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Aortic Surgery—Back to the Roots and Looking to the Future
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Aortic Surgery—Back to the Roots and Looking to the Future

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Cardiac Surgery".

Deadline for manuscript submissions: 31 May 2026 | Viewed by 1694

Special Issue Editors

Dr. Ezin Deniz

E-Mail Website
Guest Editor
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
Interests: aortic surgery; minimally invasive approaches; perioperative management; translational cardiovascular research
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Aron-Frederik Popov

E-Mail Website
Guest Editor
Department of Cardiac Surgery, Asklepios Klinikum Harburg, Hamburg, Germany
Interests: mechanical circulatory support; cardiothoracic transplantation; minimally invasive cardiac surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Aortic surgery stands at a pivotal crossroads where time-tested open techniques meet rapidly evolving endovascular and hybrid innovations.

This Special Issue seeks to illuminate the evolving landscape of aortic surgery by bridging its historical foundations with the latest technological and clinical advances shaping its future.

From the pioneering open procedures that established the foundation of modern aortic surgery to minimally invasive and hybrid strategies, the field continues to evolve rapidly. Advances in imaging, perfusion strategies, cerebral protection, perioperative care, and the development of novel biomaterials are further broadening the spectrum of therapeutic possibilities.

This Special Issue aims to provide a platform for original research, reviews, and perspectives that highlight both historical milestones and current innovations, with the goal of fostering a comprehensive understanding of the past, present, and future of aortic surgery. By integrating tradition with cutting-edge innovation, it will offer readers a unique opportunity to reflect on landmark achievements, engage with state-of-the-art progress, and explore forward-looking concepts that will shape future standards of care.

We warmly invite contributions from experts in surgery, cardiology, anesthesiology, radiology, and biomedical sciences to enrich this multidisciplinary discourse.

You may choose our Joint Special Issue in Journal of Clinical Medicine.

Dr. Ezin Deniz
Prof. Dr. Aron-Frederik Popov
Guest Editors

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 submissions that pass pre-check are 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 250 words) can be sent to the Editorial Office for assessment.

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. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). 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.

Keywords

  • aortic surgery
  • hybrid and endovascular innovations
  • perioperative management
  • cerebral and organ protection
  • biomaterials
  • translational cardiovascular research
  • imaging in aortic disease
  • long-term outcomes
  • cardiovascular surgery

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Published Papers (3 papers)

