Background:The presence of a small aortic annulus (SAA) in patients undergoing aortic valve replacement (AVR) remains a clinical challenge in cardiac surgery. Continuous suture technique (CST) has been considered to allow implantation of relatively larger prostheses compared with interrupted pledgeted suture (IPS). This study aimed to compare early clinical outcomes of CST versus IPS in patients with SAA who underwent surgical AVR. Methods:Between 2023 to 2025, 250 patients who received surgical AVR with implanted prostheses size <23 mm at our department were enrolled for retrospective analysis: 99 in the CST group and 151 in the IPS group. Early clinical outcomes were analyzed using propensity score matching, with postoperative peak aortic velocity as the primary endpoint. Results:The CST group exhibited comparable early clinical outcomes to the IPS group, with no postoperative paravalvular leak observed. Shorter surgery time (P=0.03) and cross-clamp time (P=0.045) were shown in the raw CST group; this advantage also reached a significant difference in the isolated AVR subgroup analysis. Our cohort presented that AVR with CST was associated with significantly lower peak aortic velocity compared with IPS in both raw cohort {2.0 [interquartile range (IQR), 1.7-2.2] vs. 2.2 (IQR, 2.0-2.6) m/s; P<0.001} and propensity-matched analyses (P=0.03). Multivariable linear regression also confirmed CST as an independent predictor of reduced postoperative peak aortic velocity (coefficient -0.192; 95% confidence interval, -0.292 to -0.092; P<0.001). Conclusions:The treatment with CST in AVR could be a valid and well-promoted alternative strategy for patients with SAA and showed a trend toward better hemodynamic performance compared to the traditional IPS approach.

Background: This study aimed to evaluate the perioperative outcomes of concomitant coronary artery bypass grafting (CABG) in patients undergoing surgical repair for acute type A aortic dissection (ATAAD) and to assess the impact of CABG on mortality and complications. Methods: A retrospective analysis was conducted on 1198 ATAAD patients who underwent surgical treatment at our center between January 2016 and December 2022. Patients were categorized into CABG and non-CABG groups. Preoperative characteristics, surgical data, and perioperative outcomes were collected and analyzed. Results: A total of 1198 patients underwent surgical treatment in this study, of whom 979 (81.7%) were male. The mean age was 51.7 ± 11.5 years. Among these patients, 91 (7.6%) underwent concomitant CABG. Patients in the CABG group had significantly higher incidences of chronic coronary artery disease (58.2% vs. 22.6%, p < 0.001), acute myocardial infarction (59.3% vs. 9.5%, p < 0.001), and neurological events (28.6% vs. 18.2%, p = 0.016) compared to the non-CABG group before surgery. Among all patients who underwent surgical treatment, 96 (8.0%) experienced perioperative death. The perioperative mortality rate was significantly higher in the CABG group (39.6% vs. 5.4%, p < 0.001). Patients in the CABG group also had higher rates of postoperative complications, including heart failure, neurological events, continuous renal replacement therapy (CRRT), re-exploration for bleeding, multiple organ dysfunction syndrome (MODS), and need for extracorporeal membrane oxygenation (ECMO) support (all p-values < 0.001). Compared to patients without concomitant CABG, those undergoing CABG had a much higher rate of mortality (Odds Ratio = 2.729, 95% CI = 1.282–5.812, p = 0.009). Conclusions: Concomitant CABG in ATAAD patients was significantly associated with higher perioperative mortality and complication rates.

