Jae-Sung Choi

Aberrant right subclavian artery (ARSA) is the most common anomaly of the aortic arch and is usually asymptomatic. In a minority of patients, ARSA may caus

Background: Transcatheter aortic valve replacement (TAVR) and sutureless/rapid-deployment aortic valve replacement (SUAVR) have each undergone rapid technological advances and expanding indications. However, direct comparative evidence between the two, particularly for long-term outcomes, remains limited. Methods: We conducted an updated meta-analysis of propensity score-matched studies using reconstructed individual patient data (IPD) to compare TAVR with SUAVR. The protocol was registered in PROSPERO (CRD420251046330). Published Kaplan-Meier survival curves were digitized, IPD reconstructed, and pooled analyses performed. Meta-regression was conducted on the pooled population. Results: A total of 6604 matched patients from 14 studies were included (TAVR: 3298; SUAVR: 3306). TAVR was associated with lower long-term survival (52.5% vs. 64.6% at 9 years; hazard ratio = 1.48, 95% CI: 1.27–1.72; P < 0.001), higher 30-day mortality [odds ratio (OR) = 2.26, 95% CI: 1.36–3.76], and increased rates of permanent pacemaker implantation (PPI; OR = 1.85, 95% CI: 1.10–3.10) and moderate-or-greater paravalvular leak (PVL; OR = 4.46, 95% CI: 2.58–7.71). In contrast, mean pressure gradient (mean PG) was lower with TAVR (standardized mean difference = −0.52, 95% CI: −0.75 to −0.29). Meta-regression suggested that higher rates of PPI, prosthesis-patient mismatch, and moderate-or-greater PVL may attenuate the survival advantage of SUAVR, although the magnitude of this effect appeared modest. Conclusion: SUAVR was associated with superior long-term survival and favorable early outcomes compared with TAVR, whereas mean PG favored TAVR. These findings suggest that SUAVR may mitigate the surgical trauma inherent to conventional AVR, narrowing the gap with TAVR, and the choice of TAVR or SUAVR should be carefully individualized, especially in patients with longer life expectancy.

Background/Objective: Atrial fibrillation (AF) is associated with more grave and fatal outcomes than the other stroke etiologies. Left ventricular diastolic dysfunction (LVDD) is prevalent in elderly people and is associated with AF risk. We investigated whether higher preadmission CHA₂DS₂-VASc score is related to LVDD severity and functional outcome among stroke patients with nonvalvular AF. Methods: A retrospective cross-sectional analysis of data on consecutive acute ischemic stroke patients with AF within a week of onset was conducted from March 2015 to February 2018. Patients were compared by median LVDD value (13.0). CHA₂DS₂-VASc was assessed by score, with three categories (low risk [a CHA₂DS₂-VASc score of 0–2], moderate risk [3,4], and high risk [≥5]), and its individual component. Functional outcome was measured with the modified Rankin Scale (mRS) at 3 months poststroke, and unfavorable outcome was defined as mRS ≥ 3. Results: A total of 256 patients (mean age, 73.3 ± 10.2; male, 51.6%) were included. In multivariable regression analysis, CHA₂DS₂-VASc was associated with LVDD (OR 1.70, 95% CI: 1.31–2.21 for score and 9.92, 2.99–32.88 for high risk ≥ 5 versus low risk 0–2). Increasing CHA₂DS₂-VASc score and high risk ≥ 5 versus low risk 0–2 was associated with mRS ≥ 3 (1.72, 1.27–2.33 and 6.48, 1.37–30.60, respectively). The C-statistic of the CHA₂DS₂-VASc score was 0.75 (0.70–0.80) for LVDD and 0.80 (0.75–0.85) for mRS ≥ 3. The sensitivity of the CHA₂DS₂-VASc score for mRS ≥ 3 was higher than for LVDD. Conclusions: Higher preadmission CHA₂DS₂-VASc score can be a cumulative determinant of short-term functional outcome more than LVDD severity among stroke patients with nonvalvular AF.

Dong Jae Han, M.D., You Jung Ok, M.D., Ph.D., Se Jin Oh, M.D., Ph.D., Jae-Sung Choi, M.D., Ph.D., Yong Won Seong, M.D., Hyeon Jong Moon, M.D.. J Chest Surg 2024;57:477-83. https://doi.org/10.5090/jcs.24.026

Sangil Yun, M.D., You Jung Ok, M.D, Ph.D., Se Jin Oh, M.D., Ph.D., Jae-Sung Choi, M.D., Ph.D., Hyeon Jong Moon, M.D., Yong Won Seong, M.D.. J Chest Surg 2024;57:329-38. https://doi.org/10.5090/jcs.23.161

