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Advances in Aortic Surgery
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Advances in Aortic Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (30 June 2025) | Viewed by 2560

Special Issue Editors

Dr. Antonio Fiore

E-Mail Website
Guest Editor
1. Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
2. CEpiA Team, IMRB U955, Inserm, Université Paris Est Créteil, F-94000 Créteil, France
Interests: aortic surgery; extracorporeal membrane oxygenation; cardiac surgery; venoarterial; ECMO; endocarditis, acute aortic syndrome; aortic valve repair
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Joseph Touma

E-Mail Website
Guest Editor
Department of Vascular Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
Interests: aortic surgery; endovascular procedure; EVAR; aneurysm

Special Issue Information

Dear Colleagues,

This Journal of Clinical Medicine Special Issue focuses on the significant advancements in aortic and aortic valve surgery. It highlights the evolution of aortic surgery, driven by innovations in imaging, surgical strategies, and perioperative care, which have made complex procedures safer and more effective. The issue will explore the latest technologies, focusing on diagnostic and operational innovations. It highlights cutting-edge diagnostic technologies, including 4D MRI and high-resolution CT, which enhance the precision of aortic disease assessment.

On the operational side, the issue covers contemporary minimally invasive techniques, endovascular treatments, and transcatheter approaches, showcasing their impact on improving surgical outcomes and patient recovery. The goal is to share cutting-edge research, case studies, and reviews that contribute to improving patient outcomes in this rapidly evolving field.

We are looking forward to your submissions.

Dr. Antonio Fiore
Prof. Dr. Joseph Touma
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 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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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
  • aortic disease
  • aortic valve surgery
  • endovascular treatment
  • aortic imaging techniques
  • aortic aneurysm
  • acute aortic syndrome

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Published Papers (4 papers)

