Background:Continuous renal replacement therapy (CRRT) represents a critical complication following extensive aortic arch repair for type A aortic dissection (TAAD), significantly influencing patient outcomes. This study evaluates the impact of different hypothermic circulatory arrest (HCA) temperature strategies on postoperative CRRT requirements. Methods:A total of 1,283 TAAD patients who underwent total arch replacement (TAR) with frozen elephant trunk (FET) procedure were retrospectively enrolled [2010-2018]. Patients were divided into CRRT (N=123) and non-CRRT (N=1,160) groups. Core temperature during HCA was categorized into deep hypothermia (DH) (≤20 ℃), low-moderate hypothermia (LMH) (20.1-24 ℃), high-moderate hypothermia (HMH) (24.1-28 ℃), and mild hypothermia (MH) (>28 ℃). Results:The CRRT group exhibited significantly higher early mortality (38.2% vs. 3.7%, P<0.001) and lower long-term survival during a 6.02-year follow-up. Multivariate analysis revealed a significant interaction between core temperature and cardiopulmonary bypass (CPB) time (P=0.02). Higher temperature groups demonstrated protective effects compared to DH (P for trend =0.001). However, as CPB time substantially prolongs, the protective effect of higher core temperatures appears to gradually diminish, and the trend may even reverse. Conclusions:Higher core temperatures are associated with reduced CRRT risk during TAR with FET procedure. However, this association appears to be modified by CPB duration, and caution is warranted regarding potential renal injury associated with increased core temperatures in complex surgeries with prolonged CPB time.

Background: Marfan syndrome (MFS) is a heritable connective tissue disorder associated with a heightened risk of acute type A aortic dissection (ATAAD). The long-term impact of MFS on outcomes following total arch replacement with frozen elephant trunk (TAR with FET) remains poorly characterized. This study aimed to evaluate this impact in a large cohort from a single high-volume aortic center. Methods: Patients with ATAAD who underwent TAR with FET at Fuwai Hospital (2010-2018) were categorized into MFS and non-MFS groups. Long-term follow-up was complete for all surviving patients, with a median follow-up of 6.08 years (terminating in December 2023). Clinical characteristics and longterm follow-up outcomes were analyzed, with primary endpoints including survival, reoperation rates, and functional status. Multivariable logistic regression and competing risks Cox regression models were employed to identify independent predictors of outcomes. Results: Among 1,086 patients with a mean age of 46.6 years (104 MFS, 982 non-MFS), Marfan patients were significantly younger (36.1 vs. 47.7 years, P<0.001) with higher rates of previous cardiovascular surgery (11.5% vs. 2.2%, P<0.001) and root replacement (76.0% vs. 22.7%, P<0.001). Overall operative mortality was 7.4% (80/1,086) with no significant between-group difference. At median follow-up of 6.08 years, 10year survival was 80.6% and comparable between groups (P=0.22). Over 90% of survivors maintained complete self-care ability. Among 67 total reoperations, 25 occurred in Marfan patients. MFS remained an independent risk factor for reoperation (hazard ratio 2.06, 95% confidence interval: 1.18-3.59, P=0.01). Conclusions: While MFS does not compromise long-term survival in ATAAD patients undergoing TAR with FET, significantly elevated reoperation rates necessitate specialized long-term surveillance.