OBJECTIVE:This study aimed to assess the five year follow up results from a prospective, single arm, multicentre study evaluating the efficacy of the Fabulous stent system (DiNovA Meditech, Hangzhou, China) in the treatment of complicated Stanford type B aortic dissection (cTBAD). METHODS:Between December 2017 and October 2019, 144 patients from 14 centres in China were prospectively enrolled. Primary outcomes were freedom from all cause death and long term aortic related adverse events. Secondary five year outcomes were the changes in the false lumen (FL) and true lumen (TL) in the bare stent and distal bare stent segments. RESULTS:The five year freedom from all cause death was 86.6%, and imaging follow up was completed by 64 patients (mean age 54.4 years; 89.1% male). From pre-procedure to the five year follow up there was a consistent increase in the minimum diameter of the TL (13.01 ± 6.52 mm pre-procedure; 23.16 ± 5.37 mm one year follow up; 24.68 ± 5.27 mm five year follow up) and a simultaneous reduction in the maximum diameter of the FL within the bare stent segment (28.69 ± 7.09 mm pre-procedure; 9.08 ± 12.84 mm one year follow up; 7.67 ± 12.51 mm five year follow up). The proportion of patients with complete FL thrombosis in the bare stent segment increased from 64% to 81%. During the five year follow up, three patients developed retrograde type A aortic dissection and three patients underwent a second intervention. CONCLUSION:Following endovascular treatment using the Fabulous system, the five year cTBAD cohort outcomes demonstrated encouraging results regarding TL expansion and FL thrombosis. These results should enhance the understanding of the application of the Proximal ExTension To Induce COmplete ATtachment (PETTICOAT) technique in cTBAD.

OBJECTIVE:Endovascular repair of Stanford type A aortic dissection (TAAD) remains technically challenging because of the complex anatomy and dynamic biomechanics of the ascending aorta. This study aimed to evaluate the technical feasibility and safety of an innovative stent graft system in patients with acute ascending aortic syndromes. METHODS:Ten patients were enrolled across three centres. Diagnoses comprised classic TAAD (n = 2), retrograde TAAD (n = 4), penetrating aortic ulcer (n = 1), and intramural haematoma (n = 3). All procedures were performed under general anaesthesia with percutaneous femoral access. One patient experienced fatal cardiac arrest during anaesthesia induction before device deployment and was excluded from analysis, as per protocol. The remaining nine patients underwent successful stent graft implantation. Primary outcomes included technical success and major adverse events at 1, 6, and 12 months. RESULTS:Among the nine patients, the stent graft system was successfully implanted intra-operatively in all cases. However, technical success at 30 days was achieved in eight patients, as one patient developed a type Ia endoleak on post-operative day seven. Two patients experienced new aortic dissections during follow up: one de novo and one stent graft induced new entry; only the latter underwent surgical intervention. At 12 months, no death, stroke, myocardial infarction, spinal cord injury, or stent graft migration was observed. CONCLUSION:The innovative stent graft system demonstrated technical feasibility and an acceptable short term safety profile for endovascular repair of acute ascending aortic syndromes. This anatomically responsive design may expand the therapeutic options for selected high risk patients. Larger, long term studies are needed to confirm these preliminary findings.

OBJECTIVES:The objective of this study was to assess the feasibility and effectiveness of the novel stented graft in treating Stanford type A aortic dissection (TAAD). METHODS:This research was a prospective, multicentre, single-arm study that enrolled patients with Stanford TAAD at high risk for open aortic repair. Primary end-points included aorta-related mortality or reintervention at 1 month. Secondary end-points comprised type Ia and III endoleak, major adverse cardiovascular and cerebrovascular events at 1 month, 6 months, and 12 months. RESULTS:Fifty-three patients were enrolled with a mean age of 63.3 years (range 30-81), of whom 44 (83.0%) were male. Forty-six (86.8%) patients presented with retrograde Stanford TAAD, while the remainder had DeBakey type II aortic dissection. Forty-eight patients (90.6%) were in the acute phase. Carotid-to-subclavian artery bypass was performed in 17(32.1%) patients. The stented graft was successfully delivered via the femoral artery in all cases. Follow-up occurred at 1 month, 6 months, and 12 months. The median follow-up was 6 months (range 1-24). The all-cause mortality was 3.8% (2/53) and the aorta-related mortality was 1.9% (1/53). Six(11.3%) patients required open surgery due to left ventricular rupture (1 patient), retrograde progression of aortic dissection (3 patients), and severe type Ia endoleak (2 patients). Mild type Ia endoleak was observed in 1 patient and 1 patient suffered from cerebral infarction. CONCLUSIONS:The early and midterm results of the first-in-man evaluation of the new stented graft for Stanford TAAD were satisfactory, achieving 100% technical success and 1.9% aorta-related mortality. CLINICAL TRIAL REGISTRATION NUMBER:This clinical trial was registered in the Chinese Clinical Trial Registry under the identifier ChiCTR2200057706 (Chinese Clinical Trial Register (ChiCTR)-The world health organization international clinical trials registered organization registered platform).