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Research

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17 pages, 1101 KB  
Article
Proximal Landing Zone’s Impact on Outcomes of Branched and Fenestrated Aortic Arch Repair
by Petroula Nana, Konstantinos Spanos, Giuseppe Panuccio, José I. Torrealba, Fiona Rohlffs, Christian Detter, Yskert von Kodolitsch and Tilo Kölbel
J. Clin. Med. 2025, 14(10), 3288; https://doi.org/10.3390/jcm14103288 - 8 May 2025
Viewed by 463
Abstract
Background/Objectives: The impact of the proximal landing zone has not been investigated in fenestrated and branched endovascular aortic arch repair (f/bTEVAR). This study aimed to analyze the f/bTEVAR outcomes in patients with non-native (nNPAL) vs. native proximal aortic landing (NPAL). Methods: The [...] Read more.
Background/Objectives: The impact of the proximal landing zone has not been investigated in fenestrated and branched endovascular aortic arch repair (f/bTEVAR). This study aimed to analyze the f/bTEVAR outcomes in patients with non-native (nNPAL) vs. native proximal aortic landing (NPAL). Methods: The STROBE statement was followed in order to conduct a single-center retrospective analysis of patients with nNPAL vs. NPAL managed, from 1 September 2011 to 30 June 2022, with f/bTEVAR. The primary outcomes were technical success, 30-day mortality and stroke. Results: A total of 83 patients with nNPAL vs. 126 patients with NPAL were included. Among the nNPAL group, 34 (39.7%) underwent previous aortic arch replacement and the remaining underwent an ascending aortic replacement. The nNPAL patients were more commonly treated for chronic dissections (nNPAL: 70.6% vs. NPAL: 21.6%, p < 0.001), presented a more proximal disease (zone 0: nNPAL: 27.7% vs. NPAL: 7.1%, p < 0.001; zone 1: nNPAL: 50.6% vs. NPAL: 10.2%, p < 0.001) and received more triple-branch devices (nNPAL: 16.9% vs. NPAL: 3.2%, p < 0.001), with a higher rate of Ishimaru zone 0 landing (nNPAL: 86.8% vs. NPAL: 51.6%, p < 0.001). Technical success (nNPAL: 98.8% vs. NPAL: 94.4%, p = 0.07) and 30-day mortality (nNPAL: 6.0%, vs. NPAL: 11.9%, p = 0.16) were similar. Stroke was lower among nNPAL patients (nNPAL: 4.8% vs. NPAL: 13.5%, p = 0.04). A multivariate regression analysis confirmed nNPAL as an independent protector for stroke (p = 0.002). Survival (log rank: p = 0.02) was higher within the nNPAL group at 24 months. Conclusions: f/bTEVAR in patients with nNPAL zone showed encouraging outcomes. Despite more proximal landing in zone 0, stroke was significantly lower when compared to NPAL patients. Full article
(This article belongs to the Special Issue Advances in Aortic Surgery)
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11 pages, 2937 KB  
Article
Retrospective Comparison of Stiff Wire-Based 2D3D, Traditional 3D3D Image Fusion, and Non-Image Fusion Techniques and Their Role in Thoracic Aortic Endovascular Repair
by Peter Osztrogonacz, Zsolt Garami, Alan B. Lumsden, Csaba Csobay-Novák and Ponraj Chinnadurai
J. Clin. Med. 2025, 14(2), 301; https://doi.org/10.3390/jcm14020301 - 7 Jan 2025
Viewed by 708
Abstract
Objective: The aim of this study was to compare the outcomes of stiff wire-based 2D3D, 3D3D image fusion (IF), and non-image fusion techniques for simple zone 2 and zone 3 TEVAR cases in terms of radiation exposure, contrast dose, and fusion and [...] Read more.
Objective: The aim of this study was to compare the outcomes of stiff wire-based 2D3D, 3D3D image fusion (IF), and non-image fusion techniques for simple zone 2 and zone 3 TEVAR cases in terms of radiation exposure, contrast dose, and fusion and projection accuracy. Methods: A single-center retrospective observational study was conducted based on data gathered from patients who underwent TEVAR between 2016 and 2023 at our tertiary aortic referral center. Those who underwent Z2 and Z3 TEVAR during the indicated period were included. The dose area product and number of DSAs were considered as primary outcomes, while projection accuracy and image fusion accuracy were considered as secondary outcomes. Results: A total of 79 patient were included. They were allocated to non-image fusion (NIF, n = 40), 2D3D IF (n = 14), and 3D3D IF (n = 25) groups. DAP was significantly lower both in the NIF [1542.75 µGym2 (751.72–3351.25 µGym2), p = 0.011] and 2D3D IF [1320.1 µGym2 (858.57–2572.07 µGym2), p = 0.013 groups compared to the 3D3D [2758.61 µGym2 (2074.73–4772.9 µGym2)] cohort. In the Z3 subgroup, DAP was significantly lower in the 2D3D IF group compared to the 3D3D IF group [(1270.84 µGym2 (860.56–2144.69 µGym2) vs. 2735.76 µGym2 (1583.86–5077.23 µGym2), p = 0.044]. 2D3D image fusion was associated with a significantly lower number of pre-deployment angiographies compared to NIF [1 (1–1) vs. 2 (1–3), p = 0.031], which we used as a surrogate for contrast dose. Conclusions: The entire study population analysis showed a significantly lower DAP with 2D3D IF compared to 3D3D IF, while there was no significant difference compared to NIF. It seems that stiff wire-based 2D3D IF does not cost in terms of DAP compared to NIF, while it is more favorable compared to 3D3D IF. Additionally, simple Z3 TEVAR cases might be improved by implementing the stiff wire-based 2D3D technique as a result of decreased DAP compared to 3D3D IF and decreased contrast dose compared to NIF. Full article
(This article belongs to the Special Issue Advances in Aortic Surgery)
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Review

