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An update on surgery for acute type A aortic dissection: Aortic root repair, endovascular stent graft, and genetic research

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Abstract

Acute type A aortic dissection remains a lethal disease. With advances in operative methods and perioperative management, surgical outcomes continue to improve, but in-hospital mortality still ranges from 10% to 30% in most series. The surgical technique of choice for aortic root repair remains controversial. Thus, we review the surgical techniques and introduce endovascular stent graft treatment and genetic studies for acute type A aortic dissection.

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References

  1. Hirst AE Jr, Johns VJ Jr, Kime SW Jr. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958;37:217–279.

    Google Scholar 

  2. Shennan T. Dissecting aneurysm. Medical Research Council Special Report 193. London: His Majesty’s Stationery Office; 1934.

    Google Scholar 

  3. Anagnostopoulos CE, Prabhakar MJS, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol 1972;30:263–273.

    Article  PubMed  CAS  Google Scholar 

  4. Lauterbach SR, Cambria RP, Brewster DC, Gertler JP, Lamuraglia GM, Isselbacher EM, et al. Contemporary management of aortic branch compromise resulting from acute aortic dissection. J Vasc Surg 2001;33:1185–1192.

    Article  PubMed  CAS  Google Scholar 

  5. Suzuki S, Imoto K, Uchida K, Takanashi Y: Aortic root necrosis after surgical treatment using Gelatin-Resorcinol-Formaldehyde (GRF) glue in patients with acute type A aortic dissection. Ann Thorac Cardiovasc Surg 2006;12:333–340.

    PubMed  Google Scholar 

  6. Sabik JF, Lytle BW, Blackstone EH, McCarthy PM, Loop FD, Cosgrove DM. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg 2000;119:946–962.

    Article  PubMed  CAS  Google Scholar 

  7. Kirsch M, Soustelle C, Houel R, Hillion ML, Loisance D. Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg 2002;123:318–325.

    Article  PubMed  Google Scholar 

  8. Erasmi AW, Stierle U, Bechtel JFM, Schmidtke C, Sievers HH, Kraatz EG. Up to 7 years experience with valve-sparing aortic root remodeling/reimplantation for acute type A dissection. Ann Thorac Surg 2003;76:99–104.

    Article  PubMed  Google Scholar 

  9. Hagan PG, Nienaber CA, Isselbacher EM, Burckman D, Karavite DJ, Russman PL, et al. The international registry of acute aortic dissection (IRAD). JAMA 2000;283:897–903.

    Article  PubMed  CAS  Google Scholar 

  10. Gallo A, Davies RR, Coe MP, Elefteriades JA, Coady MA. Indications, timing, and prognosis of operative repair of aortic dissections. Semin Thorac Cardiovasc Surg 2005;17:224–235.

    Article  PubMed  Google Scholar 

  11. Geirsson A, Bavaria JE, Swarr D, Keane MG, Woo YJ, Szeto WY, et al. Fate of the residual distal and proximal aorta after acute type A dissection repair using a contemporary surgical reconstruction algorithm. Ann Thorac Surg 2007;84:1955–1964.

    Article  PubMed  Google Scholar 

  12. Bachet J, Goudot B, Dreyfus GD, Brodaty D, Dubois C, Delentdecker P, et al. Surgery for acute type A aortic dissection: The hospital Foch experience (1977–1998). Ann Thorac Surg 1999;67:2006–2009.

    Article  PubMed  CAS  Google Scholar 

  13. Estrera AL, Miller CC 3rd, Villa MA, Lee TY, Meada R, Irani A, et al. Proximal reoperations after repaired acute type A aortic dissection. Ann Thorac Surg 2007;83:1603–1609.

    Article  PubMed  Google Scholar 

  14. Nakajima T, Kawazoe K, Kataoka T, Kin H, Kazui T, Okabayashi H, et al. Midterm Results of aortic repair using a fabric neomedia and fibrin glue for type A acute aortic dissection. Ann Thorac Surg 2007;83:1615–1620.