OBJECTIVES:In this study, we aimed to assess 18fluorodeoxyglucose (18F-FDG) uptake in patients with type A aortic intramural haematoma (IMH) to establish its association with disease progression. METHODS:Patients with type A IMH receiving medical management were included. After the patient agreed to participate, 18F-FDG PET/CT was performed. The aortic 18F-FDG uptake was measured in standardized uptake value (SUV). The primary outcome was disease progression, which was defined as a condition requiring aortic intervention. The median follow-up was calculated by the inverse Kaplan-Meier method. RESULTS:A total of 32 patients were included in this study. During a median follow-up of 28.3 months (95% CI, 4.8-51.7), 14 events occurred in 14 patients (43.8%). Patients with disease progression had significantly higher SUVmax compared to the stable group (4.9 [SD:1.1] vs 3.5 [SD:1.0], P = .001). ROC curve analysis revealed that an SUVmax cut-off of 4.25 had a sensitivity of 78.6% and specificity of 77.8% for predicting disease progression, with an area under the curve (AUC) of 0.806 (95% CI, 0.653-0.958). The 2-year progression-free survival rates for the SUVmax increased (>4.25) and non-increased (≤4.25) were 20.7% and 75.0% (P = .019), respectively. CONCLUSIONS:Increased aortic 18F-FDG uptake was associated with high risk for adverse aortic events in type A IMH. The SUVmax of 18F-FDG should be considered in the risk stratification and management of these patients.

PURPOSE:To report the outcomes of the IN-DEPT trial assessing the feasibility, preliminary safety data, and 12-month outcomes of a new drug-coated balloon (DCB) product for peripheral artery disease (PAD) in Chinese patients. MATERIALS AND METHODS:This is a prospective, multicenter, single-arm clinical trial. A total of 160 patients with superficial femoral artery (SFA) and/or proximal popliteal artery lesions were treated with a new paclitaxel-coated DCB. The preliminary effectiveness end point was 12-month primary patency. The primary safety end point was freedom from device- and procedure-related mortality over 30 days and freedom from major target limb amputation and clinically driven target lesion revascularization (CD-TLR) within 12 months after the index procedure. RESULTS:In total, 160 patients presented with 162 target lesions. A total of 139 lesions (85.8%) were treated with 1 DCB, whereas the other 23 lesions (14.2%) were treated with 2 devices. The device success rate was 100%. A total of 135 subjects reached the preliminary effectiveness end point, with a 12-month primary patency rate of 84.4%. There was no 30-day device- or procedure-related death or unplanned major target limb amputation at 12 months. Five CD-TLRs (3.1%) occurred during the 12-month follow-up period. CONCLUSIONS:Results from the IN-DEPT SFA trial showed satisfactory feasibility and safety of the new DCB over 12 months in Chinese patients with PAD and femoropopliteal de novo lesions, including both stenoses and total occlusions.

Abstract Postoperative acute kidney injury requiring dialysis (PO‐AKID) is a serious adverse event that not only affects acute morbidity and mortality, but also long‐term prognosis. Here, we developed a practical and explainable web‐based calculator (PO‐AKID‐teller) to detect patients who might experience PO‐AKID after acute type A aortic dissection (ATAAD) surgery. This retrospective study reviewed 549 patients undergoing ATAAD surgery from October 2016 to June 2021. PO‐AKID frequency was 19.7% (108 of 549 patients). The initial dataset was split into an 80% training cohort (n = 439) and a 20% test cohort (n = 110). There were seven predictors that could indicate PO‐AKID, including prior cardiovascular surgery, platelet, serum creatinine, the terminal site of dissection involvement, right coronary artery involvement, estimated blood loss, and urine output. Among six machine learning classifiers, the random forest model exhibited the best predictive performance, with an area under the curve of 0.863 in the training cohort and 0.763 in the test cohort. This model was translated into a web‐based risk calculator PO‐AKID‐teller to estimate an individual's probability of PO‐AKID. The PO‐AKID‐teller can accurately estimate an individual's risk for PO‐AKID in an interpretable manner, which may aid in informed decision‐making, patient counseling, perioperative optimization, and longer‐term care provision.

