Objective To identify the risk factors for postoperative spinal cord injury in Stanford type A aortic dissection patients.Methods 210 Stanford type A aortic dissection(TAAD) patients underwent Sun's procedure in Beijing Aortic Disease Center during July 2014 to March 2015.14 patients had spinal cord injury after surgery.Clinical data and computed tomography angiography(CTA) imaging of aorta were retrospectively analyzed and multi-logistic regression analysis was performed to identify risk factors for spinal cord injury post operation.Results 14 out of 210(6.7％) patients had transient or permanent spinal cord injury after surgery.Univariate analysis showed only false lumen derived intercostal arteries at eighth thoracic vertebral level (T8) to first lumbar vertebral level (L1) was significantly associated with post-surgery spinal cord injury (P =0.000).Multi-logistic regression analysis showed that false lumen derived intercostal arteries (P =0.000) and age (P =0.016) were significantly associated with postoperative spinal cord injury.Conclusion Major intercostal arteries derived from false lumen and rapid thrombogenesis in false lumen are the major risk factors for postoperative spinal cord injury in Stanford type A aortic dissection patients.

Objective To identify the risk factors for acute kidney injury (AKI) in overweight patients who underwent surgery for the treatment of acute type A aortic dissection(TAAD).Methods A retrospective study including 108 consecutive overweight patients(body mass index(BMI) ≥24) between January 2010 and May 2013 in Beijing Anzhen Hospital was performed with Sun's procedure of total aortic arch replacement and frozen elephant trunk implantation.AKI was as defined according to Acute Kidney Injury Network (AKIN) criteria based on serum creatinine(sCr) or urine output.Results The mean age of the patients was(43.69 ± 9.66) years.During the postoperative period seventy-two patients(66.7％) developed AKI.The overall postoperative mortality rate was 7.4％,8.3％ in AKI group and 5.6％ in non-AKI group.There is no statistically significant difference between the two groups(P =0.32).A logistic regression analysis was performed to find out the independent risk factors for AKI:elevated preoperative sCr level and postoperative drainage volume.Renal replacement therapy(RRT) was performed in fifteen patients (13.9 ％).Conclusion A higher incidence of AKI (66.7 ％) in overweight patients following acute TAAD was identified.The logistic regression model found out elevated preoperative sCr level and 72 hour drainage volume as the two independent risk factors for AKI in overweight patients.More attention should be paid to prevent AKI in overweight patients following TAAD.

Objective Acute aortic dissection occurs when a tear in the inside of the aorta causes blood to flow between the layers of the wall of the aorta,forcing the layers apart.In most cases this is associated with a sudden onset of severe chest or back pain,often described as "tearing" in character.The main management includes medication,endovascular repair and surgery.Medical management plays an very important role in the management of acute aortic dissection.Aortic dissection generally presents as a hypertensive emergency.Individuals can benefit from blood pressure control and anti-impulse therapy in perioperative period.

In mammalian species, females are born with a number of oocytes exceeding what they release via ovulation. In humans, an average girl is born with over a thousand times more oocytes than she will ovulate in her lifetime. The reason for having such an excessive number of oocytes in a neonatal female ovary is currently unknown. However, it is well established that the oocyte number decreases throughout the entire lifetime until the ovary loses them all. In this review, data published in the past 80 years were used to assess the current knowledge regarding the changing number of oocytes in humans and mice, as well as the reported factors that contribute to the decline of oocyte numbers. Briefly, a collective estimation indicates that an average girl is born with approximately 600,000 oocytes, which is 2,000 times more than the number of oocytes that she will ovulate in her lifetime. The oocyte number begins to decrease immediately after birth and is reduced to half of the initial number by puberty and almost zero by age 50 years. Multiple factors that are either intrinsic or extrinsic to the ovary contribute to the decline of the oocyte number. The inflammation caused by the ovulatory luteinizing hormone surge is discussed as a potential contributing factor to the decline of the oocyte pool during the reproductive lifespan.

Objective:To summarize and analyze the early clinical outcomes of aortic endovascular remodeling device (AERD) for single-stage complete repair of acute aortic dissection.Methods:A total of 19 patients with acute aortic dissection who underwent proximal aortic dissection repair combined with distal AERD implantation at the Center for Aortic Surgery of Beijing Anzhen Hospital, Capital Medical University between May 2023 and October 2023, of whom 6 had type A aortic dissection and 13 had type B aortic dissection, were retrospectively analyzed. One-month postoperative follow-up and aortic CTA were completed to compare pre- and postoperative abdominal branch outcomes and aortic wall remodeling.Results:The success rate of AERD implantation in this patient cohort was 100%, and no complications such as paraplegia or visceral ischemia were observed during the perioperative and postoperative follow-up periods. All abdominal branches were patent postoperatively, and 15 branches had preoperative " high-risk" subtype malperfusion, 14 of which improved postoperatively. All patients showed significant increase of the true lumen volume compared with the preoperative one, and 89.5% (17/19) had a postoperative true lumen/overall volume ratio of more than 70%.Conclusion:The single-stage complete repair of proximal aortic dissection repair combined with distal AERD implantation is simple, safe and effective, associated with satisfactory early outcomes.