OBJECTIVES:To report our strategy and outcomes in open surgically treating adult Kommerell's diverticulum (KD) over the past decade. METHODS:44 patiens who underwent open surgical repair for KD at our institution between 2015 and 2024 were enrolled. Patients were classified as aneurysm group (n = 25, 56.8%) or dissection (n = 19, 43.2%) group. Depending on the position and pathology, 1 of 4 procedures was performed: (1) descending aorta replacement and aberrant subclavian artery reconstruction; (2) total arch and partial descending aorta replacement; (3) thoracoabdominal aortic replacement; or (4) total arch replacement with frozen elephant trunk. Long-term prognosis and perioperative safety were analyzed. RESULTS:Early mortality and composite adverse events for the overall cohort were 13.6% and 20.5%, respectively, without significant differences between the aneurysm and dissection groups (8.0% vs 21.1%, P = 0.42; 16.0% vs 26.3%, P = 0.32). However, the dissection group had a higher rate of acute kidney injury (52.6% vs 20.0%, P = 0.02), longer mechanical ventilation (33.4 [13.2∼122.1] vs 14.2 [6.8∼22.7] h, P = 0.005), longer intensive care unit stay (5 [3∼10] vs 2 [1∼5] d, P = 0.001), and longer postoperative hospitalization (15 [14∼21] vs 10 [7∼18] d, P = 0.007). For the entire cohort, 5-year overall survival and freedom from aortic-related reintervention were 77.8% and 88.9%. Patients in the dissection group had significantly lower 5-year overall survival (61.2% vs 92.0%, P=0.022) and freedom from aortic-related reintervention rates (77.3% vs 100%, P=0.036). CONCLUSIONS:Open surgical strategy was selected arrording to the position and pathology of KD. Open surgery achieved acceptable early and long-term outcomes. Once KD progressed to dissection, the difficulty and risk of open surgery increased and the long-term prognosis was impaired.

Spinal cord injury (SCI) is a severe complication after thoracoabdominal aortic repair (TAAR), substantially increasing postoperative mortality and disability. This study aimed to develop an improved machine learning model using comprehensive perioperative data to predict SCI risk. 270 patients were included in the study, and 66 potentially meaningful variables were selected from 84 original variables as input data to drive machine learning. An optimized machine learning algorithm (PSO-FLXGBoost) was applied to stratify and rank predictors, and Shapley additive explanations (SHAP) were used to interpret feature contributions. The PSO-FLXGBoost model achieved strong discrimination with an AUC of 0.895. SHAP analysis highlighted four key predictors: intraoperative hemoglobin < 70 g/L, preoperative D-dimer > 6 µg/mL, platelet count > 250 × 10^9/L, and operation time > 500 min, all of which significantly increased SCI risk. The optimized PSO-FLXGBoost model reliably predicts SCI after TAAR, emphasizing intraoperative hemoglobin, coagulation status, and operative duration as critical risk factors. These insights may guide tailored perioperative strategies to improve patient outcomes.

Background:Postoperative cognitive dysfunction (POCD) is a common complication following aortic arch replacement. This study aimed to identify risk factors for early POCD in patients undergoing aortic arch replacement and determine the effect of POCD on long-term survival. Methods:In this prospective cohort study, 103 patients who underwent aortic arch replacement for complex aortic arch diseases were enrolled. Cognitive function was assessed preoperatively and on postoperative days 5 to 7 using the Montreal Cognitive Assessment. POCD was defined as a ≥20% decline in total score compared with baseline. Results:The incidence of POCD was 15.5%. Compared with the non-POCD group, patients with POCD were significantly older (62 ± 13 vs. 52 ± 13, p = 0.008), had a higher proportion of females (68.8 vs. 37.9%, p = 0.044), and experienced greater intraoperative blood loss (751 ± 165 vs. 667 ± 122 mL; p = 0.018). Postoperative adverse events were similar between the two groups. Significant declines were observed in the domains of visuospatial/executive function (p = 0.003), attention/concentration/working memory (p < 0.001), and orientation (p = 0.002). Multivariable logistic regression analysis identified age, female sex, and antegrade cerebral perfusion (ACP) time as independent risk factors for POCD. Midterm survival was similar between POCD and non-POCD groups (1-year survival: 100 vs. 95.2%; p = 0.437). Conclusion:POCD remains a common complication after aortic arch replacement. Advanced age, female sex, and prolonged ACP time are independent predictors of POCD. POCD was not associated with worse midterm survival. These findings may help preoperative risk stratification and optimization of intraoperative management.

