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Aortic Surgery: State of the Art and Future Directions
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Aortic Surgery: State of the Art and Future Directions

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

Deadline for manuscript submissions: 15 June 2026 | Viewed by 527

Special Issue Editor

Dr. Dimos E. Karangelis

E-Mail Website
Guest Editor
Department of Cardiothoracic Surgery, University General Hospital, Democritus University of Thrace, 68100 Alexandroupolis, Greece
Interests: aortic surgery; aortic dissection; frozen elephant trunk technique; aortic arch; CABG; aortic valve; mitral surgery; mitral valve repair; coronary artery disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Aortic surgery stands at a pivotal juncture. With the recent recognition by the EACTS of the aorta as an organ in its own right, the field has entered a new era—one that demands a deeper understanding of aortic structure and function, as well as continuous development of treatment strategies. Advances in open and hybrid surgical techniques, along with developments in imaging, device technology, and biologically inspired materials, are expanding the possibilities for durable, anatomy-preserving repair. However, major challenges remain: achieving long-term procedural durability, optimizing timing and patient selection, and translating innovation into measurable improvements in outcomes.

This Special Issue will capture both the current landscape and the future directions of aortic surgery at this defining crossroad. We welcome original research on novel surgical and hybrid approaches. We also encourage outcome analyses and institutional experiences from established centers and multidisciplinary teams, as well as systematic reviews and meta-analyses. By bringing together clinical, surgical, and scientific expertise, this Special Issue will define the state of the art today and highlight the advances shaping the future of aortic therapy.

Dr. Dimos E. Karangelis
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 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 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 aneurysm
  • aortic dissection
  • aortic arch
  • biomaterials
  • endovascular approach
  • FET
  • TEVAR

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Published Papers (2 papers)

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Research

14 pages, 1818 KB  
Article
Clinical, Physiologic, and Anatomic Outcomes of a Novel Bioprosthetic Aortic Valved Conduit
by Sedem Dankwa, Ely Erez, Adrian R. Acuna Higaki, Shiv Verma, Irbaz Hameed, Sriharsha Talapaneni, Kristina Wang, Sem Asmelash, Titilayo Oden Shobayo, Pavan Khosla, Kwasi Ansere Ofori, Roland Assi and Prashanth Vallabhajosyula
J. Clin. Med. 2026, 15(9), 3437; https://doi.org/10.3390/jcm15093437 - 30 Apr 2026
Viewed by 108
Abstract
Background: In 2020, the first pre-assembled bioprosthetic aortic valved conduit (AVC) was approved in the United States. This study compares its anatomic and functional outcomes to traditional hand-sewn composite conduits in patients undergoing aortic root replacement. Methods: This retrospective study compared 118 patients [...] Read more.
Background: In 2020, the first pre-assembled bioprosthetic aortic valved conduit (AVC) was approved in the United States. This study compares its anatomic and functional outcomes to traditional hand-sewn composite conduits in patients undergoing aortic root replacement. Methods: This retrospective study compared 118 patients receiving the pre-assembled AVC (2021–2023) versus 66 patients with hand-sewn conduits (2012–2020) after elective bio-Bentall procedures. Primary outcomes were post-operative mortality and complication rates. Secondary outcomes included anatomic and hemodynamic changes. Graft dimensions were obtained from post-operative computed tomography (CT). Echocardiographic parameters were collected at early and late follow-up. Between-group differences and longitudinal changes were assessed using linear mixed-effects models. Results: Groups were comparable in age (pre-assembled 63 ± 11 vs. hand-sewn 64 ± 11 years) and predominantly male. Despite significantly higher concomitant hemiarch rates in pre-assembled conduits (91.5% vs. 28.8%, p < 0.001), 30-day mortality, stroke, and reoperation for bleeding were comparable between groups. Pre-assembled conduits demonstrated superior hemodynamics with lower baseline peak gradients (Δ 9.1 mmHg, p < 0.001), lower mean gradients (Δ 5.3 mmHg, p < 0.001), and larger indexed effective orifice area (Δ 0.27 cm2/m2, p = 0.018). Annual rates of hemodynamic and dimensional change were minimal and comparable between groups. Kaplan–Meier analysis showed no survival difference at 3 years. Conclusions: The pre-assembled AVC demonstrates equivalent safety and superior early hemodynamic performance compared to hand-sewn conduits, with stable mid-term anatomic and functional outcomes. Full article
(This article belongs to the Special Issue Aortic Surgery: State of the Art and Future Directions)
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12 pages, 1406 KB  
Article
Strategies for Aortic Root Measurement in Patients Undergoing Surveillance for Thoracic Aortic Disease
by Asama Rana, Irbaz Hameed, Sedem Dankwa, Danial Ahmad, Cameron Best, Sem Asmelash, Jose Anzueto, Sriharsha Talapaneni, Michela Cupo, Akbar Bazarbaev, Shiv Verma, Chanseo Lee, Titilayo Oden Shobayo and Prashanth Vallabhajosyula
J. Clin. Med. 2026, 15(9), 3349; https://doi.org/10.3390/jcm15093349 - 28 Apr 2026
Viewed by 162
Abstract
Objectives: Several measurement techniques have been proposed to address the non-circular geometry of the aortic root. The Laplace diameter metric incorporates the cloverleaf anatomy of the aortic root and is derived via measurement of sinus-to-commissure lengths with subsequent doubling of the largest [...] Read more.
Objectives: Several measurement techniques have been proposed to address the non-circular geometry of the aortic root. The Laplace diameter metric incorporates the cloverleaf anatomy of the aortic root and is derived via measurement of sinus-to-commissure lengths with subsequent doubling of the largest radius from the center. This study compares the conventional sinus-to-sinus with the novel Laplace method for sizing the aortic root and quantifying its implication on surgical decision-making. Methods: Patients undergoing surveillance at a high-volume aortic center were categorized by aortic root morphology as nondilated, non-syndromic dilated, bicuspid aortic valve and Marfan syndrome. Aortic root diameters by sinus-to-sinus and Laplace diameter methods were measured on computed tomography, compared using paired t-tests, and correlated using Spearman rank coefficients. Results: Of the 1297 patients assessed, 530 were included in the final analysis (nondilated n = 113, non-syndromic dilated n = 347, bicuspid aortic valve n = 50, Marfan syndrome n = 17). Aortic root diameters were significantly larger by Laplace than sinus-to-sinus diameter across all groups (sinus-to-sinus: 1.9 ± 5.5 mm; Laplace: 44.9 ± 7.0 mm; 95% confidence interval 2.72–3.34; p < 0.0001). Although Laplace and sinus-to-sinus diameter were correlated (Spearman r = 0.6789, 95% CI 0.6–0.7; p < 0.0001), the relationship was non-linear (R2 = 0.492). Laplace diameter increased the proportion of patients meeting surgical thresholds (2022 AHA/ACC guidelines) versus sinus-to-sinus: nondilated 0% vs. 1.77%, non-syndromic dilated 4.9% vs. 25.1%, bicuspid aortic valve 10.0% vs. 26.0%, and Marfan syndrome 23.5% vs. 52.9%. Conclusions: On average, Laplace diameter exceeded sinus-to-sinus diameter by 3 mm and would extend surgical eligibility to an additional 21% of patients under current guidelines. Full article
(This article belongs to the Special Issue Aortic Surgery: State of the Art and Future Directions)
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