Prospective Evaluation of Adventitial Histopathology in Borderline Ascending Aortic Dilatatio

N/AActive Not RecruitingNCT07034586

Samsun University102 enrolled

Overview

This prospective study investigates microscopic changes in the outer layer (adventitia) of the ascending aorta in patients undergoing coronary artery bypass grafting (CABG) surgery. The study includes two groups of patients: (1) those with borderline ascending aortic dilatation (4.0-5.0 cm), and (2) a control group with normal aortic diameter (\<4.0 cm), all undergoing the same surgical procedure. During CABG, a small circular punch is routinely made in the ascending aorta for the proximal saphenous vein graft anastomosis. The tissue removed from this punch site is collected and used for histopathological and immunohistochemical analysis. The study aims to determine whether adventitial changes correlate with aortic size and whether these changes can help identify patients at risk for future aortic dissection or rupture. The findings may guide surgical decision-making in patients with borderline aortic enlargement.

Study Type

OBSERVATIONAL

Enrollment

102

Conditions

Ascending Aortic Aneurysm Aortic Adventitial Pathology Coronary Artery Bypass Grafting (CABG)Borderline Aortic Dilatation

Eligibility

Medical Language ↔ Plain English

Inclusion Criteria: 1. Adults aged between 20 and 70 years 2. Patients scheduled for elective open-heart coronary artery bypass grafting (CABG) 3. Patients undergoing their first cardiac surgery 4. Metabolically stable patients 5. Aortic diameter: 1. Observational aortic dilatation group: between 4.0 cm and 5.0 cm 2. Control group: less than 4.0 cm 6. Written informed consent obtained from the patient Exclusion Criteria: 1. History of previous cardiac surgery 2. History of aortic dissection or rupture 3. Known genetic syndromes (e.g., Marfan, Loeys-Dietz, Ehlers-Danlos) 4. Known systemic vasculitis 5. Presence of acute infection or systemic inflammatory disease 6. Inadequate biopsy material for pathological analysis 7. Patients not undergoing any aortic intervention during surgery

Outcomes

Primary Outcomes

Association Between Histopathological Findings and Aortic Diameter

Comparison of adventitial tissue samples between patients with borderline ascending aortic dilatation (4.0-5.0 cm) and those with normal-sized aortas (\<4.0 cm). Pathological evaluation includes staining for Carbonic Anhydrase IX (CA9), Smooth Muscle Actin (SMA), D2-40, Verhoeff-Van Gieson elastin, and Prussian blue. The presence of fibrosis, inflammation, neovascularization, and hypoxia-related markers will be recorded. Analysis of the correlation between the degree of histopathological changes and the measured ascending aortic diameter. Metrics include inflammatory cell infiltration, vasa vasorum density, and adventitial fibrosis severity.

Time frame: Postoperative period (within 1 month)