Scott A. LeMaire

Aortic Dilatation Associated With Bicuspid Aortic Valve: Relation to Sex, Hemodynamics, and Valve Morphology (the National Heart Lung and Blood Institute-Sponsored National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions)

This study analyzed the impact of sex, hemodynamic profile, and valve fusion pattern on aortopathy associated with bicuspid aortic valve (BAV). The National Heart Lung and Blood Institute-sponsored National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC) provided comprehensive information on a large population of well-characterized patients with BAV. Of 969 enrolled patients with BAV, 551 (57%, 77% male) had already undergone valvular and/or aortic surgery. Echocardiographic imaging data were available on 339 unoperated or preoperative participants who formed the basis of this study. BAV function was normal in 45 (14%), with a predominant aortic regurgitation (AR) in 127 (41%) and a predominant aortic stenosis (AS) in 76 (22%). Moderate-severe AR was associated with larger sinus of Valsalva (SOV) diameters compared with normal function and AS (all pu2009<0.01). Moderate-severe AS was associated with a larger ascending aortic (AscAo) diameter compared with normal function (pu2009=u20090.003) but not with AR. The SOV diameter was larger in men than in women (3.7u2009±u20090.7 vs 3.3u2009±u20090.6u2009cm, pu2009<0.0001), whereas AscAo diameters were comparable (3.9u2009±u20090.9 vs 3.7u2009±u20090.9u2009cm, pu2009=u20090.08). Right-left commissural fusion was associated with a larger SOV diameter (3.7u2009±u20090.7 vs 3.3u2009±u20090.6u2009cm, pu2009<0.0001) compared with a right-noncoronary fusion pattern. Predominant AR was more common in men (45% vs 27%, pu2009=u20090.004), whereas AS was more common in women (29% vs 18%, pu2009=u20090.04). In conclusion, in the GenTAC Registry, AR was associated with diffuse (annular, SOV, and AscAo) enlargement, whereas moderate-severe AS was only associated with AscAo enlargement. Male sex and right-left cusp pattern of cusp fusion were associated with larger SOV diameters and a greater likelihood of AR, whereas women had a higher prevalence of AS.

Understanding Open Repair of the Descending Thoracic and Thoracoabdominal Aorta

Although substantial innovation has characterized the field of aortic surgery during the last 50 years, successful repair remains a formidable challenge. Aortic repair has grown to encompass adjuncts designed to ameliorate specific surgical morbidities, such as spinal cord and renal ischemia, while the strategy of repair remains largely dictated by the extent of repair. Repair of the distal aorta, namely the descending thoracic and thoracoabdominal aorta, poses different risks than proximal aortic repair; thus, operative strategy and expected outcomes vary tremendously with the extent of aorta that requires replacement. An accurate understanding of the extent of aortic involvement is critical to planning appropriate management.

Hepatopancreaticobiliary Values after Thoracoabdominal Aneurysm Repair.

BACKGROUNDnAfter thoracoabdominal aortic aneurysm (TAAA) repair, blood tests assessing hepatopancreaticobiliary (HPB) organs commonly have abnormal results. The clinical significance of such abnormalities is difficult to determine because the expected postoperative levels have not been characterized. Therefore, we sought to establish expected trends in HPB laboratory values after TAAA repair.nnnMETHODSnThis 5-year study comprised 155 patients undergoing elective Crawford extent II TAAA repair. In accordance with a prospective study protocol, all repairs involved left-sided heart bypass, selective visceral perfusion, and cold renal perfusion. Blood levels of aspartate transaminase (AST), alanine transaminase (ALT), γ-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), total bilirubin, amylase, and lipase were measured before TAAA repair and for 7 days afterward. Ratios between postoperative and baseline levels were compared for each time point with 95% confidence intervals.nnnRESULTSnTemporal patterns for the laboratory values varied greatly. Amylase, lipase, and AST underwent significant early increases before decreasing to preoperative levels. LDH increased immediately and remained significantly elevated, whereas ALT increased more gradually. GGT remained near baseline through postoperative day 4, and then increased to more than twice baseline. Total bilirubin never differed significantly from baseline. After adjusted analysis, the ischemic time predicted the maximum AST, lipase, GGT, and LDH values.nnnCONCLUSIONSnAlthough most HPB laboratory values increase significantly after elective TAAA repair, the temporal trends for different values vary substantially. The ischemic time predicts the maximum AST, lipase, GGT, and LDH levels. These trends should be considered when laboratory values are assessed after TAAA repair.