BACKGROUND:Previous research has strongly supported the utility of spaced learning in enhancing memory, but its effectiveness in complex surgical procedures has largely been unexplored. The main objective of this study was to evaluate whether, in comparison to concentrated learning, spaced learning improves the short-term acquisition and long-term retention of cosmetic suturing skills as outcomes of surgical resident training courses. METHODS:This randomized controlled trial was conducted from February 2023 to June 2023. Surgical residents were recruited from a teaching hospital in Guangzhou, China. The participants were randomly assigned at a 1:1 ratio to either the spaced training group (40 min of training followed by a 20-minute break) or the concentrated training group (3 h of continuous training), in which they received one-on-one training for cosmetic suturing skills. The short-term acquisition and long-term retention outcomes were evaluated by three independent raters using an objective scoring scale to assess the participants' cosmetic suturing skills before the training (pretraining test), within one hour after the training (posttraining test), and three months after the completion of the training (follow-up test). The score for each participant was calculated as the average of three independent scores. RESULTS:The study included 23 surgical residents, 12 in the spaced training group and 11 in the concentrated training group. The pretraining test revealed no significant difference between the groups. However, in the post-training test, the spaced training group achieved a significantly higher total score than did the concentrated training group (74.06 ± 5.87 vs. 63.43 ± 10.73, p = 0.0070). Specifically, the suture technique scores were 28.46 ± 1.78 and 22.85 ± 3.75, respectively, which were significantly different (p = 0.0002). During the long-term follow-up test, the spaced training group consistently outperformed the concentrated training group by having significantly higher total (75.60 ± 4.78 vs. 60.68 ± 10.40, p = 0.0001), suture quality (32.26 ± 4.01 vs. 26.23 ± 4.16, p = 0.0019), suture technique (28.68 ± 2.63 vs. 22.18 ± 3.94, p = 0.0001), and suturing time scores (14.67 ± 1.15 vs. 12.27 ± 6.07, p = 0.0460). CONCLUSIONS:Incorporating the principles of spaced learning into the instructional process of obtaining cosmetic suture skills for surgical residents not only significantly enhances short-term skill improvement but also contributes to the long-term retention of training outcomes.