    Article  PubMed  Google Scholar 

  15. Hata H, Takano H, Matsumiya G, Fukushima N, Kawaguchi N, Sawa Y. Late complications of Gelatin-Resorcin-Formalin Glue in the repair of acute type A aortic dissection. Ann Thorac Surg 2007;83:1621–1627.

    Article  PubMed  Google Scholar 

  16. Dake MD, Kato N, Mitchell RS, Semba CP, Razavi MK, Shimono T, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 1999;340:1546–1552.

    Article  PubMed  CAS  Google Scholar 

  17. Kato N, Shimono T, Hirano T, Ishida M, Yada I, Takeda K. Transluminal placement of endovascular stent-grafts for the treatment of type A aortic dissection with an entry tear in the descending thoracic aorta. J Vasc Surg 2001;34:1023–1028.

    Article  PubMed  CAS  Google Scholar 

  18. Suzuki S, Imoto K, Uchida K, Takanashi Y, Kichikawa K. Midterm results of transluminal endovascular grafting in patients with DeBakey type III dissecting aortic aneurysms. Ann Thorac Cardiovasc Surg 2006;12:42–49.

    PubMed  Google Scholar 

  19. Zhang H, Li H, Jin W, Wang Z. Endoluminal and surgical treatment for the management of Stanford type A aortic dissection. Eur J Cardiothorac Surg 2004;26:857–859.

    Article  PubMed  Google Scholar 

  20. Ihnken K, Sze D, Dake MD, Fleischmann D, Van der Starre P, Robbins R. Successful treatment of a Stanford type A dissection by percutaneous placement of a covered stent graft in the ascending aorta. J Thorac Cardiovasc Surg 2004;127:1808–1810.

    Article  PubMed  Google Scholar 

  21. Zimpfer D, Czerny M, Kettenbach J, Schoder M, Wolner E, Lammer J, et al. Treatment of acute type A dissection by percutaneous endovascular stent-graft placement. Ann Thorac Surg 2006;82:747–749.

    Article  PubMed  Google Scholar 

  22. Senay S, Alhan C, Toraman F, Karabulut H, Dagdelen S, Cagil H. Endovascular stent-graft treatment of type A dissection: case report and review of literature. Eur J Vasc Endovasc Surg 2007;34:457–460.

    Article  PubMed  CAS  Google Scholar 

  23. van der Starre P, Guta C, Dake M, Ihnken K, Robbins R. The value of transesophageal echocardiography for endovascular graft stenting of the ascending aorta. J Cardiothorac Vasc Anesth 2004;18:466–468.

    Article  PubMed  Google Scholar 

  24. Meng RL, Najafi H, Javid H, Hunter JA, Goldin MD. Acute ascending aortic dissection: surgical management. Circulation 1981;64(Pt 2):II231–II234.

    PubMed  CAS  Google Scholar 

  25. DeSanctis RW, Doroghazi RM, Austen WG, Buckley MJ. Aortic dissection. N Engl J Med 1987;317:1060–1067.

    Article  PubMed  CAS  Google Scholar 

  26. Miller DC, Stinson EB, Oyer PE, Rossiter SJ, Reitz BA, Griepp RB, et al. Operative treatment of aortic dissections. Experience with 125 patients over a sixteen-years period. J Thorac Cardiovasc Surg 1979;78:365–382.

    PubMed  CAS  Google Scholar 

  27. Miller DC, Mitchell RS, Oyer PE, Stinson EB, Jamieson SW, Shumway NE. Independent determinants of operative mortality for patients with aortic dissections. Circulation 1984;70(Pt 2):I153–I164.

    PubMed  CAS  Google Scholar 

  28. Fann JI, Glower DD, Miller DC, Yun KL, Rankin JS, White WD, et al. Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg 1991;102:62–75.

    PubMed  CAS  Google Scholar 

  29. Mazzucotelli JP, Deleuze PH, Baufreton C, Duval AM, Hillion ML, Loisance DY, et al. Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg 1993;55:1513–1517.

