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Turk Gogus Kalp Damar Cerrahisi Dergisi Oct 2021This study aims to investigate incisional hernia incidence and risk factors after abdominal aortic aneurysm and aortic occlusive disease surgery via a midline laparotomy.
BACKGROUND
This study aims to investigate incisional hernia incidence and risk factors after abdominal aortic aneurysm and aortic occlusive disease surgery via a midline laparotomy.
METHODS
A total of 110 patients (66 males, 44 females; mean age: 69.3±8.8 years; range, 36 to 88 years) who underwent open elective surgery for aortoiliac occlusive diseases or abdominal aortic aneurysm between January 2005 and December 2016 were retrospectively analyzed. Both patient groups were compared in terms of surgical procedures, sex, age, American Society o f A nesthesiologists s core ( 1-3), b ody m ass i ndex (<25 vs. ≥25 kg/m), smoking (non-smoker <1 pack/day, smoking ≥1 pack/day), and time to incisional hernia development.
RESULTS
Incisional hernia occurred in 14.3% of the patients operated for aortoiliac occlusive disease and in 17.6% of the patients operated for abdominal aortic aneurysm (p=0.643). Incisional hernia was seen in three (5.7%) of 53 patients with a body mass index of <25 kg/m and was in 15 (26.3%) of 57 patients with a body mass index of ≥25 kg/m (p=0.03).
CONCLUSION
High body mass index is a risk factor for incisional hernia in patients undergoing aortic reconstructive surgery.
PubMed: 35096443
DOI: 10.5606/tgkdc.dergisi.2021.22340 -
Frontiers in Cardiovascular Medicine 2021Prosthesis-patient mismatch (PPM) is present when the effective area of a prosthetic valve inserted into a patient is inferior to that of a normal human valve; the... (Review)
Review
Prosthesis-patient mismatch (PPM) is present when the effective area of a prosthetic valve inserted into a patient is inferior to that of a normal human valve; the hemodynamic consequence of a valve too small compared with the size of the patient's body is the generation of higher than expected transprosthetic gradients. Despite evidence of increased risk of short- and long-term mortality and of structural valve degeneration in patients with PPM after surgical aortic valve replacement, its clinical impact in patients subject to transcatheter aortic valve implantation (TAVI) is yet unclear. We aim to review and update on the definition and incidence of PPM after TAVI, and its prognostic implications in the overall population and in higher-risk subgroups, such as small aortic annuli or valve-in-valve procedures. Last, we will focus on the armamentarium available in order to reduce risk of PPM when planning a TAVI procedure.
PubMed: 34150868
DOI: 10.3389/fcvm.2021.670457 -
Molecular Neurobiology Jan 2021The SARS-CoV-2 virus that is the cause of coronavirus disease 2019 (COVID-19) affects not only peripheral organs such as the lungs and blood vessels, but also the... (Review)
Review
The SARS-CoV-2 virus that is the cause of coronavirus disease 2019 (COVID-19) affects not only peripheral organs such as the lungs and blood vessels, but also the central nervous system (CNS)-as seen by effects on smell, taste, seizures, stroke, neuropathological findings and possibly, loss of control of respiration resulting in silent hypoxemia. COVID-19 induces an inflammatory response and, in severe cases, a cytokine storm that can damage the CNS. Antimalarials have unique properties that distinguish them from other anti-inflammatory drugs. (A) They are very lipophilic, which enhances their ability to cross the blood-brain barrier (BBB). Hence, they have the potential to act not only in the periphery but also in the CNS, and could be a useful addition to our limited armamentarium against the SARS-CoV-2 virus. (B) They are non-selective inhibitors of phospholipase A isoforms, including cytosolic phospholipase A (cPLA). The latter is not only activated by cytokines but itself generates arachidonic acid, which is metabolized by cyclooxygenase (COX) to pro-inflammatory eicosanoids. Free radicals are produced in this process, which can lead to oxidative damage to the CNS. There are at least 4 ways that antimalarials could be useful in combating COVID-19. (1) They inhibit PLA (2) They are basic molecules capable of affecting the pH of lysosomes and inhibiting the activity of lysosomal enzymes. (3) They may affect the expression and Fe/H symporter activity of iron transporters such as divalent metal transporter 1 (DMT1), hence reducing iron accumulation in tissues and iron-catalysed free radical formation. (4) They could affect viral replication. The latter may be related to their effect on inhibition of PLA isoforms. Inhibition of cPLA impairs an early step of coronavirus replication in cell culture. In addition, a secretory PLA (sPLA) isoform, PLA2G2D, has been shown to be essential for the lethality of SARS-CoV in mice. It is important to take note of what ongoing clinical trials on chloroquine and hydroxychloroquine can eventually tell us about the use of antimalarials and other anti-inflammatory agents, not only for the treatment of COVID-19, but also for neurovascular disorders such as stroke and vascular dementia.