BACKGROUND Secondary thoracoabdominal aortic replacement after a total arch repair is a complex procedure that has a risk of complications such as stroke and renal failure. Patients with Marfan syndrome are more at risk of distal aortic re-interventions. This report describes a 52-year-old woman with Marfan syndrome and a history of type A aortic dissection treated with total arch replacement and frozen elephant trunk implantation using a sutureless integrated stented graft (SISG), who presented 3 years later with a distal aortic dissection aneurysm requiring secondary thoracoabdominal aortic replacement. CASE REPORT A 52-year-old woman with Marfan syndrome underwent ascending aortic and total arch replacement with frozen elephant trunk implantation using a sutureless integrated stented graft (SISG) for acute type A aortic dissection 3 years earlier. One month before the current operation, thoracoabdominal aortic replacement was performed because follow-up imaging demonstrated false lumen expansion of the residual thoracoabdominal aortic dissection, with a maximal diameter exceeding 5.5 cm. Intraoperatively, significant false lumen thrombosis and obliteration were observed in the elephant trunk region. A 2-cm unstented graft segment at the distal end of the elephant trunk facilitated proximal anastomosis in the current surgery. Given the patient's Marfan syndrome, all branch vessels were reconstructed. Follow-up aortic computed tomography demonstrated satisfactory morphology, and the patient was discharged 2 weeks after surgery. CONCLUSIONS This case demonstrates successful staged repair of residual thoracoabdominal aortic dissection following initial total arch replacement using a SISG in a patient with Marfan syndrome. The sutureless graft facilitated secondary procedure by providing a suitable proximal landing zone, with complete false lumen thrombosis confirming effective primary repair and favorable outcomes.

Aortic dissection (AD) is a fatal acute cardiovascular emergency. SUMOylation participates in cell proliferation, apoptosis, and inflammation, but its role in AD, especially via TOPORS, remains unclear. This study investigates how TOPORS regulates AD pathogenesis through SUMOylation. AD and normal aortic samples were collected to detect TOPORS expression. AD mouse and VSMCs models were constructed to assess TOPORS depletion and overexpression effects on AD progression. In AD aortic tissues, TOPORS expression was upregulated, while tripartite motif containing 27 (TRIM27) and Sentrin-specific protease 6 (SENP6) expression showed no significant change. In vivo and in vitro experiments demonstrated that inhibition of TOPORS alleviated aortic dilation and elastic fiber degradation. TOPORS knockout suppressed the secretion of inflammatory cytokines (TNF-α, IL-1β, IL-6, and IFN-α), promoted PI3K/AKT phosphorylation, and downregulated p53 signaling. The p53 inhibitor PFTα reduced AD-induced cell apoptosis and upregulation of inflammatory cytokines. Co-immunoprecipitation further confirmed that inhibition of TOPORS decreases SUMOylation of p53. Conclusions: TOPORS activates p53, inhibits PI3K/AKT phosphorylation via SUMOylation, promotes vascular smooth muscle cell (VSMC) apoptosis and inflammation, and exacerbates AD pathogenesis.

Introduction Aortic dissection (AD) is a life-threatening cardiovascular emergency with a high mortality rate, and acute Stanford Type A AD is the most dangerous form, often requiring surgical intervention. Factors contributing to the progression of AD include increased heart rate, blood pressure and the rate of ventricular contraction (dP/dt). While heart rate control is a cornerstone of preoperative management for AD per existing guidelines, the recommended target (eg, ≤60 bpm in American Heart Association 2010) is consensus-driven (Level C) and thus not grounded in high-level evidence. The ESCORT (Efficacy and Safety of preoperative Controlling heart Rate in patients with acute Type A aortic dissection) trial is designed to address this critical gap by providing high-level evidence from a randomised controlled trial to define the optimal preoperative heart rate target.Methods and analysis The study is a multicentre, single-blind, RCT involving adult patients diagnosed with acute (Stanford Type A) AD, scheduled for aortic arch prosthetic vascular replacement and elephant trunk stent implantation surgery. 680 patients will be randomised into two groups: low heart rate target group (55–65 beats per minute) and standard heart rate target group (75–85 beats per minute). The intervention involves protocol-directed medication to achieve the target heart rates, with esmolol as the primary recommended agent. The primary outcome measure is the rate of major adverse cardiovascular event within 30 days after surgery, and secondary outcomes include various clinical, economic and biochemical measures.Discussion The ESCORT study is the large-scale RCT to investigate the optimal preoperative heart rate control in patients with acute type A AD. The results of this study have the potential to fill the evidence gap in current clinical guidelines and provide evidence-based support for clinical management. The findings may influence the standard of care by either endorsing lower heart rate targets or providing alternative guidance for managing heart rate in this high-risk patient population. The study’s results will be disseminated through publications and presentations at both national and international conferences, ensuring that the results are accessible to the medical community and relevant patient organisations.Ethics and dissemination This study, including the study protocol (version 1.3, 3 December 2022), was approved by the Ethics Committee of Fuwai Hospital, CAMS and PUMC (approval number: 2022-1886). Additional approvals were obtained from the ethics committees of participating subcentres (approval numbers are listed in the main text). The findings will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences.Trial registration number ChiCTR2300067811.

