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The fate of residual aortic regurgitation after ascending aorta replacement in type A aortic dissection
- Source :
- The Journal of thoracic and cardiovascular surgery. 160(6)
- Publication Year :
- 2019
-
Abstract
- Objective This study aimed to evaluate the changes in postoperative aortic regurgitation (AR) and determine the predictors of significant AR and root reoperation after ascending aortic replacement (AAR) in patients with acute type A aortic dissection. Methods From January 1995 to December 2017, 271 consecutive patients underwent valve/root-preserving AAR (n = 225) and root replacement (n = 46). AR grade trend over time was analyzed by the ordinal mixed-effects model. Significant AR was defined as AR grade ≥3+ during the follow-up period. Predischarge and follow-up echocardiograms were obtained in 95.6% and 88.8% of enrolled patients, respectively. Results At predischarge, postoperative ≥2+ AR was present in 20 (9.3%) and 1 (2.3%) patients in the AAR and root replacement groups, respectively. With increasing time after surgery, the grade of AR increased. At 10 years, 4.6% of patients had developed 3+ or 4+ AR. Considering death as the competing risk, the 10-year cumulative incidence of significant AR was significantly higher in the AAR than in the root replacement group (12.3% vs 2.2%; P = .047). The risk of root reoperation at 10 years was not different between the groups (P = .118). On Cox analysis, preoperative ≥3+ AR (P = .002), postoperative ≥2+ AR (P = .040), and false to true lumen ratio (P = .005) were associated predictors of significant AR. Conclusions Although valve/root-preserving AAR demonstrated reasonable long-term outcomes when compared with root replacement, preoperative ≥3+ AR, postoperative ≥2+ AR, and high false to true lumen ratio significantly increased the risk of significant AR. Therefore, careful echocardiographic surveillance may be warranted in patients with postoperative ≥2+ AR and small true lumen.
- Subjects :
- Pulmonary and Respiratory Medicine
Marfan syndrome
Male
medicine.medical_specialty
Time Factors
Aortic Valve Insufficiency
Lumen (anatomy)
Regurgitation (circulation)
030204 cardiovascular system & hematology
Transesophageal echocardiogram
03 medical and health sciences
Blood Vessel Prosthesis Implantation
0302 clinical medicine
Postoperative Complications
Internal medicine
medicine.artery
Ascending aorta
medicine
Humans
Cumulative incidence
In patient
Aorta
Retrospective Studies
Aortic dissection
medicine.diagnostic_test
Aortic Aneurysm, Thoracic
business.industry
Middle Aged
medicine.disease
Prognosis
Aortic Dissection
030228 respiratory system
Cardiology
Disease Progression
Surgery
Female
Cardiology and Cardiovascular Medicine
business
Tomography, X-Ray Computed
Echocardiography, Transesophageal
Follow-Up Studies
Subjects
Details
- ISSN :
- 1097685X
- Volume :
- 160
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Accession number :
- edsair.doi.dedup.....4c61e17b8dd788971aa25c15fbe48f6f