Purpose: The purpose was to evaluate the clinical outcomes of a dedicated venous stent with the tripartite composite segments for the treatment of iliofemoral venous obstruction (IVO) in a mixed cohort of nonthrombotic iliac vein lesion (NIVL) and post-thrombotic syndrome (PTS) over a period of 12 months. Methods: The Grency Trial is a prospective, multicenter, single-arm, open-label, pivotal study, which was conducted at 18 large tertiary hospitals in China from August 2019 to October 2020. A total of 133 hospitalized patients were screened and 110 patients with clinical, etiology, anatomical, and pathophysiology clinical class (CEAP) clinical grade C>3 and iliac vein stenosis >50% or occlusion, including 72 patients with NIVL and 38 patients with PTS, were implanted with Grency venous stents. Primary endpoint was stent patency at 12 months follow-up, and secondary outcomes were technical success; improvement in venous clinical severity score (VCSS) at 3, 6, and 12 month follow-up; and rates of clinical adverse events. Results: Among 110 patients who were implanted with Grency venous stents, 107 patients completed the 12 month follow-up. All 129 stents were successfully implanted in 110 limbs. Twelve-month primary patency rate was 94.39% [95% confidence interval [CI]=88.19%-97.91%] overall, and 100% [94.94%-100%] and 83.33% [67.19%-93.63%] in the NIVL and PTS subgroups, respectively. Venous clinical severity score after iliac vein stenting improved significantly up to 12 months follow-up. There were 3 early major adverse events (1 intracerebral hemorrhage and 2 stent thrombosis events related to anticoagulation therapy), and 7 late major adverse events (1 cardiovascular death, 1 intracranial hemorrhage with uncontrolled hypertension, and 5 in-stent restenosis cases without stent fractures or migration). Conclusions: The Grency venous stent system appeared excellent preliminary safe and effective for IVO treatment. Further large-scale studies with longer-term follow-up are needed to evaluate long-term patency and durability of stent. Clinical impact The design of venous stents for iliofemoral venous obstruction (IVO) must address engineering challenges distinct from those encountered in arterial stenting. The Grency venous stent, a nitinol self-expanding stent specifically tailored for IVO, features a composite structure designed to meet the stent requirements of various iliac vein segments. The Grency Trial is a prospective, multicenter, single-arm, open-label pivotal study aimed at evaluating the efficacy and safety of the Grency stent system. Following a 12-month follow-up period, the Grency venous stent system has demonstrated both safety and efficacy in treating iliofemoral venous outflow obstruction.

BackgroundsThe goal of this study was to assess the impact of neutrophil count, in patients with acute type A aortic dissection (ATAAD).MethodsThis study retrospectively collected data from patients between September 2017 and June 2021. Youden's index was used to determine the optimal cut-off value for the neutrophil count and patients were divided into two subgroups. A restricted cubic spline (RCS) was used to model the relationship between variables and in-hospital mortality. The least absolute shrinkage and selection operator (LASSO) method and multivariate logistic regression analyses were used to investigate the independent prognostic factors for in-hospital mortality in patients with ATAAD.ResultsA total of 467 patients were enrolled in this study. In-hospital mortality was 7.28%. The group with elevated neutrophil counts had significantly higher mortality than the group with decreased neutrophil counts (10.8% vs. 3.2%, P = 0.02). This data shows that elevated neutrophil count was significantly associated with in-hospital mortality (OR 3.07, 95% CI 1.22–7.62, P = 0.02).ConclusionsNeutrophil count is an independent risk factor for in-hospital mortality in patients with ATAAD. It is an effective inflammatory index, which can be individualized for patients.

Background: The purpose of this trial was to assess the safety and effectiveness of a paclitaxel-coated balloon catheter in Chinese patients with de novo or nonstented restenotic femoropopliteal atherosclerotic lesions. Methods: BIOLUX P-IV China is a prospective, independently adjudicated, multicenter, single -arm trial conducted in China. Patients with Rutherford class 2e4 were eligible, excluded were patients in which predilation resulted in severe (& GE; grade D) flow-limiting dissection or residual stenosis > 70%. Follow-up assessments were conducted at 1, 6, and 12 months. The primary safety end point was 30-day major adverse event rate and the primary effectiveness end point was primary patency at 12 months. Results: We enrolled 158 patients with 158 lesions. Mean age was 67.6 & PLUSMN; 9.6 years, diabetes was present in 53.8% (n = 85), and previous peripheral intervention/surgeries in 17.1% (n = 27). Lesions were 4.1 & PLUSMN; 0.9 mm in diameter and 74 & PLUSMN; 50 mm long with a mean diameter stenosis of 91 & PLUSMN; 13%; 58.2% (n = 92) were occluded (core laboratory analysis). Device success was achieved in all patients. The rate of major adverse events was 0.6% (95% confidence interval: 0.0; 3.5) at 30 days, consisting of 1 target lesion revascularization. At 12 months, binary reste-nosis was present in 18.7% (n = 26) and target lesion revascularization was performed in 1.4% (n = 2, all clinically driven), resulting in a primary patency of 80.0% (95% confidence interval: 72.4, 85.8); no major target limb amputation occurred. Clinical improvement at 12 months,