    Article  PubMed  CAS  Google Scholar 

  30. Von Segesser LK, Lorenzetti E, Lachat M, Niederhäuser U, Schönbeck M, Vogt PR, et al. Aortic valve preservation in type A aortic dissection: is it sound? J Thorac Cardiovasc Surg 1996;111:381–391.

    Article  Google Scholar 

  31. Collins JJ Jr, Cohn LH. Reconstruction of the aortic valve: correcting valve incompetence due to acute dissecting aneurysm. Arch Surg 1973;106:35–37.

    PubMed  Google Scholar 

  32. Kouchoukos NT, Marshall WG, Wedige-Stxcher TA. Elevenyear experience with composite graft replacement of the ascending aorta and aorta valve. J Thorac Cardiovasc Surg 1986;92:691–705.

    PubMed  CAS  Google Scholar 

  33. DeBakey ME, McCollum CH, Crawford ES, Morris GC Jr, Howell J, Noon GP, et al. Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically. Surgery 1982;92:1118–1134.

    PubMed  CAS  Google Scholar 

  34. Braunwald NS, Gay W, Tatooles CJ. Evaluation of cross-linked as a tissue adhesive and hemostatic agent. Experimental study. Surgery 1966;59:1024–1030.

    PubMed  CAS  Google Scholar 

  35. Guilmet D, Bachet J, Goudot B, Laurian C, Gigou F, Bical O, et al. Use of biological glue in acute aortic dissection. Preliminary clinical results with a new surgical technique. J Thorac Cardiovasc Surg 1979;77:516–521.

    PubMed  CAS  Google Scholar 

  36. Bachet J, Gigou F, Laurian C, Bical O, Goudot B, Guilmet D. Four-year clinical experience with the gelatine-resorcine-formol glue in acute aortic dissection. J Thorac Cardiovasc Surg 1982;83:212–217.

    PubMed  CAS  Google Scholar 

  37. Bachet J, Goudot B, Dreyfus GD, Brodaty D, Dubois C, Delentdecker P, et al. Surgery for acute type A aortic dissection: The hospital Foch experience (1977–1998). Ann Thorac Surg 1999;67:2006–2009.

    Article  PubMed  CAS  Google Scholar 

  38. Weinschelbaum EE, Schamun C, Caranutti V, Tacchi H, Cors J, Favaloro RG. Surgical treatment of acute type A dissecting aneurysm with preservation of the native aortic valve and use of biologic glue. Follow-up to 6 years. J Thorac Cardiovasc Surg 1992;103:369–374.

    PubMed  CAS  Google Scholar 

  39. Westaby S, Katsumata T, Freitas E. Aortic valve conservation in acute type A dissection. Ann Thorac Surg 1997;64:1108–1112.

    Article  PubMed  CAS  Google Scholar 

  40. Hata M, Shiono M, Orime Y, Yagi S, Yamamoto T, Okumura H, et al. The efficacy and mid-term results with use of gelatin resorcin formalin (GRF) glue for aortic surgery. Ann Thorac Cardiovasc Surg 1999;5:321–325.

    PubMed  CAS  Google Scholar 

  41. Fukunaga S, Karck M, Harringer W, Cremer J, Rhein C, Haverich A. The use of gelatin-resorcin-formalin glue in acute aortic dissection type A. Eur J Cardiothorac Surg 1999;15:564–570.

    Article  PubMed  CAS  Google Scholar 

  42. Bingley JA, Gradner MAH, Stanford EG, Mau TK, Pohlner PG, Tam RKW, et al. Late complications of tissue glues in aortic surgery. Ann Thorac Surg 2000;69:1764–1768.

    Article  PubMed  CAS  Google Scholar 

  43. Kazui T, Washiyama N, Bashar AHM, Terada H, Suzuki K, Yamashita K, et al. Role of biologic glue repair of proximal aortic dissection in the development of early and midterm redissection of the aortic root. Ann Thorac Surg 2001;72:509–514.

    Article  PubMed  CAS  Google Scholar 

  44. Suehiro K, Hata T, Yoshitaka H, Tsushima Y, Matsumoto M, Hamanaka S, et al. Late aortic root redissection following surgical treatment for acute type A aortic dissection using gelatin-resorcin-formalin Glue. Jpn J Thorac Cardiovasc Surg 2002;50:195–200.

