Publications
2026
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Meta-analysis of the histopathological features of surgically removed aortas classified according to the SCVP and AECVP consensus documents
The Society for Cardiovascular Pathology (SCVP) and the Association for European Cardiovascular Pathology (AECVP) published consensus statements on the surgical pathology of the aorta to unify nomenclature and provide a new classification scheme to systematically evaluate the degenerative and inflammatory lesions of the thoracic aorta. The aim of this meta-analysis was to determine the histopathological features of thoracic aneurysmatic aortas, thoracic dissected aortas, and thoracic aortas in... -
Surveillance after thoracic aortic surgery yields to low number of reinterventions: A Retrospective Cohort Study
CONCLUSION: Postoperative imaging surveillance after thoracic aortic surgery was associated with substantial imaging burden but low immediate procedural yield, with clinically relevant findings concentrated in a minority of patients. These findings support the need to better define patient-specific risk and imaging efficiency, but do not establish that less intensive surveillance would be safe without prospective validation. -
Degenerative histopathology in ascending aortic aneurysms: comparative analysis by aneurysm location
Aortic aneurysms have traditionally been studied as a single pathological entity, with emphasis on valve morphology. While histopathological differences between bicuspid (BAV) and tricuspid (TAV) aortopathy are well documented, less is known about how these mechanisms interact with aneurysm location within the ascending aorta. This gap complicates risk assessment and surgical planning beyond diameter-based criteria. We aimed to evaluate histopathological features of ascending aortic aneurysms... -
Extent of Acute Type A Aortic Dissection in Patients With Organ Cysts
CONCLUSIONS: The presence of cysts in patients requiring surgery for acute type A aortic dissection may reflect the extent of aortic wall tissue degeneration. -
Diagnosis of traumatic diaphragmatic injury remains a clinical challenge - Brief report
Traumatic diaphragmatic injury (TDI) is a rare injury accounting for 10% to 15% of penetrating injuries and 1% to 8% of blunt injuries to the thoracoabdominal region. The most common mechanism of blunt trauma is motor vehicle collision, while stabbings and gunshot wounds are the most frequent causes of penetrating TDIs. More than 62% of TDIs are initially undiagnosed. We identified 22 TDIs. Of these, diagnosis was delayed > 24 h in eight patients. The diagnosis was missed in seven patients, even... -
Ultrasound-Guided Superficial Parasternal Intercostal Plane Block for Early Pain Management in Patients Undergoing Cardiac Surgery-A Randomized Controlled Trial
CONCLUSION: In this randomized controlled trial a single-shot SPIP block did not reduce the 24-h cumulative opioid consumption after cardiac surgery. -
Reply: How would a heterogeneous research population aid in interpreting study results?
No abstract
2025
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Reply: How would a heterogeneous research population aid in interpreting study results?
No abstract -
Severity of Ascending Aortic Degeneration in Patients With Chronic Obstructive Pulmonary Disease
Background Ascending aortic dilatation is associated with increased susceptibility to aortic events. Chronic obstructive pulmonary disease (COPD) may add to tissue degeneration and inflammation associated with the risk of increased aortic dilatation. We studied the characteristics and aortic wall degeneration of patients with COPD during ascending aortic dilatation. Methodology We enrolled 35 consecutive patients who underwent elective surgery for ascending aortic dilatation between February... -
Ticagrelor and Aspirin or Aspirin Alone after Coronary Surgery for Acute Coronary Syndrome
CONCLUSIONS: Among patients who underwent CABG for an acute coronary syndrome, ticagrelor plus aspirin did not result in a lower incidence of death, myocardial infarction, stroke, or repeat coronary revascularization than aspirin alone at 1 year. (Funded by the Swedish Research Council and others; TACSI ClinicalTrials.gov number, NCT03560310; EudraCT number, 2017-001499-43; EU Clinical Trials number, 2023-508551-40-00.). -
Diabetes Mellitus Is Associated with Distinctive Aortic Wall Degeneration During Acute Type A Aortic Dissection
Background: Non-adjustable patient characteristics such as diabetes mellitus may influence surgical decision-making and outcome after acute type A aortic dissection (ATAAD). The aim of this study was to compare the degree of aortic wall atherosclerosis and surgical solutions in patients with diabetes mellitus versus those without during ATAAD. Methods: Altogether, 123 consecutive patients undergoing surgery for ATAAD at Tampere University Heart Hospital were evaluated. The ascending aortic wall... -
Superficial Parasternal Intercostal Plane Block and Full Sternotomy; A Randomized Trial
CONCLUSIONS: SPIP before aortic valve surgery via full sternotomy impacts postoperative respiratory function and venous/arterial IL6 ratio. -
Prevalence and risk factors of thoracic aortic dilatation detected incidentally in adjuvant radiotherapy planning CT scans in patients with breast cancer
