 years; interquartile range [IQR], 65–78 years), with a median follow-up period of 6.0 years (IQR, 2.8–9.7 years). Results: The mean logistic EuroSCORE was 20.9 ± 14.8%: the logistic EuroSCORE of the zone 1 group (23.3 ± 16.1) was significantly higher than that of the zone 2 group (19.3 ± 12.4%, p = 0.045). The operative time and hospital stay of the zone 1 group were significantly longer than those of the zone 2 group. On the other hand, the in-hospital and late outcomes did not differ significantly between the two groups. There were no significant differences in cumulative survival (66.8% vs. 78.0% at 10 years, Log-rank p = 0.074), aorta-related death-free rates (97.6% vs. 99.2% at 10 years, Log-rank p = 0.312), and aortic event-free rates (81.4% vs. 87.9% at 10 years, Log-rank p = 0.257). Conclusions: Zone 1- and 2-landing hybrid TEVAR outcomes were satisfactory. Despite the high procedural difficulty and surgical risk, the outcomes of zone 1-landing hybrid TEVAR were equal to those of zone 2-landing hybrid TEVAR. If the surgical risk is high, zone 1-landing hybrid TEVAR should not be avoided. Full article
(This article belongs to the Special Issue Surgical Approaches for Complex Thoracic Aortic Diseases)
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Review

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11 pages, 237 KiB  
Review
New Directions in Diagnostics for Aortic Aneurysms: Biomarkers and Machine Learning
by Kyle C. Alexander, John S. Ikonomidis and Adam W. Akerman
J. Clin. Med. 2024, 13(3), 818; https://doi.org/10.3390/jcm13030818 - 31 Jan 2024
Cited by 1 | Viewed by 1636
Abstract
This review article presents an appraisal of pioneering technologies poised to revolutionize the diagnosis and management of aortic aneurysm disease, with a primary focus on the thoracic aorta while encompassing insights into abdominal manifestations. Our comprehensive analysis is rooted in an exhaustive survey [...] Read more.
This review article presents an appraisal of pioneering technologies poised to revolutionize the diagnosis and management of aortic aneurysm disease, with a primary focus on the thoracic aorta while encompassing insights into abdominal manifestations. Our comprehensive analysis is rooted in an exhaustive survey of contemporary and historical research, delving into the realms of machine learning (ML) and computer-assisted diagnostics. This overview draws heavily upon relevant studies, including Siemens’ published field report and many peer-reviewed publications. At the core of our survey lies an in-depth examination of ML-driven diagnostic advancements, dissecting an array of algorithmic suites to unveil the foundational concepts anchoring computer-assisted diagnostics and medical image processing. Our review extends to a discussion of circulating biomarkers, synthesizing insights gleaned from our prior research endeavors alongside contemporary studies gathered from the PubMed Central database. We elucidate the prevalent challenges and envisage the potential fusion of AI-guided aortic measurements and sophisticated ML frameworks with the computational analyses of pertinent biomarkers. By framing current scientific insights, we contemplate the transformative prospect of translating fundamental research into practical diagnostic tools. This narrative not only illuminates present strides, but also forecasts promising trajectories in the clinical evaluation and therapeutic management of aortic aneurysm disease. Full article
(This article belongs to the Special Issue Surgical Approaches for Complex Thoracic Aortic Diseases)
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