    Article  PubMed  Google Scholar 

  45. Von Oppell UO, Karani Z, Brooks A, Brink J. Dissected aortic sinuses repaired with gelatin-resorcin-formaldehyde (GRF) glue are not stable on follow up. J Heart Valve Dis 2002;11:249–257.

    Google Scholar 

  46. Ennker J, Ennker IC, Schoon D, Schoon HA, Dorge S, Meissler M, et al. The inpact of gelatin-resorcinol glue on aortic tissue: A histomorphologic evaluation. J Vasc Surg 1994;20:34–43.

    PubMed  CAS  Google Scholar 

  47. Bachet J, Guilmet D. The use of biological glue in aortic surgery. Cardiol Clin.1999;17:779–796, ix–x.

    Article  PubMed  CAS  Google Scholar 

  48. Bavaria JE, Pochettino A, Brinster DR, Gorman RC, Wozniak T, Gardner TJ, et al. Prospective randomized study of BioGlue tissue adhesive during repair of acute type A aortic dissection. Presented at the American Association for Thoracic surgery, May 2001.

  49. Chao HH, Torchiana DF. BioGlue: Albumin/Glutaraldehyde sealant in cardiac surgery. J Card Surg 2003;18:500–503.

    Article  PubMed  Google Scholar 

  50. Raanani E, Georghiou GP, Kogan A, Wandwi B, Shapira Y, Vidne BA. “BioGlue” for the repair of aortic insufficiency in acute aortic dissection. J Heart Valve Dis 2004;13:734–737.

    PubMed  Google Scholar 

  51. Mitrev Z, Belostotskii V, Hristov N. Suture line reinforcement using suction-assisted bioglue application during surgery for acute aortic dissection. Interact Cardiovasc Thorac Surg 2007;6:147–149.

    Article  PubMed  Google Scholar 

  52. Séguin JR, Picard E, Frapier JM, Chaptal PA. Aortic valve repair with fibrin glue for type A acute aortic dissection. Ann Thorac Surg 1994;58:304–307.

    Article  PubMed  Google Scholar 

  53. Casselman FP, Tan ESH, Vermeulen FEE, Kelder JC, Morshuis WJ, Schepens MAAM. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg 2000;70:1227–1233.

    Article  PubMed  CAS  Google Scholar 

  54. Suzuki S, Imoto K, Uchida K, Karube N. The use of Fibrin glue and Teflon felts for root reconstructions of acute type A aortic dissection. Presented at Aortic Surgery Symposium X. April 2006.

  55. Floten HS, Ravichandran PS, Furnary AP, Gately HL, Starr A. Adventitial inversion technique in repair of aortic dissection. Ann Thorac Surg 1995;59:771–772.

    Article  PubMed  CAS  Google Scholar 

  56. Garcia-Rinaldi R, Carballido JC, Mojica J, Soltero ER, Curcic S, Barcelo J, et al. Surgical treatment of aortic dissections: initial experience with the adventitial inversion technique. Ann Thorac Surg 1998;65:1255–1259.

    Article  PubMed  CAS  Google Scholar 

  57. Tanaka K, Morioka K, Li W, Yamada N, Takamori A, Handa M, et al. Adventitial inversion technique without the aid of biologic glue or Teflon buttress for acute type A aortic dissection. Eur J Cardiothorac Surg 2005;28:864–870.

    Article  PubMed  Google Scholar 

  58. Gott VL, Gillinov AM, Pyeritz RE, Cameron DE, Reitz BA, Greene PS, et al. Aortic root replacement: risk factor analysis of a seventeen-year experience with 270 patients. J Thorac Cardiovasc Surg 1995;109:536–544.

    Article  PubMed  CAS  Google Scholar 

  59. Mingke D, Dresler C, Stone CD, Borst HG. Composite graft replacement of the aortic root in 335 patients with aneurysm or dissection. Thorac Cardiovasc Surg 1998;46:12–19.

