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Acute type A aortic dissection extending beyond ascending aorta: Limited or extensive distal repair.

Authors :
Rylski B
Beyersdorf F
Kari FA
Schlosser J
Blanke P
Siepe M
Source :
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2014 Sep; Vol. 148 (3), pp. 949-54; discussion 954. Date of Electronic Publication: 2014 May 22.
Publication Year :
2014

Abstract

Objective: The aim of our study was to delineate the effect of aortic arch surgery extension on the outcomes in acute type A dissection extending beyond the ascending aorta.<br />Methods: From 2001 to 2013, of 197 patients with type A dissection, 153 (78%) with dissection extending beyond the ascending aorta (age, 61 years; first quartile, 50; third quartile, 69; 67% men) were identified. Aortic repair involved isolated ascending replacement (n = 102), hemiarch (n = 37), and total arch replacement (n = 14). The median follow-up period was 4.9 years (first quartile, 2.5; third quartile, 7.6; 733 patient-years).<br />Results: In-hospital mortality was 9.8%, 21.6%, and 28.6% (P = .122) for patients with no, hemiarch, and total arch replacement. Age > 80 years (odds ratio [OR], 9.37; P = .006), malperfusion syndrome (OR, 4.74; P = .004), and total arch replacement (OR, 6.47; P = .016) were independent predictors of perioperative mortality. Freedom from distal reintervention was 93% ± 3%, 97% ± 3%, and 100% at 1 year and 89% ± 3%, 97% ± 3%, and 100% at 5 years for the no, hemiarch, and total arch replacement groups, respectively (log-rank, P = .440). Marfan syndrome (OR, 12.40; P = .038) and dissection of all aortic segments (OR, 10.68; P = .007) predicted distal aortic reintervention. In-hospital mortality for elective reintervention was 0%.<br />Conclusions: Limiting the extent of surgery for type A aortic dissection to ascending aortic replacement was associated with low perioperative mortality. Thus, aortic arch repair can be deferred, because it can be performed electively with a lower mortality risk.<br /> (Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)

Details

Language :
English
ISSN :
1097-685X
Volume :
148
Issue :
3
Database :
MEDLINE
Journal :
The Journal of thoracic and cardiovascular surgery
Publication Type :
Academic Journal
Accession number :
25018156
Full Text :
https://doi.org/10.1016/j.jtcvs.2014.05.051