[Abstract]The pathogenesis of aortic disease is not fully understood. Gut dysbiosis may play a role in the occurrence and development of aortic diseases. Several studies showed that the diversity of microbiota in abdominal aortic aneurysms significantly decreases and is correlated with the diameter of the aneurysm. Characteristic microbial communities associated with abdominal aortic aneurysm, such as Roseburia, Bifidobacterium, Ruminococcus, Akkermansia have been found in human and animal studies. The gut microbiota of patients with aortic dissection varies greatly. Characteristic microbial communities like Lachnospiraceae and Ruminococcus present a potential impact on the pathogenesis of aortic dissection. Bifidobacterium may be associated with Takayasu arteritis and thoracic aortic aneurysm. The gut microbiota affects the physiological functions of the host by synthesizing bioactive metabolites, which causes aortic diseases, mainly involving metabolites such as trimethylamine N-oxide (TMAO), lipopolysaccharides (LPS), tryptophan, and short chain fatty acids. More and more evidence supports the causal relationship between gut microbiota dysbiosis and aortic disease. Clarifying abnormal changes in gut microbiota may provide clues for finding potential therapeutic targets.
【Abstract】 Objective To reduce restenosis in vein grafts after coronary artery bypass grafting, to investigate theeffect of human tissue factor pathway inhibitor(TFPI) gene del ivery on neointima formation. Methods The eukaryotic expressed plasmid vector pCMV-(Kozak) TFPI was constructed. Forty-eight Japanese white rabbits were randomly divided into 3 groups with 16 rabbits in each group: TFPI group, empty plasmid control group and empty control group. Animal model of common carotid artery bypass grafting was constructed. Before anastomosis, vein endothel iocytes were transfected with cationic l iposome containing the plasmid pCMV- (Kozak) TFPI (400 μg) by pressurizing infusion (30 min) in TFPI group. In empty plasmid control group, vector pCMV- (Kozak) TFPI was replaced by empty plasmid pCMV (400 μg). In empty control group, those endothel iocytes were not interfered. After operation, vein grafts were harvested at 3 days for immunohistochemical, RTPCR and Western-blot analyses of exogenous gene expression and at 30 days for histopathology measurement of intimal areas, media areas and calculation of intimal/media areas ratio. Luminal diameter and vessel wall thickness were also measured byvessel Doppler ultrasonography and cellular category of neointima was analyzed by transmission electron microscope at 30 days after operation. Results Human TFPI mRNA and protein were detected in TFPI group. The mean luminal diameter of the TFPI group, empty plasmid control group and empty control group was (2.68 ± 0.32) mm, (2.41 ± 0.23) mm and (2.38 ± 0.21) mm respectively. There were statistically significant differences between TFPI group and control groups (P lt; 0.05). The vessel wall thickness of the TFPI group, empty plasmid control group and empty control group was (1.09 ± 0.11) mm, (1.28 ± 0.16) mm and (1.34 ± 0.14) mm respectively. There were statistically significant differences between TFPI group and other control groups (P lt; 0.01). The mean intimal areas, the ratio of the intimal/media areas of the TFPI group were (0.62 ± 0.05) mm2and 0.51 ± 0.08 respectively, which were reduced compared with those of the two control groups(P lt; 0.05). The mean media areas had no significant differences among three groups (P gt; 0.05). Through transmission electron microscope analyses, no smoothmuscle cells were seen in neointima of TFPI group in many visual fields, but smooth muscle cells were found in neointima of two control groups. Conclusion Human TFPI gene transfection reduced intimal thickness in vein grafts.
ObjectiveTo compare the outcomes following emergency surgery or conservative treatment for patients with acute type A aortic intramural hematoma (IMH).MethodsClinical data of consecutive patients diagnosed with acute type A aortic IMH in our hospital from September 2014 to December 2018 were retrospectively analyzed. The patients who met our surgical indications received surgery (an operation group) and other patients received strict conservative treatment (a conservative treatment group).ResultsFinally 127 patients were enrolled, including 112 males and 15 females with an average age of 53.6±13.0 years. Of 127 patients, 85 (66.9%) patients accepted emergency surgery and 42 (33.1%) patients accepted strict conservative treatment. There was no difference between the two groups in early mortality or complications (P＞0.05). The 5-year survival rate was 90.4% in the operation group and 74.3% in the conservative treatment group (P=0.010). A maximum aortic diameter in the ascending aorta and aortic arch≥45 mm and maximum thickness of IMH in the same section≥8 mm were risk factors for IMH-related death in patients undergoing conservative treatment (P＜0.001).ConclusionThe mortality associated with emergency surgery for patients with acute type A aortic IMH is satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than conservative treatment for patients with acute type A aortic IMH.
ObjectiveTo compare the perioperative and mid-term follow-up outcomes of patients undergoing coronary endarterectomy combined with coronary artery bypass grafting (CE-CABG) versus those undergoing CABG alone. MethodsA retrospective cohort of 2 070 patients who underwent surgery for coronary artery disease at the Department of Cardiac Surgery, Guangdong Provincial People's Hospital between 2016 and 2024 was included. Patients were excluded if they had missing data, concomitant valve, aortic, or congenital heart surgery, or underwent off-pump CABG. Eligible patients were divided into a CE-CABG group and a CABG group, and 1 : 1 propensity score matching was performed using the "MatchIt" package in R software. ResultsA total of 202 patients were included after matching (172 males, 30 females), with a mean age of (60.3±7.5) years. Baseline characteristics were well-balanced between the two groups (standardized mean difference<0.1 for all covariates). There were no statistical differences in operative mortality (4.0% vs. 4.0%) or early postoperative major adverse cardiovascular and cerebrovascular events (MACCE) (4.0% vs. 5.0%, both P >0.05) between the CE-CABG and CABG groups. The CE-CABG group exhibited significantly prolonged operative time [(401.1±105.9) min vs. (353.3±95.6) min], cardiopulmonary bypass (CPB) time [(206.4±65.2) min vs. (174.6±63.1) min], aortic cross-clamp time [125.0 (101.0, 159.5) min vs. 93.0 (70.0, 126.0) min] and postoperative hospital stay [24.0 (18.5, 33.5) d vs. 21.0 (15.0, 28.0) d] (all P<0.05). During a median follow-up of 33 months (follow-up rate: 93.1%), no statistical differences were observed in all-cause mortality (3.0% vs. 5.5%, P=0.498) or MACCE incidence (14.9% vs. 16.8%, P=0.700) between the two groups. However, the rates of cardiac-related readmission (23.8% vs. 37.6%, P=0.033) and coronary angiography re-examination (13.9% vs. 27.7%, P=0.015) were significantly lower in the CE-CABG group. Conclusion CE-CABG facilitates complete revascularization in patients with diffuse coronary artery disease (DCAD) without increasing operative mortality or the incidence of MACCE. CE-CABG is associated with longer CPB time, aortic cross-clamp time, operative time, and postoperative hospital length of stay. Follow-up results indicate that CE-CABG reduces the rates of cardiac-related readmission and coronary angiography re-examination in patients with DCAD. These findings demonstrate that the CE procedure itself does not increase operative risk and serves as a safe and effective strategy for achieving complete revascularization in patients with DCAD.