ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardioneurology
Association between circulating levels of miR-29 and postoperative neurological complications in acute type A aortic dissection patients
Xiaochai Lv
Yong Lin
Yan-Ting Hou
Min-Xia Xie
Liangwan Chen
Fujian Medical University Union Hospital, Fuzhou, China
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Abstract
Objectives. Postoperative neurological complications (PONC), which are associated with substantial morbidity and mortality, represent a prevalent clinical challenge following surgical repair of acute type A aortic dissection (AAD). This study aimed to identify novel biomarkers for the early diagnosis of PONC, facilitating timely clinical intervention. Methods. We established deep hypothermic circulatory arrest (DHCA) rat models, extracted total RNA from the hippocampus of rats (DHCA and control groups), performed microRNA (miRNA) sequencing, screened for differentially expressed genes (DEGs) between the two groups, and analysed their associated biological processes and pathways. A cohort of 95 patients with AAD was included in this study. Comprehensive clinical assessments and a standardized neuropsychological test battery were systematically conducted. Serum miR-29 levels were quantified via reverse transcription quantitative real-time polymerase chain reaction. Results. Transcriptomic profiling of the rat hippocampus under DHCA/cardiopulmonary bypass (CPB) revealed 31 differentially expressed miRNAs (FC>1.5, P<0.05), with miR-29a-5p and miR-29b-3p showing the most significant dysregulation. Functional enrichment analysis revealed that MAPK signalling and cellular junction pathways are involved in blood‒brain barrier modulation. To translate these findings clinically, we analysed a cohort of 95 AAD patients. Compared with patients without PONC, those who developed PONC had significantly longer CPB duration [164.00 (137.00–193.00) vs. 140.00 (120.25–161.00) min; P=0.012], higher preoperative interleukin-6 levels [106.60 (87.80–154.90) vs. 47.00 (35.45–71.73) pg/mL; P<0.001], and altered miR-29 expression profiles. Multivariate analysis confirmed that preoperative miR-29b-3p (OR=2.53, 95% CI 1.17–5.47) and postoperative miR-29a-5p (OR=0.21, 95% CI 0.05–0.96) were independent predictors of PONC. The nomogram demonstrated robust discrimination (AUC=0.867) and clinical utility (net benefit=0.23), with 30-day survival analysis revealed an increased risk of mortality associated with miR-29b-3p (P=0.041). Conclusions. This study identified dysregulated miR-29 as a key mechanism linked to CPB/DHCA and validated circulating miR-29b-3p as an independent predictor of PONC and mortality in AAD patients, providing a basis for early risk assessment.
Summary
Keywords
Acute type A aortic dissection, biomarker, deep hypothermic circulatory arrest, miR-29a-5p/miR-29b-3p, postoperative neurological complications, predictive nomogram
Received
26 January 2026
Accepted
02 February 2026
Copyright
© 2026 Lv, Lin, Hou, Xie and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Liangwan Chen
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