    Article  PubMed  CAS  Google Scholar 

  60. Ergin MA, McCullough J, Galla JD, Lansman SL, Griepp RB. Radical replacement of the aortic root in acute type A dissection: indications and outcome. Eur J Cardiothorac Surg 1996;10:840–844.

    Article  PubMed  CAS  Google Scholar 

  61. Moon MR, Sundt TM III, Pasque MK, Barner HB, Huddleston CB, Damiano MD Jr, et al. Does the extent of proximal or distal resection influence outcome for type A dissection? Ann Thorac Surg 2001;71:1244–1250.

    Article  PubMed  CAS  Google Scholar 

  62. Lai DT, Miller DC, Mitchell RS, Oyer PE, Moore KA, Robbins RC, et al. Acute type A aortic dissection complicated by aortic regurgitation: composite valve graft versus separate valve graft versus conservative valve repair. J Thorac Cardiovasc Surg 2003;126:1978–1986.

    Article  PubMed  Google Scholar 

  63. Edmund H. Thorombotic and bleeding complications of prosthetic heart valves. Ann Thorac Surg 1987;44:430–445.

    Article  Google Scholar 

  64. David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg 1992;103:617–621.

    PubMed  CAS  Google Scholar 

  65. Yacoub M, Fagan A, Stassano P, Radley-Smith R. Result of valve conserving operations for aortic regurgitation. Circulation 1983;68:311–321.

    Google Scholar 

  66. David TE, Ivanov J, Armstrong S, Feindel CM, Webb GD. Aortic valve-sparing operations in patients with aneurysms of the aortic root or ascending aorta. Ann Thorac Surg 2002;74:S1758–S1761.

    Article  PubMed  Google Scholar 

  67. Mehta RH, Suzuki T, Hagan P, Bossone E, Gilon D, Liowet A, et al. Predicting death in patients with acute type A aortic dissection. Circulation 2002;105:200–226.

    Article  PubMed  Google Scholar 

  68. Leyh RG, Schmidtke C, Bartels C, Siever HH. Valve-sparing aortic root replacement (remodeling/reimplantation) in acute type A dissection. Ann Thorac Surg 2000;70:21–24.

    Article  PubMed  CAS  Google Scholar 

  69. Graeter TP, Langer F, Nikoloudakis N, Aicher D, Schäfers HJ. Valve-preserving operation in acute aortic dissection type A. Ann Thorac Surg 2000;70:1460–1465.

    Article  PubMed  CAS  Google Scholar 

  70. Kallenbach K, Pething K, Leyh RG, Haverich A, Harringer W. Acute dissection of the ascending aorta: first results of emergency valve sparing aortic root reconstruction. Eur J Cardiothorac Surg 2002;22:218–222.

    Article  PubMed  CAS  Google Scholar 

  71. Leyh RG, Fischer S, Kallenbach K, Kofidis T, Pethig K, Harringer W, et al. High failure rate after valve-sparing aortic root replacement using the “remodeling technique” in acute type A aortic dissection. Circulation 2002;106(suppl I):I-229–I-33.

    Google Scholar 

  72. Miller DC. Valve-sparing aortic root replacement in patients with the Marfan syndrome. J Thorac Cardiovasc Surg 2003;125:773–778.

    Article  PubMed  Google Scholar 

  73. David TE, Feindel CM, Webb GD, Colman JM, Armstrong S, Maganti M. Long-term results of aortic valve-sparing operations for aortic root aneurysm. J Thorac Cardiovasc Surg 2006;132:347–354.

    Article  PubMed  Google Scholar 

  74. Kallenbach K, Oelze T, Salcher R, Hagl C, Karck M, Leyh RG, et al. Evolving strategies for treatment of acute aortic dissection type A. Circulation 2004;110(suppl II):II-243–II-249.

    Article  Google Scholar 

  75. De Paulis R, De Matteis GM, Nardi P, Scaffa R, Colella DF, Chiarello L. A new aortic Dacron conduit for surgical treatment of aortic root pathology. Ital Heart J 2000;1:457–463.

