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Extent of surgical repair and outcomes after surgery for type A aortic dissection
F. Biancari, D. Fileccia, L. Ferrante, T. Mäkikallio, T. Juvonen, M. Jormalainen, G. Mariscalco, Z. El-Dean, M. Pettinari, J. Rodriguez Lega, AG. Pinto, A. Perrotti, F. Onorati, K. Wisniewski, T. Demal, P. Kacer, J. Rocek, D. Di Perna, I....
Language English Country England, Great Britain
Document type Journal Article, Multicenter Study
Grant support
Italian Ministry of Health
NLK
Directory of Open Access Journals
from 2017
PubMed Central
from 2017
Europe PubMed Central
from 2017
Oxford Journals Open Access Collection
from 2017-02-01
ROAD: Directory of Open Access Scholarly Resources
from 2017
- MeSH
- Aortic Aneurysm surgery mortality MeSH
- Blood Vessel Prosthesis Implantation * adverse effects mortality methods MeSH
- Aortic Dissection * surgery mortality MeSH
- Middle Aged MeSH
- Humans MeSH
- Hospital Mortality * MeSH
- Postoperative Complications * epidemiology mortality etiology MeSH
- Registries * MeSH
- Reoperation statistics & numerical data MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Europe MeSH
BACKGROUND: Acute Stanford type A aortic dissection is a severe emergency condition that, if left untreated, is associated with a high mortality rate. The extent of surgical repair may impact the outcomes of these patients. METHOD: Patients operated for acute type A aortic dissection from a multicentre European registry were included. Patients were categorized based on the following types of surgical intervention: isolated ascending aortic replacement, ascending aortic replacement with concomitant aortic valve replacement, aortic root replacement, partial or total arch replacement, and partial or total arch replacement with concomitant aortic root replacement. The primary outcome was mortality rate, both in-hospital and at 10 years. Secondary outcomes were acute kidney injury requiring dialysis, neurological complications, a composite endpoint including in-hospital death, neurological complications and/or dialysis, and proximal endovascular or surgical aortic re-operations at 10 years. RESULTS: 3702 patients were included. The adjusted risk of in-hospital mortality was higher in all subsets of patients compared to those who underwent isolated ascending aortic replacement. The adjusted rates of in-hospital mortality ranged from 16.4% (95% c.i. 15.3 to 17.4) among patients who underwent isolated ascending aortic replacement to 27.7% (95% c.i. 23.3 to 31.2) among those who underwent aortic arch and concomitant aortic root replacement. The adjusted risks of neurological complications, renal replacement therapy and of the composite endpoint were significantly higher in patients who underwent partial/total aortic arch replacement. The adjusted risk estimates of 10-year mortality rate were markedly higher in patients who underwent partial/total aortic arch replacement with or without concomitant aortic root replacement. Extensive aortic repair did not significantly reduce the risk of distal or proximal aortic reoperations. CONCLUSION: These findings suggest that, when feasible, limiting the extent of aortic replacement for acute type A aortic dissection may be beneficial in reducing mortality rate and major complications both in the short and long term. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04831073.
Cardiac Surgery Molinette Hospital University of Turin Turin Italy
Cardiothoracic Department Azienda Sanitaria Universitaria Friuli Centrale Udine Italy
Cardiovascular Surgery Department University Hospital Gregorio Marañón Madrid Spain
Department of Cardiac Surgery Centre Hospitalier Annecy Genevois Epagny Metz Tessy France
Department of Cardiac Surgery Cologne University Hospital Cologne Germany
Department of Cardiac Surgery Glenfield Hospital Leicester UK
Department of Cardiac Surgery LMU University Hospital Ludwig Maximilian University Munich Germany
Department of Cardiac Surgery Martin Luther University Halle Wittenberg Halle Germany
Department of Cardiac Surgery Ziekenhuis Oost Limburg Genk Belgium
Department of Cardiothoracic Surgery University Hospital Muenster Muenster Germany
Department of Cardiovascular Surgery Centro Cardiologico Monzino IRCCS Milan Italy
Department of Cardiovascular Surgery University Heart and Vascular Center Hamburg Hamburg Germany
Department of Medicine South Karelia Central Hospital University of Helsinki Lappeenranta Finland
Department of Thoracic and Cardiovascular Surgery University of Franche Comte Besancon France
Division of Cardiac Surgery University of Verona Medical School Verona Italy
German Centre for Cardiovascular Research Partner Site Munich Heart Alliance Munich Germany
Liverpool Centre for Cardiovascular Sciences Liverpool Heart and Chest Hospital Liverpool UK
Mondor Biomedical Research Institute Université Paris Est Créteil Inserm CEpiA Team Créteil France
References provided by Crossref.org
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