BACKGROUND:The impact of intimal tear location on outcomes in acute Stanford type A aortic dissection remains unclear. This study investigated the impact of different tear locations on early and long-term death in patients undergoing total arch replacement with frozen elephant trunk. METHODS:This single-center retrospective study included 1524 patients with acute Stanford type A aortic dissection who underwent total arch replacement with frozen elephant trunk from January 2010 to December 2022. Patients were stratified by primary entry tear location: ascending aorta (n=857 [56.2%]), aortic arch (n=459 [30.1%]), and descending aorta (n=208 [13.6%]). Primary end points were in-hospital death and long-term survival. Multivariable regression analyses with further sensitivity analyses for early and long-term outcomes were performed. RESULTS:In-hospital death differed significantly among groups (P=0.035): descending tear (21 [10.1%]) versus ascending (46 [5.4%]) versus arch (24 [5.2%]). Multivariable analysis identified descending tear as an independent predictor of in-hospital death (odds ratio, 3.728 [95% CI, 1.934-7.188]; P<0.001). During a median follow-up period of 48.2 months, descending tear location remained independently associated with increased long-term mortality risk (hazard ratio [HR], 2.140 [95% CI, 1.418-3.230]; P<0.001), while arch tears showed no significant difference from ascending tears (HR, 1.232; P=0.227). Reintervention rates did not differ among groups after multivariable adjustment. CONCLUSIONS:Intimal tear location significantly impacts acute Stanford type A aortic dissection prognosis. Descending aortic tears confer substantially higher early and long-term mortality rates, requiring aggressive perioperative management and closer surveillance. Tear location should be incorporated into risk stratification systems for individualized treatment planning.

AIMS:As the global population ages, cardiovascular diseases, particularly heart failure (HF), have become leading causes of mortality and disability among elderly patients. Diabetes and hypertension are major risk factors for cardiovascular diseases, making this group especially vulnerable to HF. Current clinical tools for predicting HF risk are often complex, requiring extensive clinical parameters and laboratory tests, which limit their practical application. Therefore, a need exists for a predictive model that is both simple and effective in assessing HF risk in elderly patients with diabetes and hypertension. METHODS AND RESULTS:This study utilized data from the National Health and Nutrition Examination Survey, spanning seven cycles from 2003 to 2016, including 71 058 subjects. The study focused on elderly patients (aged 65 and above) diagnosed with both diabetes and hypertension, ultimately including 1445 participants. We examined seven novel composite indices: a body shape index (ABSI), atherogenic index of plasma (AIP), BARD score, body fat percentage (BFP), body roundness index (BRI), fatty liver index (FLI), and prognostic nutritional index (PNI). These indices were selected for their simplicity and ease of calculation from routine clinical assessments. The primary outcome was HF status, and data pre-processing included imputation for missing values using random forest algorithms. Various machine learning models were applied, including random forest, logistic regression, XGBoost, and others, with model performance assessed through metrics like accuracy, precision, recall, F1 score, and receiver operating characteristic-area under the curve (ROC AUC). The best-performing model was further analysed using SHAP (SHapley Additive exPlanations) values to determine feature importance. The study found that the XGBoost model demonstrated superior performance across all evaluation metrics, with an area under the curve (AUC) value of 0.96. Significant predictors of HF included BRI and PNI, which had the highest SHAP values, indicating their substantial influence on model predictions. The study also highlighted the robust predictive capabilities of AIP, particularly in assessing cardiovascular events in elderly patients. CONCLUSION:The study demonstrates that novel composite indices like ABSI, AIP, BARD score, BFP, BRI, FLI, and PNI have significant potential in predicting HF risk among elderly diabetic and hypertensive patients. These indices offer clinicians new tools for cardiovascular risk assessment that are simpler and potentially more effective in clinical practice. Future research should focus on validating these findings in different populations and exploring their longitudinal predictive power. LAY SUMMARY:This study explores simple and effective ways to predict heart failure risk in elderly patients with diabetes and hypertension by using novel, easy-to-calculate indices.Indices like ABSI, AIP, BARD score, BFP, BRI, FLI, and PNI are highly effective in predicting heart failure risk in elderly diabetic and hypertensive patients.The XGBoost machine learning model, which uses these indices, demonstrated strong predictive power with an AUC of 0.96, highlighting its clinical applicability.