    PubMed  Google Scholar 

  76. De Paulis R, De Matteis GM, Nardi P, Scaffa R, Colella DF, Bassano C, et al. One-year appraisal of a new aortic root conduit with sinuses of Valsalva. J Thorac Cardiovasc Surg 2002;123:33–39.

    Article  PubMed  Google Scholar 

  77. Farhat F, Durand M, Boussel L, Scnchez I, Villard J, Jegaden O. Should a reimplantation valve sparing procedure be done systematically in type A aortic dissection? Eur J Cardiothorac Surg 2007;31:36–42.

    Article  PubMed  Google Scholar 

  78. Settepani F, Szeto WY, Pacini D, De Paulis R, Chiariello L, Di Bartolomeo R, et al. Reimplantation valve-sparing aortic root replacement in Marfan syndrome using the Valsalva conduit: an intercontinental multicenter study. Ann Thorac Surg 2007;83:S769–S773.

    Article  PubMed  Google Scholar 

  79. Fazel SS, David TE. Aortic valve-sparing operations for aortic root and ascending aortic aneurysms. Curr Opin Cardiol 2007;22:497–503.

    Article  PubMed  Google Scholar 

  80. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991;5:491–499.

    Article  PubMed  CAS  Google Scholar 

  81. Parodi JC. Endovascular stent graft repair of aortic aneurysms. Curr Opin Cardiol 1997;12:396–405.

    PubMed  CAS  Google Scholar 

  82. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994;331:1729–1734.

    Article  PubMed  CAS  Google Scholar 

  83. Mitchell RS, Miller DC, Dake MD, Semba CP, Moore KA, Sakai T. Thoracic aortic aneurysm repair with an endovascular stent graft: “first generation”. Ann Thorac Surg 1999;67:1971–1980.

    Article  PubMed  CAS  Google Scholar 

  84. Demer P, Miller DC, Kee ST, Sze D, Razavi M, Dake MD. Midterm results of endovascular repair of descending thoracic aortic aneurysms with first-generation stent graft. J Thorac Cardiovasc Surg 2004;127:664–673.

    Article  Google Scholar 

  85. Grabenwoger M, Fleck T, Czerny M, Hutschala D, Ehrlich M, Schoder M, et al. Endovascular stent graft placement in patients with acute thoracic aortic syndromes. Eur J Cardiothorac Surg 2003;23:788–793.

    Article  PubMed  Google Scholar 

  86. Chuter TA, Schneider DB, Reilly LM, Lobo EP, Messina LM. Modular branched stent graft for endovascular repair of aortic patch aneurysm and dissection. J Vasc Surg 2003;38:859–863.

    Article  PubMed  Google Scholar 

  87. Waldenberger P, Fraedrich G, Mallouhi A, Jaschke WR, Perkmann R, Jung T, et al. Emergency endovascular treatment of traumatic aortic arch rupture with multiple arch vessel involvement. J Endovasc Ther 2003;10:728–732.

    Article  PubMed  Google Scholar 

  88. Lee B, Godfrey M, Vitale E, Hori H, Mattei MG, Sarfarazi M, et al. Linkage of Marfan syndrome and a phenotypically related disorder to two different fibrillin gene. Nature 1991;352:330–334.

    Article  PubMed  CAS  Google Scholar 

  89. Sood S, Eldadah ZA, Krause WL, McIntosh I, Dietz HC. Mutation in fibrillin-1 and Marfanoid-craniosynostosis (Shprintzen-Goldberg) syndrome. Nat Genet 1996;12:209–211.

    Article  PubMed  CAS  Google Scholar 

  90. Faivre L, Gorlin RJ, Wirtz MK, Godfrey M, Daugoneau N, Samples JR, et al. In frame fibrillin-1 gene deletion in autosomal dominant Weil-Marchesani syndrome. J Med Genet 2003;40:34–36.

    Article  PubMed  CAS  Google Scholar 

  91. Francke U, Berg MA, Tynan K, Bernn T, Liu W, Aoyama T, et al. A Gly1127Ser mutation in an EGF-like domain of the fibrillin-1 gene is a risk factor for ascending aortic aneurysm and dissection. Am J Hum Genet 1995;56:1287–1296.