Objectives:Isolated abdominal aortic dissection (IAAD) is extremely rare, with its optimal treatment and intervention timing remaining poorly understood. We aimed to study the natural history of IAAD and facilitate better clinical decision. Methods:Consecutive patients admitted to our institution from January 2016 to April 2021 were enrolled and followed up prospectively. All-cause death was taken as the primary endpoint. Results:A total of 68 patients with IAAD were included. The mean age at presentation was 61.2 ± 14.8 (Range: 26.0, 93.0) years and 55 (80.9%) were male. A total of 38 (55.9%) patients were treated conservatively, 27 (39.7%) received endovascular aneurysm repair (EVAR), and 3 (4.4%) underwent open surgery. After a mean follow-up of 2.4 years (Range: 0.1, 5.5), 9 (13.2%) patients died, 8 of whom (21.0%) were treated conservatively and 1 EVAR (3.7%). Compared with EVAR/open surgery, patient treated conservatively had a much worse survival (p = 0.043). There was no significant difference between different IAAD aortic sizes regarding mortality (p = 0.220). Patients with completely thrombosed false lumen fared improved survival rate, followed by partial thrombosis and patency, respectively, although not significantly (p = 0.190). No significant difference was observed between male and female concerning survival rate (p = 0.970). Patients without symptoms had a significantly improved survival (p = 0.048). Conclusion:On the basis of patients' preference and surgeons' experience, a more aggressive treatment regimen for IAAD should be considered, with EVAR being the first choice, especially for those with persistent symptoms and patent false lumen, regardless of sex, age, or aortic size.

