Methodist DeBakey cardiovascular journal
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The biology of aortic aneurysm and dissection has evolved to where we now understand the genetic implications of changes in extracellular matrix proteins, smooth muscle cells, and growth factors and how they affect aortic wall homeostasis. These predeterminants are influenced by smoking, hypertension, and atherosclerosis, and the result in an inflammatory response coupled to an accelerated proteolytic cascade that disrupts both elastin and collagen in the aortic wall.
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Methodist Debakey Cardiovasc J · Jul 2011
ReviewAortic arch debranching: advanced and hybrid techniques.
Aortic arch procedures have traditionally involved complex surgery with increased risk of mortality and morbidity. Throughout the last decade, however, novel and safe surgical approaches aimed at debranching the great vessels with definitive aortic arch repair have been developed. ⋯ In the future, aortic pathology may also benefit from the development of branched and fenestrated endografts that would be deployed in a modular fashion. This article describes the rationale, procedural steps, and recent outcomes data of novel aortic arch procedures.
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Acute aortic syndromes are a life-threatening set of conditions that require rapid triage and intervention to obtain satisfactory outcomes. The Methodist Hospital is the first institution to establish an Acute Aortic Treatment Center (AATC) based on a clinical care pathway that expedites the care of acute aortic syndromes. This pathway has resulted in a 64% reduction in time to definitive therapy and a reduction in intensive care unit (ICU) length of stay. Establishment of a multidisciplinary pathway to treat acute aortic syndromes improves efficiency and enhances outcomes.