Journal and News Scan

To date, there has been no unianimous method to calculate the diameter of the aorta prior to the occurence of type A aortic dissection. In this study, reseachers from Osaka, Japan, reported the efforts in developing equations for estimating the predissection diameters of the ascending aorta and the arch based on postdissection measurements. These equations have the potential of determining the size of stent grafts in the management of patients with type A dissection.

Researchers of the Canadian Thoracic Aortic Collaborative (CTAC) analyzed the operative outcomes in 1653 patients (30% women) undergoing thoracic aortic surgery with hypothermic circulatory arrest between 2002 and 2017 in 10 institutions. Outcomes of interest were in-hospital death, stroke, and a modified Society of Thoracic Surgeons-defined composite (STS-COMP) for mortality or major morbidity (stroke, renal failure, deep sternal wound infection, reoperation, prolonged ventilation).

Compared with men, women were older (66 versus 61 years; P < 0.001) and had more hypertension and renal failure, but they had less coronary disease, less previous cardiac surgery, and higher ejection fractions. Rates of aortic dissection were similar between two genders, as were rates of hemiarch, total arch, and thoracoabdominal aortic repair. However, women had less aortic root reconstruction, including aortic root replacement, Ross, or valve-sparing root operations (29% versus 45%; P < 0.001). Men had longer cross-clamp and cardiopulmonary bypass times than women, but they had similar durations of circulatory arrest, methods of cerebral perfusion, and nadir temperatures. Women had a higher rate of death (11% versus 7.4%; P = 0.02), stroke (8.8% versus 5.5%; P = 0.01), and STS-COMP (31% versus 27%; P = 0.04). On multivariable analyses, female sex was an independent predictor of mortality (odds ratio [OR], 1.81; P < 0.001), stroke (OR, 1.90; P < 0.001), and STS-COMP (OR, 1.40; P < 0.001).

Given the worse outcomes in women, the authors call for earlier surgery once diagnosis of thoracic aortic disease is made in women and further investigation to better delineate which measures may reduce sex-related outcome differences after complex aortic surgery.

Descending thoracic endovascular aneurysm repair (D-TEVAR) is often performed by vascular surgeons. At many institutions, cardiothoracic surgery support is required for an elective TEVAR to take place. Oftentimes, this means a dedicated cardiopulmonary bypass team must be available.

In this study, the vascular team from NYU Langone Hospital in Brooklyn, New York, retrospectively analyzed their experience in 18 patients who underwent D-TEVAR between March 2014 and January 2018. No major complications occurred. Two patients experienced a type II endoleak. No patients required conversion to an open procedure, nor did any patients necessitate intervention by cardiothoracic surgery or cardiopulmonary bypass support.

Although these data suggest that cardiothoracic surgery support is not required D-TEVAR, the conclusion should be interpreted very cautiously. The importance of multidisciplinary collaboration in treating patients with aortic disease cannot be overemphasized.

A number of interesting findings in early follow up of this randomized controlled trial on one type of transcatheter aortic valve against conventional surgery: the mechanics of the valve and the incidence of complete heart block, to name but a few. We await the longer follow up.