It is known that the Proximal Extension To Induce Complete Attachment (PETTICOAT) technique improves the distal aortic remodeling compared with standard thoracic endovascular aortic repair (TEVAR). [ 1, 2] However, the only available Zenith Dissection Endovascular System (Cook Medical Inc., Bloomington, Ind, USA) has several limitations, including only two sizes (36 mm and 46 mm) and an one-taper design, which may not be suitable for the complex morphology of dissection at distal aorta, particular for the east Asian population. Thus, our center designed the new "Fabulous" stent system and acheieved better early curative effect. Our center designed "Fabulous" stent system based on the conception of PETTICOAT technique. It included the proximal covered stent-graft and the distal bare stent component, which were designed to include 13 models to adapt various anatomical characteristics (the diameter of stent-graft and bare stent ranged between 20–44 mm and 16–40 mm, respectively). The deployment of proximal stent-graft was similar to the standard TEVAR; the distal bare stent was placed above the level of the celiac artery orifice with 3–4 cm overlapping with the proximal stent-graft. To further assess whether the "Fabulous" stent system was associated with better aortic remodeling versus standard TEVAR alone, we conducted a comparative study between the group with "Fabulous" stent system and with standard stent-grafts at 1-year follow-up. The study was approved by the relevant ethics committee (unique protocol ID: WQ1601). All patients enrolled provided written informed consent. The "Fabulous" stent system group was a prospective single-arm study conducted at multicenter between December 2017 and October 2019 comprised of 134 type B aortic dissection (TBAD) patients, [ 3] and 159 TBAD patients receiving standard TEVAR from multicenter during the same period were included in control group. Two groups have the consistent inclusion and exclusion criteria, and Inverse Probability Treatment Weighting (IPTW) was used to balance baseline characteristics and analyze the outcomes [Supplementary Table 1, https://links.lww.com/CM9/B504]. There was no significant difference in the rate of endoleak between the two groups, but all patients in "Fabulous" group have no reintervention and stent graft-induced new entry (SINE). The possible reason might be that the high and low wave with semi-suturing and flexibility design ensured that the bare stent component had good plasticity and adapted well to the aorta, reducing the risk of SINE. To assess aortic remolding, the distal aorta was divided into two segments: (segment 1) the thoracic aorta from distal end of the stent graft to the celiac trunk which contained the bare stent; (segment 2) from the celiac trunk to the lower renal artery. Patients in "Fabulous" group had better outcomes of true lumen (TL) expansion and false lumen (FL) diminution than those in the standard TEVAR group in the segment 1(22.95 ± 5.55 mm vs. 18.99 ± 6.12 mm, P = 0.001, minimum diameter of TL; 9.06 ± 12.27 mm vs. 25.20 ± 12.65 mm, P <0.001, maximum diameter of FL). As for the outcomes of the segment 2, "Fabulous" group further demonstrated better outcomes of TL expansion and FL diminution than standard TEVAR therapy (16.97 ± 5.01 mm vs. 15.23 ± 4.76 mm, P = 0.025, TL diameter; 11.53 ± 8.87 mm vs. 18.14 ± 10.10 mm, P <0.001, FL diameter). To better showed the changes of distal aortic remodeling of pre-operation and 1-year follow-up between the two groups, line graphs were made to compare the differences. In the segment 1, "Fabulous" group had better trend of TL expansion and FL regression than the standard TEVAR group (8.98 ± 0.91 mm ["Fabulous" group] vs. 5.84 ± 0.79 mm [standard TEVAR group], P <0.001, change of minimum diameter of TL; –20.9 ± 1.67 mm ["Fabulous" group] vs. –4.96 ± 1.46 mm [standard TEVAR group], P <0.001, change of maximum diameter of FL), and "Fabulous" group decreased the total aortic lumen area (7.36 ± 3.17 mm 2 [1-year follow-up] vs. 8.58 ± 2.62 mm 2 [pre-operation], P <0.001, total aortic lumen area). As for the outcomes in the segment 2, "Fabulous" group still showed better trend of TL diameter expansion than standard TEVAR group (2.71 ± 0.42 mm ["Fabulous" group] vs. 2.54 ± 0.4 mm [standard TEVAR group], P <0.001) and no obvious trend of total aortic lumen area expansion (6.32 ± 2.47 mm 2 [1-year follow-up] vs. 6.21 ± 1.66 mm 2 [pre-operation], P = 0.510, total aortic lumen area) [ Figure 1A]. In the aspect of FL thrombosis, patients in "Fabulous" group had better trend of FL thrombosis than those in standard TEVAR group at segment 1 [ Figure 1B].Figure 1: The comparison of aortic remodeling between "Fabulous" and standard TEVAR. (A) Line graph of aortic diameter changes at the segment 1 and 2 between the standard TEVAR and "Fabulous" groups. (B) The change rate of FL thrombosis at segment 1. FL: False lumen; TEVAR: Thoracic endovascular aortic repair; TL: Ture lumen.Compared with Zenith Dissection Endovascular System, although patients in Study for the Treatment of complicated Type B Aortic Dissection using Endoluminal repair (STABLE) trials benefitted from the PETTICOAT technique in terms of promoting distal FL thrombosis and TL expansion at 1-year follow-up, the diameter of abdominal aorta exhibited significant overall increase both in the SI and II trials. [ 4, 5] On the contrary, no obvious distal aortic enlargement was observed in our "Fabulous" group (6.32 ± 2.47 mm 2 [1-year follow-up] vs. 6.21 ± 1.66 mm 2 [pre-operation], P = 0.510, total aortic lumen area in segment 2). The potential reasons might be listed as follows: Firstly, the supporting section of bare stent was knitted with monofilament nitinol wire to ensure bearing certain radial compression; secondly, the connecting section of bare stent was knitted with multiple nitinol wire to ensure that the stent had good flexibility and conformability; thirdly, the multi-taper design feature with a 15–30% rate of oversizing, which was less than that of the Zenith Dissection Endovascular system, could adapt to the different situations better. The features of bare stent design in "Fabulous" stent system gained better TL remodeling without obvious distal aortic expansion. In summary, the application of "Fabulous" stent system had better outcomes of distal aortic remodeling than standard TEVAR, while did not increase the incidence of complications. It could adapt to the Asian populations' vascular anatomy better and still needed large and long-term follow-up to test its efficiency. Funding This study was supported by grants from the National Science Foundation of China (No.81970412); Shanghai Municipal Science and Technology Commission Innovation Fund (No.22S31904800); Fujian Province Health Science and Technology Fund (No.2021GGB030); Shanghai Municipal Science and Technology Commission Innovation Fund (No.18441902400); National Clinical Research Center for Interventional Medicine Fund (No.2021-004); Shanghai Municipal Health Commission (No.20214Y0474); Xiamen Municipal Health Science And Technology Program Fund (No. 3502Z20194034); and Fudan Zhangjiang Clinical Medicine Innovation Fund (No. KP7202115)Foundation:. Conflicts of interest None.