Background: Non-A non-B aortic dissection (NANB-AD) is a rare and heterogeneous subtype involving the aortic arch and descending aorta without ascending aortic involvement, and its optimal management remains controversial, particularly in the setting of different primary entry tear locations. Evidence on the early and long-term outcomes of total arch replacement combined with frozen elephant trunk (TAR with FET) in NANB-AD is still limited. This study aimed to evaluate the early and long-term outcomes of TAR with FET in NANB-AD patients with different primary tear locations. Methods: We retrospectively collected data from patients with NANB-AD who underwent TAR with FET between 2010 and 2022. Patients were stratified into two groups based on the primary tear location: the arch entry group and the descending entry group. Clinical data were collected and long-term follow-up was conducted through August 2024. Primary outcomes included survival, freedom from aortic reintervention, and quality of life measured by activity of daily living (ADL). Competing risk analysis was conducted to assess postoperative mortality and aorta-related reintervention. Results: A total of 63 patients with NANB-AD were included, with 31 patients in the arch entry group and 32 patients in the descending entry group. Early outcomes included 2 perioperative deaths (3%) and 2 cases of permanent neurological deficit (3%). After a median follow-up of 4 years, 2 additional all-cause deaths (3%) occurred. Five patients (8%) required aortic-related reinterventions, including 2 thoracic endovascular aortic repairs (TEVARs) and 3 thoracoabdominal aortic replacements. Kaplan-Meier analysis demonstrated comparable long-term survival between groups (P=0.30), and competing risk model analysis showed no significant difference in reintervention rates. Functional assessment revealed that 54 patients (91.5%) were able to resume standard physical activities postoperatively. Conclusions: TAR with FET represents an effective surgical strategy for NANB-AD with favorable early and long-term outcomes. The anatomical location of the primary tear does not significantly influence surgical efficacy, suggesting that this approach is suitable for NANB-AD regardless of entry tear position.

Background:Reliable radiographic indicators to assess the severity and prognosis of acute type A aortic dissection (ATAAD) are lacking. This study investigates whether renal artery involvement (RAI) on preoperative imaging serves as a marker of extensive branch vessel compromise and malperfusion. Methods:This retrospective study analyzed 471 consecutive patients who underwent open surgical repair for ATAAD between January 2020 and June 2022. RAI was defined on computed tomography angiography (CTA) as dissection membrane extension to the renal artery ostium. Patients were divided into RAI (n=289) and non-RAI (n=182) groups. Propensity score matching (PSM) minimized baseline differences. Multivariable ordered logistic regression assessed the association between RAI and the number of malperfused organ systems. Cox regression identified risk factors for mortality. Results:The RAI group exhibited more extensive aortic branch involvement (P<0.05), required more concomitant branch procedures, and had a higher incidence of end-organ malperfusion (P=0.006) and serious adverse events (SAEs) (P=0.009), consistent after PSM. Ordered logistic regression showed that RAI was associated with malperfusion [odds ratio (OR) =2.00, 95% confidence interval (CI): 1.25-3.27, P=0.005]. Cox regression identified RAI as an independent risk factor for overall mortality [hazard ratio (HR) =3.48, 95% CI: 1.15-10.47, P=0.03] and mid-term mortality (HR =3.42, 95% CI: 1.14-10.31, P=0.03). Long-term follow-up recorded 11 deaths among hospital survivors; no significant association was observed between RAI and permanent dialysis dependence (log-rank P=0.18). Conclusions:RAI on preoperative CTA is a simple, objective indicator of extensive aortic branch compromise and higher malperfusion burden in ATAAD, identifying a high-risk cohort with worse perioperative outcomes and reduced mid-term survival.

