Special Issue "Thoracic Aorta"

A special issue of Hearts (ISSN 2673-3846).

Deadline for manuscript submissions: 30 June 2020.

Special Issue Editor

Prof. Dr. John Pepper
Website
Guest Editor
Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
Interests: The thoracic aorta and the aortic valve

Special Issue Information

Dear Colleagues,

This Special Issue arises from London Aorta 2019, an annual pan-London Aortic meeting. The essence of the meeting is the close collaboration between interventional cardiologists, non-interventional cardiologists and cardiac surgeons, radiologists and geneticists to provide the best advice and treatment for our patients. We have selected 10 papers which reflect the range of subjects discussed.

Disease of the thoracic aorta is mostly indolent and is only discovered in the context of an emergency, such as dissection, or by serendipity during a radiological investigation for another disease. The aorta has been called the orphan organ and there are many claimants at the orphanage: cardiac surgeons, vascular surgeons, interventional cardiologists or radiologists. There is a strong argument to apply a team approach and to make this a truly patient-centric speciality. The impact of advanced imaging, CT and MRI in particular, has transformed the management of patients with aortic disease. By combining the diagnostic and interventional skills of individuals from different specialities who have a passion for this intriguing group of diseases we can provide timely and appropriate treatment for the patient.

Much of the research undertaken on the thoracic aorta has been of a technical nature to reduce the mortality and the morbidity of surgical procedures on patients who in the elective setting are often asymptomatic. Much effort has been expended on protection of the brain and spinal cord and on the development of alternative surgical approaches, such as de-branching of the head vessels and on new procedures in endovascular aortic interventions. These developments, which have arisen from experimental work on large mammals, have proved to be very effective but they have not been tested in a randomised controlled trial. It is focussed aortic teams who will take forward the leading edge of endovascular treatment into the ascending aorta, using branched devices in the arch and the visceral segment and protecting the spinal cord. 

Research of a translational nature has been less common, but there is a growing interest in the role of inflammation as a trigger for aneurysm enlargement in the thoracic aorta. Much effort continues to be expended on the genetic and genomic mechanisms underlying inherited disease of the aortic valve, aortic root and ascending aorta, but this is yet to have a major impact in clinical decision making. Next generation sequencing with “aortic panels” are in use in specialist centres. These panels allow for genetic scrolling of the entire spectrum of aortic defects in one test.

Operations for diseases of the aorta, once considered to be too high risk for many surgeons, are now a part of the daily routine. We have learned something about the nature of the aorta, how to analyse the images and how to correct the defects. While major surgery of the thoraco-abdominal aorta is likely to decline, TEVAR is in the ascendancy. Although the early results are encouraging and the morbidity significantly less than for open surgery, the long-term results remain uncertain. Whether the future will lie in hybrid procedures or be dominated by a stent-based approach is uncertain. What is certain is that this area of activity will continue to fascinate and challenge all those who choose to tread this path.

Prof. Dr. John Pepper
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Hearts is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (2 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Review

Jump to: Other

Open AccessReview
Management of Uncomplicated Type B Aortic Dissection
Hearts 2020, 1(1), 14-24; https://doi.org/10.3390/hearts1010004 - 18 May 2020
Abstract
Acute aortic dissection has an incidence of approximately half that of symptomatic abdominal and thoracic aneurysm of the aorta and more than twice the mortality of population-based controls. While urgent undelayed open surgery is the strategy of choice in proximal dissection, medical management [...] Read more.
Acute aortic dissection has an incidence of approximately half that of symptomatic abdominal and thoracic aneurysm of the aorta and more than twice the mortality of population-based controls. While urgent undelayed open surgery is the strategy of choice in proximal dissection, medical management has been the mainstay of treatment for uncomplicated distal or type B aortic dissection, but endovascular intervention is now considered a potential treatment option for all type B dissection due to its success in complicated cases. Endovascular repair can be technically demanding in aortic dissection, and timing of the repair can have a significant influence on anatomical and clinical outcome. Observational reports of feasibility and reasonable safety are flanked by only two randomised trials; the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) trial demonstrated improved remodelling in acute dissection and the INvestigation of STEnt grafts in patients with type B Aortic Dissections (INSTEAD) trial showed better long-term survival in patients treated endovascularly in the subacute phase. Meta-analyses and other large clinical studies have demonstrated mixed results. Due to some risks associated endovascular repair and the requirement of specialist aortic care (which is not always available), a pragmatic approach for current management could involve high intensity serial imaging in the acute phase of a type B aortic dissection, thereby identifying complicated cases for early intervention and selection of patients at high risk of disease progression for deferred endovascular management in the subacute phase within 90 days. Full article
(This article belongs to the Special Issue Thoracic Aorta)
Show Figures

Figure 1

Other

Jump to: Review

Open AccessPerspective
The Management of Penetrating Aortic Ulcer
Hearts 2020, 1(1), 5-13; https://doi.org/10.3390/hearts1010003 - 15 May 2020
Abstract
Penetrating aortic ulceration (PAU) is part of the spectrum of acute aortic syndromes (AAS), and is defined as an ulcerated intimal disruption due to atherosclerotic disease. PAU may be simple, isolated and asymptomatic, or it may be symptomatic, aneurysmal and extensive; these may [...] Read more.
Penetrating aortic ulceration (PAU) is part of the spectrum of acute aortic syndromes (AAS), and is defined as an ulcerated intimal disruption due to atherosclerotic disease. PAU may be simple, isolated and asymptomatic, or it may be symptomatic, aneurysmal and extensive; these may progress and lead to rupture. This review aims to evaluate the treatment options for PAU. Treatment options range from radiological surveillance, risk factor modification, best medical therapy and open or endovascular surgical repair. Patients with PAU are frequently older and comorbid with relatively damaged aortic tissue; this can make open surgical repair more challenging. Endovascular repairs for larger, symptomatic, aneurysmal PAU may be performed with acceptable outcomes. Complex endovascular repairs may be required depending on the pathology. Patients with small, asymptomatic, uncomplicated PAU may be safely followed up with surveillance. PAU with concomitant intramural haematoma (IMH) should be closely monitored to observe for resolution or progression following conservative and medical management strategies. PAU is a unique entity and its natural history should be studied independently to better understand appropriate management strategies. This research is currently lacking, and larger studies or registries may be helpful in optimising PAU management. Full article
(This article belongs to the Special Issue Thoracic Aorta)
Back to TopTop