Thoracic aortic dilatations (TADs) are commonly detected incidentally. A TAD may develop into aortic aneurysm and subsequently lead to aortic dissection, a highly lethal condition. Earlier detection of TADs could improve the surveillance and surgical management of aneurysms, potentially reducing aortic ruptures. The opportunistic use of thoracic sectional imaging studies performed for other indications, including breast radiation therapy planning, could be used to detect TADs. However, the... -
CMKLR-1 Expression in Human Aorta Is Dominated by Smooth Muscle Cell Positivity
Chemokine-like receptor 1 (CMKLR-1) is a G-protein-coupled receptor that functions as the binding site of chemerin. It induces chemotaxis in various immune cells, and it has recently been linked to vascular remodeling in inflammation. In this study, we investigated CMKLR-1 expression in human aorta samples, focusing on its distribution across different cell types and its potential association with clinical and histomorphological data, particularly concerning aortic dissection and aneurysms. We... -
Increased angiogenesis and lymphangiogenesis in rheumatic mitral valves
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) create a global burden in the field of cardiovascular medicine due to significant morbidity and mortality, particularly in low- and middle-income countries and the underprivileged population. Sequential surgical specimens of mitral valves excised from 19 patients with moderate to marked rheumatic mitral stenosis were included in this study and compared to eight sequential surgical myxomatous degenerative valves (control). The study... -
Cardiopulmonary Bypass Time During Surgery for Acute Type A Aortic Dissection and Mid-Term Survival
We evaluated the association between cardiopulmonary bypass (CPB) time during surgery for acute type A aortic dissection (ATAAD) and mid-term survival. Data of 1122 patients who underwent surgery for ATAAD in eight Nordic centers from January 2005 to December 2014 were retrospectively analyzed. An adjusted logistic regression analysis was performed to investigate the association of incremental 30 min CPB time on 30-day mortality. In addition, the patients were divided into those that underwent... -
Systematic Morphological Assesment of the Ascending Aorta Dissection: Application of Cardiovascular Pathology Consensus Statement in Tertiaty Care Hospital in Finland
This study investigated the distinguishing characteristics between acute type A aortic dissection (ATAAD) and aortic wall dilatation. Utilizing systematic histopathology criteria from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology consensus statement, the analysis focused on degeneration, atherosclerosis, and inflammation in patients undergoing surgery in a Finnish tertiary care hospital. The study included 156 patients, those undergoing...
2024
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Prognostic analysis of acute type A aortic dissection after different surgical interventions: a cohort study
CONCLUSIONS: There was no significant difference in postoperative mortality between the Sun procedure group and the non-Sun procedure group. The incidence of spinal MPS in the Sun procedure group was higher than that in the non-Sun procedure group, while the incidence of DAEs in the Sun procedure group was lower than that in non-Sun procedure group. -
Delivering the news of an intraoperative death; literature-based guidance from the American Association for Thoracic Surgery Wellness Committee
CONCLUSIONS: In this stressful situation, precontemplation of the surgeon's duties and being armed with a bullet point guide may benefit the surgeon, family, and heath care team. The lessons learned may be applicable to other situations requiring the delivery of distressing information. -
Interplay of atherosclerosis and medial degeneration in human ascending aorta
The previous understanding has been that atherosclerosis tends to increase distally from the ascending aorta, but recent studies and practical experience have indicated that atherosclerosis occurs in the ascending aorta more than previously thought. Medial degeneration is linked to aortic aneurysms, dissection and dilatation and has been related to increased mortality. There is a lack of data on the coexistence of atherosclerosis and medial degeneration in the ascending aorta and its outcome to... -
Cardiac surgery and long-term risk for incident cancer: A nationwide population-based study
CONCLUSIONS: Patients who underwent cardiac surgery have lower risk for cancer and cancer-specific mortality than matched control subjects. -
The proximal extension of acute type A aortic dissection is associated with ascending aortic wall degeneration
CONCLUSIONS: Histopathology of the ascending aorta during ATAAD reveals distinctive aortic wall degeneration in patients with aortic root involvement vs. not. The degree of mucoid extracellular matrix accumulation assessed postoperatively is associated with the choice of surgical procedure in many patients. -
Early Graft Reperfusion and Arrhythmias After Coronary Artery Bypass Grafting