Objective:This study aims to summarize the pathological anatomy characteristics of residual aortic dissection (RAD) in patients with acute aortic dissection (AAD) during the perioperative period by measuring and analyzing the preoperative and postoperative 60-day computed tomography angiography (CTA) images of the aorta, with the intention of guiding further clinical treatment.Methods:A retrospective cohort study design was adopted. A total of 224 patients hospitalized with acute aortic dissection from December 2021 to October 2022 at a single center were included according to inclusion and exclusion criteria and divided into two groups based on Stanford classification. Computed tomography angiography (CTA) images of the aorta during the perioperative period (preoperative or postoperative 60 days) were collected, and relevant indicators were measured to describe the pathological anatomy characteristics of residual aortic dissection.Results:Among the measured range, there were 4 patients (1.8%) without distal tears, with a total of 648 identified distal tears. The numbers of tears in the A, B, and C segments were 211 (32.6%), 203 (31.3%), and 234 (36.1%), respectively. The average numbers of tears in the A, B, and C segments were 0.9±1.1, 0.9±0.9, and 1.0±1.2 per person, respectively. The corresponding average tear areas were(34.9±46.7)mm 2, (29.0±30.5)mm 2, and(18.6±23.9)mm 2, respectively. The average distances from tears to the upper and lower edges of the celiac trunk were(36.8±33.2)mm and(2.3±3.8)mm, respectively; to the upper and lower edges of the superior mesenteric artery (SMA) were(2.3±4.1 )mm and(1.2±2.6) mm, respectively; to the upper and lower edges of the left renal artery were(0.1±0.6) mm and(38.5±24.4) mm, respectively; and to the upper and lower edges of the right renal artery were(0.7±2.6) mm and(8.1±17.3) mm, respectively. True lumen blood supply for the celiac trunk was observed in 151 cases (67.4%); dual luminal supply in 49 cases (21.9%); and false lumen supply in 24 cases (10.7%). True lumen blood supply for the SMA was observed in 187 cases (83.5%); dual luminal supply in 32 cases (14.3%); and false lumen supply in 5 cases (2.2%). True lumen blood supply for the left renal artery was observed in 150 cases (67.0%); dual luminal supply in 27 cases (12.1%); and false lumen supply in 47 cases (21.0%). True lumen blood supply for the right renal artery was observed in 148 cases (66.1%); dual luminal supply in 30 cases (13.4%); and false lumen supply in 46 cases (20.5%). True lumen blood supply for both renal arteries was observed in 83 cases (37.1%); dual luminal supply in 4 cases (1.8%); and false lumen supply in 1 case (0.5%). Conclusion:The results of this study suggest that the average number of distal tears per person in patients with AAD is 2.9±1.9, with only 1.8% of patients having no distal tears. The average tear areas in the A, B, and C segments are(34.9±46.7) mm 2, (29.0±30.5) mm 2, and (18.6±23.9) mm 2, respectively. 61.2% of patients have tears in the abdominal aortic branch segment, and the tears are located at the same level as the abdominal aortic branches. Among the branches of the abdominal aorta, the renal arteries are most commonly affected by dissection, while the SMA is least affected. This study elucidates the anatomical basis for the limitations of existing repair methods and provides a theoretical basis for the design of subsequent repair techniques.

Objective To retrospectively analyze perioperative and early outcomes after Sun's procedure of type A aortic dissection patients with different tear size ratia.Methods To retrospectively analyze the general information of 120 patients with acute Stanford type A aortic dissectiontreatedin our center from November 2014 to December 2016.Patients were divided into three group according to proximal and distal tear sizeratio(PDTSR):35 patients in Group A(PDTSR≥2),44 patients in Group B (1/2 ＜ PDTSR ＜ 2)and 41 patients in Group C (PDTSR ≤ 1/2).Retrospectively reviewed the data of perioperativeand follow-up period.Results Preoperative mortality was significantly higher in Group A (37.1％ vs.2.3％ vs.2.4％;P ＜ 0.001).Preoperative morbidity higher in Group A,but there was no significant difference.Ventilator support of duration ＞ 5 days in Group A is significantly higher in Group A (P =0.006).Three-month closure rate of false lumen was higher in Group A (85.0％ vs.65.0％ vs.72.7 ％,P =0.263).Proximal tear significantly larger than distal tear was found associated with preoperative death in logistic regression analysis.Conclusion Acute type A aortic dissection patients with larger proximal tear size need more urgent surgery to fix the dissection.Sun's procedure was an effective way to cure type A aortic dissection,while patients with relatively larger distal tears need more strict postoperative follow-up.

Objective: Summarize the anatomical features of the aortic dissection of right axillary and femoral artery cannulation in Sun's surgery. Exploring whether right axillary and femoral artery cannulation can reduce the incidence of organ malperfusion and improve patient prognosis. Methods: From January 2015 to December 2017, 181 cases with aortic dissection were treated in Beijing Anzhen Hospital affiliated to Capital Medical University, Beijing Great Blood Vessel Research and Treatment Center, 122 patients were enrolled in the right axillary and femoral artery cannulation group, and 59 patients in control group were enrolled. Retrospective analysis the data of two groups, intraoperative, and postoperative univariate were compared between the two groups. Results: A total of 17 patients died in the postoperative group, with 9 (7.38%) in the combined perfusion group and 8 (13.56%) in the control group, P=0.181. Among the complications of the two groups, 18 patients(14.75%) in combined perfusion group had renal insufficiency and 17 patients (28.81%) in the control group, P= 0.025. 0 case had stransient spinal cord injury in combined perfusion group , 3 cases(5.08%) in control group , P=0.033. Conclusion Right axillary and femoral artery cannulation can reduce the incidence of complications of postoperative organ dysfunction and improve patient prognosis.