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Research

16 pages, 1600 KB  
Article
Prognostic Value of a Composite Inflammation–Renal Function Score in Type A Aortic Dissection
by Rui-Qin Zhou, Yin-Ding Peng, Hao Cai, Cheng Zhang and Qing-Chen Wu
J. Cardiovasc. Dev. Dis. 2026, 13(3), 133; https://doi.org/10.3390/jcdd13030133 - 11 Mar 2026
Viewed by 361
Abstract
Background and Objectives: Systemic inflammation and renal dysfunction play a central role in the progression and prognosis of type A aortic dissection (TAAD). This study evaluated the SCr score, a composite index combining the systemic inflammation response index (SIRI) and serum creatinine, to [...] Read more.
Background and Objectives: Systemic inflammation and renal dysfunction play a central role in the progression and prognosis of type A aortic dissection (TAAD). This study evaluated the SCr score, a composite index combining the systemic inflammation response index (SIRI) and serum creatinine, to assess its prognostic value postoperatively. Materials and Methods: Clinical data from 299 surgically treated TAAD patients were retrospectively analyzed. SCr scores were stratified into three levels using optimal cutoffs. Survival differences were examined using Kaplan–Meier curves. Independent predictors of overall survival (OS) and in-hospital mortality (IHM) were identified through multivariable Cox and logistic regression, respectively. A prognostic nomogram integrating SCr and significant clinical variables was developed, and model performance was evaluated and compared with previously published models. Results: Higher SCr scores were associated with a progressively increased mortality risk. In multivariable Cox analysis, both SCr scores of 1 and 2 emerged as independent predictors of worse long-term survival, with SCr = 2 demonstrating a particularly strong association (hazard ratio (HR) = 4.408, 95% confidence interval (CI): 1.786–10.881; p = 0.001). In logistic regression analysis, SCr scores remained an independent predictor of IHM (SCr = 1: odds ratio (OR) = 3.066, 95% CI: 1.032–9.102; SCr = 2: OR = 4.811, 95% CI: 1.081–21.409; p < 0.05 for both). A prognostic nomogram based on the SCr score and other clinical variables achieved strong discrimination for OS (area under the curve [AUC]: 0.845) and IHM (AUC: 0.821). Conclusions: The SCr score was independently associated with preoperative risk in patients with TAAD. An SCr-incorporating nomogram demonstrated favorable discriminative performance for predicting overall survival and in-hospital mortality. These findings suggest that SCr-based assessment may provide complementary information and assist in the identification of high-risk patients within established clinical assessment frameworks. Full article
(This article belongs to the Special Issue Aortic Surgery—Back to the Roots and Looking to the Future)
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10 pages, 530 KB  
Article
Valve-Sparing Versus Composite Graft Aortic Root Replacement in Acute Type A Aortic Dissection with Standardized Hemiarch Repair: A Propensity Score Matching Analysis
by Mohammed Morjan, Tong Li, Luis J. Vallejo Castano, Carlos A. Mestres, Amin Thwairan, Freya S. Jenkins, Hannan Dalyanoglu and Artur Lichtenberg
J. Cardiovasc. Dev. Dis. 2026, 13(3), 116; https://doi.org/10.3390/jcdd13030116 - 4 Mar 2026
Viewed by 351
Abstract
Objectives: The aim of this study was to compare the short- and long-term results of patients who had received aortic valve-sparing reimplantation (David I procedure) vs. aortic root replacement using a composite graft combined with a hemiarch replacement for acute type A aortic [...] Read more.
Objectives: The aim of this study was to compare the short- and long-term results of patients who had received aortic valve-sparing reimplantation (David I procedure) vs. aortic root replacement using a composite graft combined with a hemiarch replacement for acute type A aortic dissection (ATAAD) in a propensity score matching analysis. Methods: In this retrospective study we compared the outcomes before and after propensity score matching of patients who underwent emergency surgical repair for ATAAD requiring replacement of the aortic hemiarch with replacement of the aortic root between 2001 and 2023 at our institute. The 154 patients were divided into two groups: the first group consisted of patients undergoing David (n = 59), and the second group of patients undergoing Bentall (n = 95) procedures combined with an aortic hemiarch replacement. To reduce the confounding impact of pre-operative variables in this non-randomized study, 1:1 propensity score matching using the Nearest-Neighbour Matching algorithm was used. Results: Patients in the David plus Hemiarch group were significantly younger (62.16 ± 12.35 vs. 55.55 ± 10.80, p = 0.001). After the propensity score matching there were no significant differences between the two groups regarding intra-operative variables and hospital outcomes. In-hospital death was 15% (n = 6) in the David plus Hemiarch group compared to 24% (n = 10) in the Bentall plus Hemiarch group (15% vs. 24%, p = 0.40). Operation time was also similar between the two groups, being 402 and 384 min, respectively. Survival analyses also did not show any difference in long-term survival between both groups. Conclusions: When a standardized hemiarch replacement was used, no significant differences in short- and long-term outcomes were observed between a valve-sparing procedure and composite graft replacement in patients undergoing surgical repair for ATAAD. Surgeons should opt for the surgical strategy they are most comfortable with. This study represents one of the few analyses comparing the David and Bentall techniques in ATAAD patients undergoing standardized hemiarch replacement. Despite its retrospective nature, it provides clinically relevant insights for surgical decision-making in emergency settings. Full article
(This article belongs to the Special Issue Aortic Surgery—Back to the Roots and Looking to the Future)
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15 pages, 2151 KB  
Article
Development and Validation of an Acute Large Animal Model for Type A Aortic Dissection
by Ezin Deniz, Sibylle Marsen, Florian Helms, Heike Krüger, Naoki Arima, Jasmin Hanke, Ali Saad Merzah, Sadeq Al-Hasan-Al-Saegh, Sara Knigge, Saman Alhowaizy, Tanja Meyer, Rabea Hinkel, Morsi Arar, Aron F. Popov, Günes Dogan, Bastian Schmack, Alexander Weymann, Arjang Ruhparwar, Salaheldien Ali Mohamed-Glüer and Jan D. Schmitto
J. Cardiovasc. Dev. Dis. 2025, 12(12), 496; https://doi.org/10.3390/jcdd12120496 - 16 Dec 2025
Viewed by 652
Abstract
Background: Animal models are essential for translating diagnostic and therapeutic strategies into clinical practice and offer valuable insights into the pathophysiology of diseases such as aortic dissection. This study presents a novel acute in vivo large animal model of Stanford type A aortic [...] Read more.
Background: Animal models are essential for translating diagnostic and therapeutic strategies into clinical practice and offer valuable insights into the pathophysiology of diseases such as aortic dissection. This study presents a novel acute in vivo large animal model of Stanford type A aortic dissection, combining open surgical access with endovascular techniques to leverage the advantages of both. The model aims to reproducibly simulate acute dissections in swine, providing a standardized platform for evaluating diagnostics, disease mechanisms, and treatment strategies. Methods: Six pigs underwent a standardized protocol to induce aortic dissection. Arterial pressure was monitored via femoral and carotid catheterization. A conventional sternotomy was performed, followed by tangential cross-clamping of the ascending aorta and a controlled incision proximal to the brachiocephalic trunk. The intima and the media were separated using a guidewire and catheter-based technique to create a false lumen. A re-entry tear was also established to allow for controlled intraluminal access. Animals were monitored for 12 h post-intervention, with serial blood sampling. At the end of the experiment, the animals were euthanized and the aortas harvested for macroscopic and histological analysis. Results: In all 6 animals, the placement of arterial catheters in femoral and carotid arteries, as well as the sternotomy, was established without any complications. The dissection model was successfully created in 5 out of 6 animals by clinical signs such as adventitial hematoma, macroscopic wall separation and/or decreased femoral blood pressure. One animal experienced complete aortic perforation. Five animals completed the full observation period of 12 h. Conclusion: A standardized, reproducible, and robust large animal model of acute Stanford type A aortic dissection using a hybrid approach was developed. This model closely simulates the clinical and pathological features of human aortic dissection, making it a valuable tool for preclinical research in diagnostics, pathophysiology, and treatment development. Full article
(This article belongs to the Special Issue Aortic Surgery—Back to the Roots and Looking to the Future)
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