Background Arrhythmia after coronary artery bypass grafting (CABG) may occur immediately after the abrupt onset of reperfusion via all coronary bypass grafts simultaneously. We investigated whether early reperfusion of the left anterior descending coronary artery before weaning from cardiopulmonary bypass would decrease the frequency of early arrhythmias after CABG. We compared patients undergoing release of the left internal thoracic artery (LITA) graft flow before versus after aortic... -
Bleeding is associated with severely impaired outcomes in surgery for acute type a aortic dissection
Background. Surgery for acute type A aortic dissection confers a risk for significant bleeding. We analyzed the impact of massive bleeding on complications after surgery for acute type A aortic dissection. Methods. Patients undergoing surgery for acute type A aortic dissection from the retrospective multicenter Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database 2005-2014 were eligible. Massive bleeding was defined according to the Universal Definition of Perioperative... -
Antithrombotic management after aortic valve replacement with biological prosthesis: a meta-analysis
CONCLUSION: Although this meta-analysis reveals that anticoagulation therapy has a beneficial tendency in terms of mortality at 1 year after biological SAVR and suggests potential advantages in continuing anticoagulation beyond 3 months, it is limited by very low evidence certainty. The imperative for cautious interpretation and the urgent need for more robust randomised research underscore the complexity of determining optimal antithrombotic strategies in this patient population. -
The autonomic nerves around the vein of Marshall: a postmortem study with clinical implications
This study aims to analyze the vein of Marshall (VOM) in human autopsy hearts and its correlation with clinical data to elucidate the morphological substrates of atrial fibrillation (AF) and other cardiac diseases. Twenty-three adult autopsy hearts were studied, assessing autonomic nerves by immunohistochemistry with tyrosine hydroxylase (sympathetic nerves), choline acetyltransferase (parasympathetic nerves), growth-associated protein 43 (neural growth), and S100 (general neural marker)... -
Aortic elastic fiber degeneration during acute type a aortic dissection and reverse aortic remodeling
CONCLUSIONS: According to this exploratory study, histopathology reveals distinctive aortic wall degeneration during ATAAD. Reverse aortic remodeling after ATAAD is associated with the presence of ascending aortic wall elastic fiber fragmentation, loss and disorganization during ATAAD.
2023
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Detailed study of collagen, vasculature, and innervation in the human cardiac conduction system
CONCLUSIONS: Our results provide new insights into the unique morphology of the human CCS collagen, fat, vasculature, and innervation. A deeper understanding of the CCS anatomical components and morphologic substrates' role will help in elucidating the causes of cardiac arrhythmias and provide a basis for further therapeutic interventions. -
Rapid-deployment aortic valve replacement during challenging aortic valve reoperation: a case report
A previously implanted stenotic aortic valve bioprosthesis with stenotic coronary ostia and intramyocardial calcium was surgically debrided resulting in disruption of the left outflow track. A rapid-deployment aortic valve bioprosthesis was implanted to cover the remnant aortic valve annulus, ensure open coronary ostia, and secure a well-functioning aortic valve bioprosthesis with low postoperative gradient. -
Type A Aortic Dissection Repair in Patients With Prior Cardiac Surgery
CONCLUSIONS: Major adverse events after surgery for acute type A aortic dissection were more frequent in patients with previous cardiac surgery. Previous cardiac surgery itself was not an independent predictor for adverse events, although the small sample size precludes definite conclusions. Previous cardiac surgery should not deter from emergency surgery. -
Commentary: It takes two to tango: Revascularization and viable cells
No abstract
2022
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Impact of national holidays and weekends on incidence of acute type A aortic dissection repair
Previous studies have demonstrated that environmental and temporal factors may affect the incidence of acute type A aortic dissection (ATAAD). Here, we aimed to investigate the hypothesis that national holidays and weekends influence the incidence of surgery for ATAAD. For the period 1st of January 2005 until 31st of December 2019, we investigated a hypothesised effect of (country-specific) national holidays and weekends on the frequency of 2995 surgical repairs for ATAAD at 10 Nordic cities... -
Myocardial interaction of apixaban after experimental acute volume overload
CONCLUSION: Apixaban interacts with intramyocardial arteries in the left and right ventricles after AVO and ANP and MMP9 expression levels increased. Thus, the myocardial effect of Factor Xa inhibition needs to be monitored after AVO. -
Temperature effects on incidence of surgery for acute type A aortic dissection in the Nordics