    PubMed  CAS  Google Scholar 

  92. Mizuguchi T, Collod-Beroud G, Akiyama T, Abifadel M, Harada N, Morisaki T, et al. Heterozygous TGFBR2 mutations in Marfan syndrome. Nat Genet 2004;36:855–860.

    Article  PubMed  CAS  Google Scholar 

  93. Loeys BL, Chen J, Neptune ER, Judge DP, Podowski M, Holm T, et al. A syndrome of altered cardiovascular, craniofacial, neurocognitive and skeletal development caused by mutations in TGFBR1 or TGFBR2. Nat Genet 2005;37:275–281.

    Article  PubMed  CAS  Google Scholar 

  94. Loeys BL, Schwarze U, Holm T, Callewaert BL, Thomas GH, Pannu H, et al. Aneurysm syndromes caused by mutations in the TGF-beta receptor. N Engl J Med 2006;355:788–798.

    Article  PubMed  CAS  Google Scholar 

  95. Pannu H, Tran-Fadula V, Chang J, Lafont A, Hasham S, Sparks E, et al. Mutations in transformaing growth factor-β receptor type II cause familial thoracic aortic aneurysms and dissections. Circulation 2005;112:513–520.

    Article  PubMed  CAS  Google Scholar 

  96. Guo D, Hasham S, Kuang S, Vaughan CJ, Boerwinkle E, Chen Hua, et al. Familiar thoracic aortic aneurysms and dissections genetic heterogeneity with a major locus mapping to 5q13–14. Circulation 2001;103:2461–2468.

    PubMed  CAS  Google Scholar 

  97. Hasham S, Willing MC, Guo D, Muilenburg A, He R, Tran VT, et al. Mapping a locus for familial thoracic aortic aneurysms and dissections (TAAD2) to 3p24–25. Circulation 2003;107:3184–3190.

    Article  PubMed  Google Scholar 

  98. Hasham S, Lewin MR, Tran VT, Pannu H, Muilenburg A, Willing M, et al. Nonsyndromic genetic predisposition to aortic dissection: A newly recognized, diagnosable, and preventable occurrence in families. Ann Emerg Med 2004;43:79–82.

    Article  PubMed  Google Scholar 

  99. Pannu H, Tran-Fadula V, Milewicz DM. Genetic basis of thoracic aortic aneurysms and aortic dissections. Am J Med Genet C Semin Med Genet 2005;139:10–16.

    Google Scholar 

  100. Pannu H, Avidan N, Tran-Fadula V, Milewics DM. Genetic basis of thoracic aortic aneurysms and dissections: potential relevance to abdominal aortic aneurysms. Ann N Y Acad Sci 2005;1085:242–255.

    Article  CAS  Google Scholar 

  101. Tran-Fadula V, Chen JH, Lemuth D, Neichoy BT, Yuan J, Gomes N, et al. Familial thoracic aortic aneurysms and dissections: three families with early-onset ascending and descending aortic dissection in women. Am J Med Genet A.2006;140:1196–1202.

    Google Scholar 

  102. LeMaire SA, Pannu H, Tran-Fadula V, Carter SA, Coselli JS, Milewics DM. Severe aortic and arterial aneurysms associated with a TGFBR2 mutation. Natl Clin Pract Cardiovasc Med 2007;4:167–171.

    Article  Google Scholar 

  103. Guo DC, Pannu H, Tran-Fadula V, Papke CL, Yu RK, Avidan N, et al. Mutations in smooth muscle α-actin(ACTA2) lead to thoracic aortic aneurysms and dissections. Net Genet 2007;39:1488–1493.

    Article  CAS  Google Scholar 

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Suzuki, S., Masuda, M. An update on surgery for acute type A aortic dissection: Aortic root repair, endovascular stent graft, and genetic research. Surg Today 39, 281–289 (2009). https://doi.org/10.1007/s00595-008-3887-3

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