Topics: Animals; Antimalarials; Blood-Brain Barrier; COVID-19; Humans; Nervous System Diseases; SARS-CoV-2; Treatment Outcome; COVID-19 Drug Treatment
PubMed: 32897518
DOI: 10.1007/s12035-020-02093-z -
Annals of Cardiothoracic Surgery May 2024Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of a normally functioning prosthetic valve is too small in relation to the patient's body... (Review)
Review
Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of a normally functioning prosthetic valve is too small in relation to the patient's body size. The effect of PPM on outcomes and valve durability have gained credibility, making this an important possibly preventable risk factor. Transcatheter aortic valve replacement (TAVR) generally has a lower incidence of PPM than surgical aortic valve replacement (SAVR). Current surgical literature and randomized trials show an association between severe PPM and mortality in patients with SAVR but there is less evidence for an association with TAVR. Differences in the incidence of PPM may be related to the methods and cutoffs for measuring mismatch. This review will discuss the current state of field and propose standardization of measurement methods which may more accurately risk stratify patients.
PubMed: 38841078
DOI: 10.21037/acs-2023-aae-0166 -
Frontiers in Nutrition 2022Bioelectrical impedance analysis (BIA)-derived indexes [e.g., fat (FMI) and fat-free mass indexes (FFMI), visceral fat level (VFL)] are used to characterize obesity as a...
Fat-Free Mass Index, Visceral Fat Level, and Muscle Mass Percentage Better Explain Deviations From the Expected Value of Aortic Pressure and Structural and Functional Arterial Properties Than Body Fat Indexes.
UNLABELLED
Bioelectrical impedance analysis (BIA)-derived indexes [e.g., fat (FMI) and fat-free mass indexes (FFMI), visceral fat level (VFL)] are used to characterize obesity as a cardiovascular risk factor (CRF). The BIA-derived index that better predicts arterial variability is still discussed.
AIMS
To determine: (1) the association of classical [weight, height, body mass index (BMI), basal metabolic rate (BMR)] and BIA-derived indexes, with arterial properties deviations from expected values (arterial z-scores); (2) maximum arterial variations attributable to BIA-derived indexes; (3) whether the composition of total body, trunk and/or limbs is most closely associated with arterial variations.
METHODS
Hemodynamic, structural, and functional parameters of different histological types of arteries were assessed ( = 538, 7-85 years). Classical and BIA-derived indexes [fat mass and percentage, FMI, VFL, muscle mass percentage (PMM), FFMI, and percentage] were measured (mono- and multi-segmental devices). Arterial z-scores were obtained using age-related equations derived from individuals not-exposed to CRFs ( = 1,688).
RESULTS
First, regardless of the classical index considered, the associations with the arterial properties showed a specific hierarchy order: diameters and local stiffness > aortic and brachial blood pressure (BP) > regional stiffness. Second, all the associations of FMI and FFMI with z-scores were positive. Third, FFMI exceeded the association obtained with BMI and BMR, considering structural z-scores. In contrast, FMI did not exceed the association with z-scores achieved by BMI and BMR. Fourth, regardless of CRFs and classical indexes, arterial z-scores would be mainly explained by FFMI, VFL, and PMM. Fifth, regardless of the body-segment considered, the levels of association between FMI and z-scores did not exceed those found for classic and FFMI. Total fat mass and trunk indexes showed a greater strength of association with z-scores than the FMI of limbs. Sixth, compared to lower limb FFMI indexes, total and upper limbs FFMI showed higher levels of association with z-scores.
CONCLUSIONS
FFMI (but not FMI) exceeded the strength of association seen between BMI or BMR and structural z-scores. Regardless of the body segment analyzed, the associations between FMI and z-scores did not exceed those found with classic and FFMI. Arterial z-scores could be independently explained by FFMI, VFL, and PMM.