We aimed to investigate a hypothesised association between daily mean temperature and the risk of surgery for acute type A aortic dissection (ATAAD). For the period of 1 January 2005 until 31 December 2019, we collected daily data on mean temperatures and date of 2995 operations for ATAAD at 10 Nordic cities included in the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) collaboration. Using a two-stage time-series approach, we investigated the association between hot and cold... -
Human Pulmonary Vein Myocardial Sleeve Autonomic Neural Density and Cardiovascular Mortality
Myocardial sleeves around pulmonary veins (PVs) are highly innervated structures with heterogeneous morphological and electrophysiological characteristics. Autonomic nerve dysfunction in the myocardium may be associated with an increased risk of cardiovascular morbidity and mortality. This article studied autonomic neural remodeling in myocardial sleeves around PVs and atrial-PV ostia with immunohistochemical and morphometric methods with clinicopathological correlations. PVs were collected from... -
Early reversibility of histological changes after experimental acute cardiac volume-overload
Unloading the heart may aid recovery after acute cardiac volume-overload (AVO). We experimentally investigated whether unloading the heart after AVO by heterotopic transplantation histologically impacts myocardial outcome. Thirty-two syngeneic Fisher 344 rats underwent surgery for abdominal arterial-venous fistula to induce AVO. Seven hearts were heterotopically transplanted one day after AVO to simulate a non-working state of the left ventricle (AVO+Tx). In addition, six rats without AVO or... -
Is mood associated with perception of recovery? Preoperative depression versus postoperative delirium after cardiac surgery
The author alone is responsible for the Invited Commentary, which does not necessarily reflect the policy of the Journal. -
Type A Aortic Dissection Repair in Patients With Prior Cardiac Surgery
CONCLUSIONS: Major adverse events after surgery for acute type A aortic dissection were more frequent in patients with previous cardiac surgery. Previous cardiac surgery itself was not an independent predictor for adverse events, although the small sample size precludes definite conclusions. Previous cardiac surgery should not deter from emergency surgery. -
Ascending aortic wall degeneration in patients with bicuspid versus tricuspid aortic valve
CONCLUSIONS: Since degeneration of the ascending aortic wall was seldom prominent, histopathology alone may not support the need for surgery of the dilated ascending aorta in BAV patients as compared with TAV patients. -
Autonomic nerves in myocardial sleeves around caval veins: Potential role in cardiovascular mortality?
CONCLUSIONS: Decrease of superior vena cava myocardial sleeve sympathetic nerves may be associated with cardiovascular mortality and/or aging. No difference in autonomic innervation was found between subjects with documented atrial fibrillation vs. sinus rhythm. -
Once after a full moon: acute type A aortic dissection and lunar phases
CONCLUSIONS: This study found an overrepresentation of surgery for ATAAD during the full moon phase. The explanation for this is not known, but we speculate that sleep deprivation during full moon leads to a temporary increase in blood pressure, which in turn could trigger rupture of the aortic wall. While this finding is interesting, it needs to be corroborated and the clinical implications are debateable.
2021
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Commentary: Collective responsibility in combating injection drug use-related endocarditis
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Commentary: A pile of vital cells is needed to treat myocardial infarction
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Commentary: "Käytännöllistelemälläkin": Antiaggregants, anticoagulants, and endocarditis
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Once after a full moon: acute type A aortic dissection and lunar phases
CONCLUSIONS: This study found an overrepresentation of surgery for ATAAD during the full moon phase. The explanation for this is not known, but we speculate that sleep deprivation during full moon leads to a temporary increase in blood pressure, which in turn could trigger rupture of the aortic wall. While this finding is interesting, it needs to be corroborated and the clinical implications are debateable. -
Statins for secondary prevention and major adverse events after coronary artery bypass grafting
CONCLUSIONS: Ongoing statin use was associated with a markedly reduced incidence of adverse events and mortality after CABG. Initiating and maintaining statin medication is essential in CABG patients. -
Commentary: Preventive treatment of right-sided heart failure before adulthood?
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Outcome After Surgery for Acute Type A Aortic Dissection With or Without Primary Tear Resection
CONCLUSIONS: Primary tear resection alone does not determine the midterm outcome after surgery for acute type A aortic dissection. -
Commentary: It takes two to tango: Revascularization and viable cells
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Commentary: Where does your distal aortic anastomosis lead to?
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Commentary: A synthetic adeno-associated viral vector as a means of future precision treatment
No abstract