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14 pages, 3380 KB  
Review
Post-Coarctectomy Pseudoaneurysm with Recurrent Coarctation Treated with Open Surgery: A Comprehensive Literature Review and Case Report
by Serena Arianna Cutolo, Diego Soto, Diletta Loschi, Annarita Santoro, Horatius Moldovan, Marian Broasca and Germano Melissano
J. Clin. Med. 2025, 14(16), 5800; https://doi.org/10.3390/jcm14165800 - 16 Aug 2025
Viewed by 407
Abstract
Introduction: Patch aortoplasty for aortic coarctation may have a high rate of late aneurysm and pseudoaneurysm formation, with an elevated risk of rupture and subsequent mortality when it occurs. Case: A 55-year-old male with irregular follow-up after patch aortoplasty for aortic coarctation 15 [...] Read more.
Introduction: Patch aortoplasty for aortic coarctation may have a high rate of late aneurysm and pseudoaneurysm formation, with an elevated risk of rupture and subsequent mortality when it occurs. Case: A 55-year-old male with irregular follow-up after patch aortoplasty for aortic coarctation 15 years ago, presented with a late post-coarctectomy aortic arch pseudoaneurysm and re-coarctation. Through a redo thoracotomy and under left heart bypass, the pseudoaneurysm and previous patch were partially excised, and reconstruction with interposition of a “Y” shaped Dacron graft was performed, in order to preserve the patency of the left subclavian artery. The postoperative course was uneventful, and at 6 months, the CT-angio control showed adequate graft patency. Comprehensive Literature Review: A comprehensive literature review with the primary focus on the different late complications after CoA repair (post-aortic coarctation aneurysms and recoarctation), and outcomes of open and endovascular approaches was performed. Conclusions: Open surgical repair for post-coarctectomy pseudoaneurysm is feasible with excellent results. However, due to the technical challenges, it may be performed with better results in high-volume aortic centers. Full article
(This article belongs to the Special Issue Advances in Aortic Surgery)
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Other

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15 pages, 703 KB  
Systematic Review
Total Arch Replacement with Ascyrus Medical Dissection Stent Versus Frozen Elephant Trunk in Acute Type A Aortic Dissection: A Meta-Analysis
by Massimo Baudo, Fabrizio Rosati, Michele D’Alonzo, Antonio Fiore, Claudio Muneretto, Stefano Benussi and Lorenzo Di Bacco
J. Clin. Med. 2025, 14(14), 5170; https://doi.org/10.3390/jcm14145170 - 21 Jul 2025
Viewed by 558
Abstract
Background: Acute Stanford Type A aortic dissection (ATAAD) often requires total arch replacement (TAR) with frozen elephant trunk (FET) to address entry tears and support aortic remodeling. In select cases, AMDS may provide a simpler option. The present meta-analysis aims to compare [...] Read more.
Background: Acute Stanford Type A aortic dissection (ATAAD) often requires total arch replacement (TAR) with frozen elephant trunk (FET) to address entry tears and support aortic remodeling. In select cases, AMDS may provide a simpler option. The present meta-analysis aims to compare surgical outcomes between these two approaches. Methods: A comprehensive search in the Pubmed, ScienceDirect, SciELO, DOAJ, and Cochrane library databases was performed until February 2025. We included studies that reported the outcomes of patients with ATAAD undergoing TAR with AMDS or FET. To enable a meaningful comparison, we only included FET studies where patients met the same inclusion criteria as those with the AMDS. Results: Thirty-eight articles met our inclusion criteria, with a total of 319 patients in the AMDS group and 4129 in the FET group. Patients undergoing an AMDS procedure experienced significantly higher bleeding requiring surgery (21.2% vs. 6.4%, p < 0.001) and a higher hospital mortality (14.5% vs. 10.0%, p = 0.037) compared to FET. The individual patient data of 1411 patients were constructed. Overall survival at 1 and 3 years was 81.9% ± 3.3% vs. 88.8% ± 0.9% and 81.9% ± 3.3% vs. 85.2% ± 1.0% between AMDS and FET, respectively. A flexible parametric survival model demonstrated a significant mortality drawback for AMDS compared to FET up to 31 days, beyond which the difference was no longer evident. Conclusions: The comparison between AMDS and FET for ATAAD treatment remains debated, with FET favored for its lower mortality and stronger long-term evidence. AMDS, as a newer technique, shows promise but lacks sufficient data to confirm its safety and efficacy. Full article
(This article belongs to the Special Issue Advances in Aortic Surgery)
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