Hong Liu

Background: Minimally invasive techniques for harvesting arterial grafts have emerged to meet the demands for less invasive procedures. With the development of various harvesting methods, ensuring the safety and efficacy of these minimally invasive approaches remains critical. This case report describes minimally invasive direct coronary artery bypass (MIDCAB) surgery involving robotic harvesting of the left internal thoracic artery (LIMA) and laparoscopic-assisted harvesting of the right gastroepiploic artery (GEA). Case summary: A 55-year-old male patient underwent minimally invasive coronary artery bypass grafting, with robotic-assisted harvesting of the left LIMA and laparoscopic-assisted harvesting of the right GEA. The procedural workflow and our experience are described herein. Discussion: This case report emphasizes the importance of multimodality imaging in planning for minimally invasive coronary artery bypass grafting. Robotic harvesting of the IMA and laparoscopic harvesting of the right GEA are safe procedures and can be performed in selected patients.

This multicenter randomized controlled trial evaluates the efficacy of thymosin alpha 1 (Tα1) supplementation in preventing organ dysfunction following acute type A aortic dissection (ATAAD) repair. Over 330 patients will be equally assigned to receive either Tα1 plus standard care or placebo with standard management. The primary endpoint involves calculating the difference in mean postoperative Sequential Organ Failure Assessment (SOFA) scores between groups, measured daily from postoperative days 7. By targeting post-operative immune system imbalance, this study aims to establish a novel therapeutic approach for reducing systemic inflammatory response syndrome (SIRS)-mediated organ injury and improving long-term outcomes in this high-risk population. Results will be disseminated through peer-reviewed publications and international conferences.Trial registration: ClinicalTrials.gov Registry (NCT05339529).

Background: Acute type A aortic dissection (TAAD) is a life-threatening cardiovascular emergency with a high mortality rate. The peri-operative factors influencing in-hospital mortality among surgically treated TAAD patients remain unclear. This study aimed to identify key peri-operative risk factors associated with in-hospital mortality. Methods: Peri-operative laboratory data, surgical strategies, and TAAD-related risk factors, associated with mortality, were collected. Machine learning techniques were applied to evaluate the impact of various parameters on in-hospital mortality. Based on the findings, a nomogram model was developed and validated using area under the receiver operating characteristic curve (AUC) analysis, calibration plots, and internal validation methods. Results: A total of 199 patients with TAAD were included in the study cohort, which was divided into derivation and validation cohorts. Using the least absolute shrinkage and selection operator (LASSO) regression method, 66 features were narrowed down to six key predictors. These included age, lymphocyte count, use of continuous renal replacement therapy (CRRT), cardiopulmonary bypass (CPB) time, duration of mechanical ventilation, and postoperative interleukin-10 (IL-10) levels, all of which were identified as significant risk factors for in-hospital mortality following TAAD surgery. Conclusions: We developed and validated a predictive model, presented as a nomogram, to estimate in-hospital survival in patients with TAAD. Post-operative IL-10 was identified as an independent prognostic factor for patients with TAAD. The combination of IL-10 with five additional indicators significantly improved the predictive accuracy, demonstrating superiority over the use of any single variable alone. Clinical Trial Registration: This study protocol was registered at ClinicalTrials.gov (NCT04711889). https://clinicaltrials.gov/study/NCT04711889.

Background: Acute aortic dissection is a lethal cardiovascular emergency; early diagnosis is critically necessary. Novel serum biomarkers can potentially help in early detection and estimation of postoperative outcomes. Yes-associated protein (YAP) is a critical effector of the Hippo pathway, our aim was to explore the association between YAP and the diagnosis and prognosis of AD.Methods: We prospectively recruited 110 consecutive chest-pain patients [acute type A aortic dissection (ATAAD), n = 60; acute coronary syndrome (ACS), n = 50]. Blood samples were collected to determine levels of YAP and other serum biomarkers, and receiver operating characteristic curves (ROC) were constructed to assess the predictability in early diagnosis of AAD and postoperative major adverse events (MAEs).Results: YAP concentration was substantially elevated among ATAAD patients [3.45 (3.18, 3.63) vs. 2.44 (2.23, 2.59), P < 0.01]. Moreover, the white blood cell (WBC) count and plasma fibrin D-dimers were remarkably high among ATAAD patients [11.46 (9.57, 14.03) vs. 6.24 (5.10, 7.30), P < 0.01; 2,097.00 (998.75, 3,652.00) vs. 97.00 (67.25, 137.00), P < 0.01]. The serum YAP level held as a good predictive value in early diagnosis of ATAAD. The optimal cutoff value was 3.15 ng/ml, with an AUC of 0.94 (95% CI, 0.90–0.98, P < 0.01), sensitivity of 80% and specificity of 98%. The combined model of YAP, WBC count and D-Dimer exhibited an enhanced predictive power, with an AUC of 0.99 (95% CI, 0.98–1.00, P < 0.01). Serum YAP values at 12 h post-surgery provided the most accurate prediction of postoperative MAEs, with an optimal cutoff value of 3.60 ng/ml, an AUC of 0.89 (95% CI, 0.79–0.99, P < 0.01), and sensitivity and specificity of 88% and 82%, respectively.Conclusions: The serum YAP concentration is an early and sensitive serum bioindicator for distinguishing AAD from ACS. Moreover, the amount of postoperative circulating YAP is a robust indicator of postoperative MAEs.

