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Acute type A aortic dissection extending beyond ascending aorta: Limited or extensive distal repair.
- 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.)
- Subjects :
- Acute Disease
Age Factors
Aged
Aged, 80 and over
Aortic Dissection diagnosis
Aortic Dissection mortality
Aortic Aneurysm diagnosis
Aortic Aneurysm mortality
Elective Surgical Procedures
Emergencies
Female
Hospital Mortality
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Reoperation
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Aortic Dissection surgery
Aorta, Thoracic surgery
Aortic Aneurysm surgery
Blood Vessel Prosthesis Implantation adverse effects
Blood Vessel Prosthesis Implantation mortality
Subjects
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