Aortic dissection (AD) is a lethal cardiovascular disease that is related to a genetic mutation. This study showed the generation of induced pluripotent stem cell (iPSC) line (iPSC-ZPR-4-P10) from AD patients' peripheral blood mononuclear cells that carried a c.2635T > G mutation in MCTP2. The iPSC line demonstrated normal karyotype and expression of pluripotency markers, which could be an efficient tool to better investigate the mechanism of aortic dissection.

Background:The weekend effect refers to the mortality difference for patients admitted/operated on weekends compared to those on weekdays. The study aimed to provide new evidence on the impact of the weekend effect on acute type A aortic dissection (ATAAD).Methods:Primary endpoints were operative mortality, stroke, paraplegia, and continuous renal replacement therapy (CRRT). A meta-analysis of current evidence on the weekend effect was first conducted. Analyses based on single-center data (retrospective, case-control study) were further performed.Results:A total of 18,462 individuals were included in the meta-analysis. The pooled results showed that mortality was not significantly higher for ATAAD on weekends compared to that on weekdays [odds ratio (OR): 1.16, 95% CI: 0.94-1.43]. The single-center cohort included 479 patients, which also showed no significant differences in primary and secondary outcomes between the two groups. The unadjusted OR for weekend group over weekday group was 0.90 (95% CI: 0.40-1.86, P=0.777). The adjusted OR for weekend group was 0.94 (95% CI: 0.41-2.02, P=0.880) controlling for significant preoperative factors, and 0.75 (95% CI: 0.30-1.74, P=0.24) controlling for significant preoperative and operative factors altogether. In PSM matched cohort, the operative mortality was still comparable between the weekend group [10 (7.2%)] and weekday group [9 (6.5%)] (P=1.000). No significant survival difference was observed between the two groups (P=0.970).Conclusions:The weekend effect was not found to be applicable to ATAAD. However, clinicians should be cautious of the weekend effect as it is disease-specific and may vary across healthcare systems.

In this report, we analyzed the outcomes of the hybrid technique for high-risk uncomplicated type B aortic dissection with landing zone 1. We enrolled 80 patients from January 2016 to January 2020 and retrospectively analyzed their outcomes, including mortality, aortic-related adverse events, and aortic remodeling. The mean age was 51.6 & PLUSMN; 9.9 years, and 68.0% (54 of 80) were men. Technical success was achieved in 100% of cases (80 of 80), and 30-day mortality was 4% of patients (n = 3), including 2 dissection-related deaths. Immediate endoleaks occurred in 16 patients, including 11 type Ia and 5 type II. Four patients (5%) developed minor strokes postoperatively, and no short-term spinal cord ischemia and re-intervention occurred. The average length of stay was 20 & PLUSMN; 8 days. The overall mortality was 8% after a median follow-up of 44 months (38 to 52). Five patients (7%) developed strokes, and 11 (16%) had late endoleaks, including 1 type Ia, 5 type Ib, and 3 type II. Four re-interventions (5%) were necessary, 3 for endoleaks and 1 for retrograde type A dissection. Three bypass graft occlusions (5%) and 5 stoma stenoses (8%) were observed in the latest follow-up computed tomography. In conclusion, the hybrid technique with landing zone 1 might be a viable alternative to open aortic arch replacement in patients at high risk with uncomplicated type B aortic dissection with acceptable early and late outcomes. However, stroke and endoleak complications should be further addressed. & COPY; 2023 Published by