Background Acute aortic dissection (AD) in pregnancy poses a lethal risk to both mother and fetus. However, well-established therapeutic guidelines are lacking. This study aimed to investigate clinical features, outcomes and optimal management strategies for pregnancy-related AD. Methods We conducted a retrospective multicentre cohort study including 67 women with acute AD during pregnancy or within 12 weeks postpartum from three major cardiovascular centres in China between 2003 and 2021. Patient characteristics, management strategies and short-term outcomes were analysed. Results Median age was 31 years, with AD onset at median 32 weeks gestation. Forty-six patients (68.7%) had type A AD, of which 41 underwent immediate surgery. Overall maternal mortality was 10.4% (7/67) and fetal mortality was 26.9% (18/67). Compared with immediate surgery, selective surgery was associated with higher risk of composite maternal and fetal death (adjusted RR: 12.47 (95% CI 3.26 to 47.73); p=0.0002) and fetal death (adjusted RR: 8.77 (95% CI 2.33 to 33.09); p=0.001). Conclusions Immediate aortic surgery should be considered for type A AD at any stage of pregnancy or postpartum. For pregnant women with AD before fetal viability, surgical treatment with the fetus in utero should be considered. Management strategies should account for dissection type, gestational age, and fetal viability. Trial registration number NCT05501145.

Acute lung injury (ALI) is a serious adverse event in the management of acute type A aortic dissection (ATAAD). Using a large-scale cohort, we applied artificial intelligence-driven approach to stratify patients with different outcomes and treatment responses. A total of 2,499 patients from China 5A study database (2016–2022) from 10 cardiovascular centers were divided into 70% for derivation cohort and 30% for validation cohort, in which extreme gradient boosting algorithm was used to develop ALI risk model. Logistic regression was used to assess the risk under anti-inflammatory strategies in different risk probability. Eight top features of importance (leukocyte, platelet, hemoglobin, base excess, age, creatinine, glucose, and left ventricular end-diastolic dimension) were used to develop and validate an ALI risk model, with adequate discrimination ability regarding area under the receiver operating characteristic curve of 0.844 and 0.799 in the derivation and validation cohort, respectively. By the individualized treatment effect prediction, ulinastatin use was significantly associated with significantly lower risk of developing ALI (odds ratio [OR] 0.623 [95% CI 0.456, 0.851]; P = 0.003) in patients with a predicted ALI risk of 32.5–73.0%, rather than in pooled patients with a risk of 73.0% (OR 0.929 [0.682, 1.267], P = 0.642) (Pinteraction = 0.075). An artificial intelligence-driven risk stratification of ALI following ATAAD surgery were developed and validated, and subgroup analysis showed the heterogeneity of anti-inflammatory pharmacotherapy, which suggested individualized anti-inflammatory strategies in different risk probability of ALI.

Background: Acute aortic syndrome (AAS) is a life-threatening condition. Inflammation plays a key role in the pathogenesis, development and progression of AAS, and is associated with significant mortality and morbidity. Understanding the inflammatory responses and inflammation resolutions is essential for an appropriate management of AAS. Method: Thirty Chinese cardiovascular centers have collaborated to create a multicenter observational registry (named Chinese Additive Anti-inflammatory Action for Aortopathy & Arteriopathy [5A] registry), with consecutive enrollment of adult patients who underwent surgery for AAS that was started on Jan 1, 2016 and will be ended on December 31, 2040. Specially, the impact of inflammation and anti-inflammatory strategies on the early and late adverse events are investigated. Primary outcomes are severe systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), Sequential Organ Failure Assessment (SOFA) scores at 7 days following this current surgery. Secondary outcomes are SISR, 30-day mortality, operative mortality, hospital mortality, new-onset stroke, acute kidney injury, surgical site infection, reoperation for bleeding, blood transfusion and length of stay in the intensive care unit. Discussion: The analysis of this multicenter registry will allow our better knowledge of the prognostic importance of preoperative inflammation and different anti-inflammatory strategies in adverse events after surgery for AAS. This registry is expected to provide insights into novel different inflammatory resolutions in management of AAS beyond conventional surgical repair. Trial registration: ClinicalTrials.gov Identifier: NCT04398992 (Initial Release: 05/19/2020).