Postoperative continuous renal replacement therapy (CRRT) initiation for severe acute kidney injury is a clinically consequential complication after open thoracoabdominal aortic repair. We aimed to develop an interpretable machine-learning (ML) model for predicting postoperative CRRT in this high-risk population. This single-center retrospective cohort study included consecutive adult patients who underwent open thoracoabdominal aortic repair between January 2010 and December 2025. After exclusions, 372 patients were analyzed, including 66 (17.7

Background: Aortic dissection (AD) remains a significant challenge in cardiovascular medicine. Previous studies have found that reduced endothelial cell tight junction ZO-1 protein expression is associated with aortic dissection disease, but it is not clear whether the pattern of Occludin protein expression is the same. Aims: The aim of this study was to investigate the potential role of aortic endothelial cell Occludin protein in aortic dissection. Methods: Single-cell RNA sequencing was performed on the ascending aorta of five patients with AD and three heart transplant donors. Additionally, Crispr-cas9 technology and adeno-associated virus 9 (AAV9) were used to generate mouse models with endothelial cell-specific knockout and overexpression of the Ocln gene. Exploration and validation of transcription factors regulating the OCLN gene by dual luciferase gene reporter assay and yeast one-hybrid assay. Results: Single-cell RNA sequencing revealed aortic endothelial cell barrier dysfunction in human aortic dissection, in which the expression of the key target Occludin was reduced, and the reduced expression of aortic endothelial cell Occludin protein was verified by WB and immunofluorescence experiments in human and mouse aortic dissection tissue samples. Subsequently, Occludin protein was overexpressed by lentivirus and knocked down by small interfering RNA in human aortic endothelial cells (HAEC), and cell barrier function experiments showed that overexpression of Occludin protein decreased FITC-Dextran permeation, and knockdown of Occludin protein increased FITC-Dextran permeation. In the BAPN-induced AD mouse model, endothelial cell-specific knockdown of Occludin protein significantly increased mouse mortality, whereas endothelial cell-specific overexpression of Occludin protein significantly decreased mouse mortality. The upstream transcription factors of Occludin protein were predicted by KnockTF and JASPAR databases, and the interaction between upstream transcription factor KLF2 and Occludin was subsequently verified by yeast single heterozygote assay with dual luciferase gene reporter assay. Conclusions: Endothelial cell dysfunction mediated by reduced endothelial cell Occludin protein expression is an important cause of aortic dissection.

Objective To evaluate and summarize the long-term outcomes of surgical treatment in patients who developed retrograde type A aortic dissection (RTAD) following thoracic endovascular aortic repair (TEVAR). Methods Between January 2010 and June 2023, patients who underwent surgical treatment for RTAD following TEVAR at Fuwai Hospital were selected for clinical data collection and long-term follow-up. Both early postoperative outcomes and long-term follow-up results were evaluated. Results Among 67 patients who underwent surgical treatment for RTAD following TEVAR (33 acute dissections, 34 chronic dissections), 57 (85.1%) received total arch replacement (TAR) combined with frozen elephant trunk (FET). Entry tears were located predominantly in the aortic arch (73.1%). Early mortality was 6.0% (n = 4). The 1-year and 5-year survival rates were 95.1% and 90.5%, respectively. Cardiovascular reintervention rates were 16.4% at 1 year and 23.8% at 5 years. During follow-up, 5-year survival rates were similar in the acute and chronic dissection groups (90.9% vs 85.5%; P = .9). The TAR with FET group was associated with a significantly lower incidence of composite endpoint events compared to other surgical approaches (28.1% vs 70%; P = .034), with Cox analysis showing a 66% risk reduction for endpoint events in the TAR with FET group. Conclusions Surgical management of RTAD after TEVAR shows comparable outcomes between acute and chronic cases. TAR with FET was associated with favorable long-term results in our cohort, suggesting that it may be a reasonable approach to consider for these patients. Vigilant follow-up remains essential as RTAD risk persists well beyond the conventional 1-month post-TEVAR period.