PubMed: 35571946
DOI: 10.3389/fnut.2022.856198 -
The Journal of Cardiovascular Surgery Oct 2020Transcatheter aortic valve implantation (TAVI) has become today a popular alternative technique to surgical valve replacement for critical patients. However, with only... (Review)
Review
Transcatheter aortic valve implantation (TAVI) has become today a popular alternative technique to surgical valve replacement for critical patients. However, with only six years follow-up on average, little is known about the long-term durability of transcatheter implanted biological tissue. Moreover, the high cost of biological tissue harvesting and chemical treatment procedures favor the development of alternative synthetic valve leaflet materials. In that context, thin, flexible and porous textile constructions could be considered as interesting candidates. However, these constructions must be strong enough to withstand the load applied on the leaflet especially in aortic position. Moreover, the interaction of textile material with living tissue should be comparable to biological valve tissue, and the foreign body reaction (FBR) as well as the calcification mechanisms should be controlled. In the frame of heart valve tissue engineering strategies, the use of bioresorbable polymer scaffolds is expected to limit that FBR. However, to precisely control the degradation of the polymer is not trivial. Conversely, when permanent textile polymers are considered, the porosity of the fibrous scaffold tends to induce exaggerated tissue ingrowth which may prevent the implants from remaining flexible. In that context, the ideal synthetic fibrous valve leaflet remains to be found. The purpose of this study was to investigate the possible strategies which have been adopted over the last 50 years regarding the use of textile as heart valve leaflet material. Results showed that textile presented potential, despite remaining strong challenges. It came out that hybrid textiles combining bioresorbable and permanent polymer fibers arranged in both non-woven and woven or knitted way could probably help providing strength and generating appropriate tissue ingrowth.
Topics: Absorbable Implants; Animals; Aortic Valve; Foreign-Body Reaction; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Polymers; Prosthesis Design; Prosthesis Failure; Recovery of Function; Risk Factors; Time Factors; Tissue Engineering; Treatment Outcome
PubMed: 32964900
DOI: 10.23736/S0021-9509.20.11604-5 -
Annals of Cardiothoracic Surgery Nov 2023Thoracoabdominal aortic aneurysms (TAAAs) affect approximately 5.9/100,000 persons per year, with a male:female ratio of approximately 1.5-1.7:1. Data exploring... (Review)
Review
Thoracoabdominal aortic aneurysms (TAAAs) affect approximately 5.9/100,000 persons per year, with a male:female ratio of approximately 1.5-1.7:1. Data exploring sex-related variations in epidemiology and clinical presentation are scarce, as women are normally under-represented in clinical trials. As female hormones and their receptors greatly impact the functions of the vascular cells and aneurysm etiology and extent, the age at surgery and comorbidities also differ between men and women. Additionally, female patients have smaller anatomic structures, including visceral/infrarenal aorta and iliac arteries, than most men. Thus, aneurysms of a certain diameter can represent more advanced disease in women comparatively, than the same-sized aneurysms in males, and be the cause of delayed and often emergent treatment. Adjusting the aortic diameter threshold is recommended for surgery using aortic size index (ASI) [aortic diameter in cm/body surface area (BSA) in m] or aortic height index (AHI) (aortic diameter in cm/patient height in m) indices in patients who are significantly shorter or taller than average, but no specific sex-related size criteria have been indicated so far for TAAA. Data about TAAA outcomes are conflicting, but female sex has been demonstrated to be an independent risk factor for increased major postoperative complications (i.e., bleeding, acute limb ischemia, renal failure, bowel ischemia, spinal cord ischemia) with longer hospital and intensive unit care stay and in-hospital and 30-day mortality following endovascular treatment and increased long-term mortality following open repair. Despite this evidence, sex does not influence TAAA management strategies and currently the allocation to open or endovascular repair is based on anatomy and clinical setting. In light of these disadvantaged outcomes, further efforts are needed to better understand the sex-related differences in the TAAA diagnosis and management in order to allow prompt and appropriate treatment of female patients.
PubMed: 38090340
DOI: 10.21037/acs-2022-adw-0119 -
Insights Into Imaging Feb 2020Across the globe, diseases secondary to environmental exposures have been described, and it was also found that existing diseases have been modified by exposure to... (Review)
Review
BACKGROUND
Across the globe, diseases secondary to environmental exposures have been described, and it was also found that existing diseases have been modified by exposure to environmental chemicals or an environmental factor that has been found in their pathogenesis. The Institute of Medicine has shared a permanent concern related to the nations environmental health capacity since 1988.
MAIN BODY
Contemporary imaging methods in the last 15 years started reporting alterations in different human systems such as the central nervous system, cardiovascular system and pulmonary system among others; evidence suggests the existence of a human environmental disease network. The primary anatomic regions, affected by environmental diseases, recently assessed with imaging methods include Brain (lead exposure, cerebral stroke, pesticide neurotoxicity), uses MRI, DTI, carotid ultrasonography and MRS; Lungs (smoke inhalation, organophosphates poisoning) are mainly assessed with radiography; Gastrointestinal system (chronic inflammatory bowel disease), recent studies have reported the use of aortic ultrasound; Heart (myocardial infarction), its link to environmental diseased has been proved with carotid ultrasound; and Arteries (artery hypertension), the impairment of aortic mechanical properties has been revealed with the use of aortic and brachial ultrasound.
