{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T20:52:53Z","timestamp":1773867173909,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital"},{"name":"Fimlab Laboratories"},{"name":"Tampere Tuberculosis Foundation"},{"name":"Foundation of Finnish Anti-tuberculosis Association"},{"name":"Finnish Heart Association"},{"name":"Aarne Koskelo Foundation"},{"name":"Finnish Cultural Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 resected in surgery was processed for histopathological analysis of atherosclerosis, inflammation, and medial layer degeneration. Patients with and without diabetes mellitus were compared during a mean 4.7-year follow-up. Results: There were 11 patients with diabetes mellitus and 112 without. The mean age for all patients was 63.6 years (standard deviation [SD] 13.3). Altogether, 48 patients had a conduit aortic prosthesis replacing the aortic root together with the ascending aorta, including only one patient with diabetes (p = 0.049). Nine patients received a frozen elephant trunk prosthesis to treat the aortic arch together with the ascending aorta. The severity of ascending aorta atherosclerosis was more prominent in patients with diabetes mellitus as compared to patients without (0.8 [0.4] vs. 0.3 [0.5], p = 0.009, respectively). During follow-up, 8 and 78 patients with and without diabetes died, respectively (logarithmic rank p = 0.187). Conclusions: Histopathology of the ascending aorta during ATAAD reveals distinctive severity of aortic wall atherosclerosis in patients with diabetes mellitus versus those without. The degree of atherosclerosis assessed postoperatively is associated with the extent of surgical procedure in many patients and may guide follow-up protocol.<\/jats:p>","DOI":"10.3390\/jcm14134731","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T03:47:26Z","timestamp":1751600846000},"page":"4731","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Diabetes Mellitus Is Associated with Distinctive Aortic Wall Degeneration During Acute Type A Aortic Dissection"],"prefix":"10.3390","volume":"14","author":[{"given":"Santtu","family":"Heikurinen","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Tampere University Hospital, Heart Hospital, 33520 Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4089-0450","authenticated-orcid":false,"given":"Ivana","family":"Kholova","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"},{"name":"Department of Pathology, Fimlab Laboratories, 33520 Tampere, Finland"},{"name":"Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, 70210 Kuopio, Finland"},{"name":"Department of Clinical Pathology, Diagnostic Imaging Center, Kuopio University Hospital, 70029 Kuopio, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timo","family":"Paavonen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"},{"name":"Department of Pathology, Fimlab Laboratories, 33520 Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5082-4161","authenticated-orcid":false,"given":"Ari","family":"Mennander","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Tampere University Hospital, Heart Hospital, 33520 Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1161\/hc0202.102246","article-title":"Predicting death in patients with acute type A aortic dissection","volume":"105","author":"Mehta","year":"2002","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Yuan, H., Sun, Z., Zhang, Y., Wu, W., Liu, M., Yang, Y., Wang, J., Lv, Q., Zhang, L., and Li, Y. 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