Objective: This study presents a single-center retrospective analysis evaluating the long-term outcomes of patients with non-A non-B aortic dissection who underwent either total arch replacement with frozen elephant trunk (TAR with FET) or thoracic endovascular aortic repair (TEVAR). Methods: From 2010 to 2022, patients with non-A non-B aortic dissection who received TEVAR or TAR with FET were selected for clinical data collection and long-term follow-up. Baseline characteristics were balanced using inverse probability weighting. Result: A total of 186 patients were included, with 123 in the TEVAR group and 63 in the FET group. No significant difference in 30-day mortality was observed between the FET and TEVAR groups in both unadjusted and inverse probability weighting analyses (P > 0.05). The FET group, however, consistently showed higher rates of continuous renal replacement therapy (11.6% vs 0.53%, P＜0.01) and prolonged intensive care unit stay (81.2 ± 70 h vs 38.3 ± 51.7 h, P＜0.01). Kaplan-Meier curve analysis showed no significant difference in overall long-term survival (P > 0.05), but landmark analysis revealed that after 6 years post-operation, the FET group had significantly higher survival rates (P＜0.01). Besides, there was no significant difference in aortic-related reintervention between groups (P > 0.05). Conclusion: Regarding early prognosis, it is difficult to determine the superiority between these two approaches. However, from a long-term perspective, TAR with FET represents a more effective treatment strategy compared to TEVAR for patients with non-A non-B type aortic dissection.

Background:Normothermic iliac perfusion has been increasingly utilized for thoracoabdominal aortic aneurysm repair; however, the long-term outcomes in large samples are lacking. This study was designed to assess the perioperative and long-term results of thoracoabdominal aortic repair using normothermic iliac perfusion.Methods:The authors retrospectively analyzed 156 patients having Crawford extent II or III thoracoabdominal aortic aneurysm replacement with normothermic iliac perfusion from 2012 to 2022. Primary endpoints were composite adverse events and long-term survival, which encompassed 30-day mortality, persistent stroke, persistent paraplegia, and acute renal failure needing continuous dialysis. The cohort was divided into two subgroups based on the use of selective visceral and cold renal perfusion techniques.Results:The combined adverse event rate was 14.1%. Specific rates were: 30-day mortality (4.5%), persistent stroke (1.9%), persistent paraplegia (4.5%), and renal failure requiring persistent dialysis (3.2%). The median follow-up time was 67 months. Overall survival rates at 1, 3, 5, 7, and 10 years were 91.6, 90.0, 85.4, 77.6, and 69.7%, respectively. Subgroup analysis showed the visceral and renal perfusion group had a significantly reduced adverse event incidence compared to the nonperfusion group (6.5 vs. 19.1%, P=0.026). Multivariable logistic regression analysis confirmed selective visceral and cold renal perfusion techniques as protective factors against postoperative adverse events (OR 0.30, 95% CI: 0.09-0.94; P=0.038). Multivariable Cox regression analysis identified age >= 50 years (HR 2.63, 95% CI: 1.10-6.27; P=0.029) and NYHA grade >= III (HR: 3.20, 95% CI: 1.04-9.87; P=0.043) as independent risk factors predicting overall survival.Conclusions:Normothermic iliac perfusion is a feasible option for thoracoabdominal aortic repair with cost benefits and simpler management, and selective visceral and cold renal perfusion techniques may further improve its safety and effectiveness. However, enhanced vigilance and meticulous care are essential, particularly for elderly patients and those with cardiac insufficiency.

Spinal Cord Injury is a disastrous complication of thoracoabdominal aortic aneurysm surgery. This study is to assess the effectiveness and safety normothermic artery bypass and visceral-anastomosis-first strategy for thoracoabdominal aortic aneurysm repair. Normothermic artery bypass and visceral-anastomosis-first strategy prioritizes the reconstruction of visceral and other distal vessels, with intercostal arteries serving as the physiological blood supply at high pressure during this period. Reconstruction of intercostal arteries and proximal anastomosis is then performed, ensuring the longest possible physiological blood supply to the spinal cord. From July 2019 to December 2023, we retrospectively analyzed early postoperative complications in two groups of patients undergoing thoracoabdominal aortic aneurysm repair using the new strategy compared to normothermic iliac artery perfusion, clarifying the protective effects of the new strategy on visceral organs, especially the spinal cord. The incidence of paraplegia was significantly lower in the NABP group than in the normothermic iliac perfusion (NIP) group (0.00