CONCLUSIONS
Environmental epidemiology has revealed that several organs and systems in the human body are targets of air pollutants. Current imaging methods that can assess the deleterious effects of pollutants includes a whole spectrum: radiography, US, CT and MRI. Future studies will help to reveal additional links among environmental disease networks.
PubMed: 32034587
DOI: 10.1186/s13244-019-0814-7 -
Perfusion Sep 2023In peripheral percutaneous (VA) extracorporeal membrane oxygenation (ECMO) procedures the femoral arteries perfusion route has inherent disadvantages regarding poor...
INTRODUCTION
In peripheral percutaneous (VA) extracorporeal membrane oxygenation (ECMO) procedures the femoral arteries perfusion route has inherent disadvantages regarding poor upper body perfusion due to watershed. With the advent of new long flexible cannulas an advancement of the tip up to the ascending aorta has become feasible. To investigate the impact of such long endoluminal cannulas on upper body perfusion, a Computational Fluid Dynamics (CFD) study was performed considering different support levels and three cannula positions.
METHODS
An idealized literature-based- and a real patient proximal aortic geometry including an endoluminal cannula were constructed. The blood flow was considered continuous. Oxygen saturation was set to 80% for the blood coming from the heart and to 100% for the blood leaving the cannula. 50% and 90% venoarterial support levels from the total blood flow rate of 6 l/min were investigated for three different positions of the cannula in the aortic arch.
RESULTS
For both geometries, the placement of the cannula in the ascending aorta led to a superior oxygenation of all aortic blood vessels except for the left coronary artery. Cannula placements at the aortic arch and descending aorta could support supra-aortic arteries, but not the coronary arteries. All positions were able to support all branches with saturated blood at 90% flow volume.
CONCLUSIONS
In accordance with clinical observations CFD analysis reveals, that retrograde advancement of a long endoluminal cannula can considerably improve the oxygenation of the upper body and lead to oxygen saturation distributions similar to those of a central cannulation.
Topics: Humans; Hydrodynamics; Aorta; Perfusion; Catheterization; Aorta, Thoracic
PubMed: 35549763
DOI: 10.1177/02676591221099809 -
Frontiers in Cardiovascular Medicine 2022The association between a body shape index (ABSI) and abdominal aortic calcification (AAC) is still unclear, so we tried to prove the association between ABSI and AAC in...
BACKGROUND
The association between a body shape index (ABSI) and abdominal aortic calcification (AAC) is still unclear, so we tried to prove the association between ABSI and AAC in the general population in this cross-sectional study.
MATERIALS AND METHODS
After excluding participants with missing data on height, weight, waist circumference (WC), and AAC, we finally selected 3,140 participants aged 40-80 years from the 2013-2014 National Health and Nutrition Examination Survey. Using multivariate logistic regression and receiver operating characteristic (ROC) curves to test the association between ABSI and AAC.
RESULTS
Participants (median age: 58.0 years; 48.3% men) were divided into two groups by the optimal cutoff point of ABSI: higher ABSI (> 0.84) and lower ABSI (≤ 0.84). Participants with higher ABSI showed significantly higher proportion of AAC than those with lower ABSI (39.8 vs. 23.7%, < 0.001). Participants with higher ABSI had an increased risk of developing AAC in crude model (ABSI as a continuous variable: OR = 2.485, 95% CI: 2.099-2.942, < 0.001; as a categorical variable: OR = 2.132, 95% CI: 1.826-2.489, < 0.001), and ABSI was still independently associated with AAC in all adjusted models (all < 0.05). Further subgroup analyses showed that higher ABSI was consistently associated with AAC in subgroups with sex (male or female), age (≤ 65 or > 65 years), smoking history (yes or no), hypertension (yes or no), diabetes (yes or no), sleep disorder (yes or no), body mass index (BMI) (< 23 or ≥ 23 kg/m), systolic blood pressure (< 140 or ≥ 140 mmHg), diastolic blood pressure (< 90 or ≥ 90 mmHg), fasting plasma glucose (< 126 or ≥ 126 mg/dL), and low-density lipoprotein cholesterol (≤ 130 or > 130 mg/dL) ( for interaction > 0.05). While in other subgroups, the association was no longer synchronized. The ROC showed that the area under the curve of ABSI was significantly higher than height, weight, BMI, WC, and waist-to-height ratio (WHtR).
CONCLUSION
Higher ABSI was closely associated with higher risk of AAC, and discriminant ability of ABSI for AAC was significantly higher than height, weight, BMI, WC, and WHtR.
PubMed: 36704474
DOI: 10.3389/fcvm.2022.1091390