Background Abdominal aortic aneurysm (AAA) is a potentially lethal condition that often remains asymptomatic until it ruptures. Recent research suggests that immune-inflammatory processes are associated with AAA development, yet the exact mechanisms remain unclear. Serum C-reactive protein (CRP) serves as a prognostic marker for AAA and various cardiovascular diseases. When CRP accumulates in damaged tissues, it transforms into a monomeric form, exacerbating tissue damage. Our previous study confirmed the presence of CRP deposition in eroded AAA and atherosclerosis regions, accompanied by an increased infiltration of inflammatory cells. However, a comprehensive understanding of the specific changes in the inflammatory cellular landscape attributable to CRP deposition is lacking. Here, we aimed to explore cellular-level alterations in AAAs associated with varying CRP levels. Methods We categorized AAA patients into High-CRP (≥0.1 mg/dL, and ≥3+ CRP IHC score, n=6) and Low-CRP (≤0.1 mg/dL, and ≤1+ CRP IHC score, n=3), and used normal aorta specimens as a baseline control. The cellular landscape of immune and stromal components was characterized using Co-Detection by Indexing (CODEX) tissue imaging with 31 DNA-barcoded antibodies, followed by single-cell-based analysis and GPU-accelerated unsupervised clustering. Results We identified 51 distinct immune and stromal cell types in the cohort and revealed significant differences in protein expression patterns among the groups. In AAA, stromal cells decreased significantly, while immune cell proportions sharply increased. Lag3+ T cell regulators decreased, leading to an increase in CD3+ T cells. The composition of immune cells within atherosclerotic plaques was associated with the degree of CRP deposition in AAA. The High-CRP group showed increased M1 and Ki67+ proliferating macrophages, while the Low-CRP group exhibited intensified fibrosis with M2 macrophages. Conclusions Our study found significant variations in immune cell distribution within AAA walls based on CRP levels. These findings suggest a potential link between CRP-related immune changes and AAA progression. HIGHLIGHTS By performing CODEX (co-detection by indexing) multiplexed imaging on paraffin-embedded, formalin-fixed archived abdominal aortic aneurysm (AAA) tissue samples with varying CRP levels, we segmented 415,365 cells into 51 distinct clusters. In AAA, the presence of CRP deposition led to variations in the spatial relationships, distances, and enrichment patterns among immune and stromal cells.. In AAA-High CRP, there was an intensified infiltration of M1 macrophages and various immune cells observed in the atherosclerotic plaque. In AAA-Low CRP, severe stromal fibrosis was associated with M2 macrophages. Our results suggest that the deposition of CRP into the atherosclerotic plaque alters the immune-stromal landscape in AAA.

Jeongwon Kim, M.D., Suk Ho Sohn, M.D., Jae-Sung Choi, M.D., Ph.D., Se Jin Oh, M.D., Ph.D., Ho Young Hwang, M.D., Ph.D.. J Chest Surg 2023;56:313-21. https://doi.org/10.5090/jcs.23.027

Background: Brachial-ankle pulse wave velocity (baPWV) and early diastolic transmitral flow velocity to mitral annular tissue velocity (E/e′)—which are markers of arterial stiffness and left ventricular (LV) filling pressure, respectively—have been associated with morbidity and mortality. We investigated their combined impact on postoperative complications and long-term survival of patients undergoing off-pump coronary artery bypass grafting (OPCAB). Methods: A cohort of 164 patients were divided into four groups: baPWV ≤ 19 m/s and E/e′ ≤ 15 (reference), baPWV > 19 m/s and E/e′ ≤ 15 (high-PWV-only), baPWV ≤ 19 m/s and E/e′ > 15 (high-E/e′-only), and baPWV > 19 m/s and E/e′ > 15 (high-PWV-and-E/e′). After inverse probability treatment weighting adjustment, each group was compared with the reference group to analyze the odds ratios of postoperative complications and the Kaplan–Meier survival curves, and to identify the group representing an independent prognostic predictor. Results: The median age and follow-up duration were 69 years and 57.2 months, respectively. Both postoperative acute kidney injury (POAKI) and atrial fibrillation (POAF) were higher in the high-PWV-and-E/e′ group (adjusted odds ratio (OR) = 89.5; 95% confidence interval (CI), 8.5–942.3; p < 0.001 and OR = 12.5; CI, 2.5–63.8; p = 0.002, respectively). Compared to the reference group, only the high-PWV-and-E/e′ group showed significantly lower survival rate (91.0%; CI, 82.8–100% vs. 44.8%; CI, 21.2–94.6%) and a higher hazard for all-cause mortality after adjustment for covariates (hazard ratio = 6.1; p = 0.002). Conclusion: Concurrent elevation in PWV and E/e′ may independently affect not only the rates of POAKI and POAF but also long-term survival after OPCAB.

Background: Brachial-ankle pulse wave velocity (baPWV) and early diastolic transmitral flow velocity to mitral annular tissue velocity (E/e’), markers of arterial stiffness and left ventricular (LV) filling pressure, respectively, have been associated with morbidity and mortality. We investigated their combined impact on postoperative complications and long-term survival of patients undergoing off-pump coronary artery bypass grafting (OPCAB). Methods: A cohort of 164 patients were divided into four groups: baPWV≤19m/s and E/e’≤15 (reference), baPWV>19m/s and E/e’≤15 (high-PWV-only), baPWV≤19m/s and E/e’>15 (high-E/e’-only), and baPWV>19 m/s and E/e’>15 (high-PWV-and-E/e’). Each group was compared with the reference group to analyze the odds ratios of postoperative complications and the Kaplan-Meier survival curves, and to identify the group representing an independent prognostic predictor. Results: The median age and follow-up duration were 66.2 years and 57.2 months, respectively. Postoperative acute kidney injury (POAKI) was higher in the high-PWV-only group and substantially higher in high-PWV-and-E/e’ group (adjusted odds ratio (OR)=4.8; 95% confidence interval (CI), 1.3-17.1; p=0.016 vs. OR=22.6; CI, 5.9–86.1; pConclusion: Concurrent elevation in PWV and E/e’ may independently affect not only the rates of POAKI, POAF, and POSD but also long-term survival after OPCAB.

Transcatheter repair of a pseudoaneurysm of the aortic sinotubular junction with coils is quite challenging because it can cause coronary or systemic embolization of coils and aortic rupture. A 71‐year‐old female patient with Behcet's disease who had received repeated surgical aortic repairs presented with a complicated pseudoaneurysm. It developed not on the native aorta, but on the ascending aortic graft. It was positioned just beside the os of the attached trifurcated vascular graft trunk connecting arch vessels. To avoid reopening the sternum, which would have been fatal, coil embolization was successfully performed. This case suggests that transcatheter coil embolization might provide an alternative treatment option for such patients with a high risk of surgical mortality.