Acute type A aortic dissection repair in younger patients

Uehara, Kyokun; Matsuda, Hitoshi; Matsuo, Jiro; Inoue, Yosuke; Omura, Atsushi; Seike, Yoshimasa; Sasaki, Hiroaki; Kobayashi, Junjiro

doi:10.1111/jocs.13558

Cited by 8 publications

(6 citation statements)

References 18 publications

(54 reference statements)

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“…Controversial results on the durability of aortic repair have been reported in a few studies evaluating young patients with TAAD. Among 51 TAAD patients younger than 50 years old, Uehara et al 3 reported distal aortic reoperations in 25% of patients after total aortic arch repair and in 17% of patients after hemiarch repair. However, 27.5% of their patients had a connective tissue disorder.…”

Section: Discussionmentioning

confidence: 99%

“…Such an extensive surgical approach, often associated with completion endovascular treatment 2 , is thought to reduce the risk of distal progression of the disease by favouring the remodelling of the dissected downstream aorta and thus preventing aortic wall degeneration. This extensive surgical approach is attractive in young patients to reduce the incidence of distal aortic complications during their long lifespan 3 . However, data on the efficacy of total aortic arch repair in young patients are scarce 3–7 .…”

Section: Introductionmentioning

confidence: 99%

“…This extensive surgical approach is attractive in young patients to reduce the incidence of distal aortic complications during their long lifespan 3 . However, data on the efficacy of total aortic arch repair in young patients are scarce 3–7 . In this multicentre study, whether total aortic arch repair may reduce the need for distal aortic reoperation in patients <60 years old with DeBakey type 1 aortic dissection was evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

Biancari,

Lega,

Mariscalco

et al. 2024

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Background Extended aortic repair is considered a key issue for the long-term durability of surgery for DeBakey type 1 aortic dissection. The risk of aortic degeneration may be higher in young patients due to their long life expectancy. The early outcome and durability of aortic surgery in these patients were investigated in the present study. Methods The subjects of the present analysis were patients under 60 years old who underwent surgical repair for acute DeBakey type 1 aortic dissection at 18 cardiac surgery centres across Europe between 2005 and 2021. Patients underwent ascending aortic repair or total aortic arch repair using the conventional technique or the frozen elephant trunk technique. The primary outcome was 5-year cumulative incidence of reoperation on the distal aorta. Results Overall, 915 patients underwent surgical ascending aortic repair and 284 patients underwent surgical total aortic arch repair. The frozen elephant trunk procedure was performed in 128 patients. Among 245 propensity score–matched pairs, total aortic arch repair did not decrease the rate of distal aortic reoperation compared to ascending aortic repair (5-year cumulative incidence, 6.7% versus 6.7%, subdistributional hazard ratio 1.127, 95% c.i. 0.523 to 2.427). Total aortic arch repair increased the incidence of postoperative stroke/global brain ischaemia (25.7% versus 18.4%, P = 0.050) and dialysis (19.6% versus 12.7%, P = 0.003). Five-year mortality was comparable after ascending aortic repair and total aortic arch repair (22.8% versus 27.3%, P = 0.172). Conclusions In patients under 60 years old with DeBakey type 1 aortic dissection, total aortic arch replacement compared with ascending aortic repair did not reduce the incidence of distal aortic operations at 5 years. When feasible, ascending aortic repair for DeBakey type 1 aortic dissection is associated with satisfactory early and mid-term outcomes. Trial registration ClinicalTrials.gov Identifier: NCT04831073.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

Biancari,

Lega,

Mariscalco

et al. 2024

BJS Open

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“…For example, Heuts et al 36 carried out a meta‐regression analysis which revealed that the treatment effect of TAR was potentialized with decreasing age, implying that the treatment effect of the more aggressive approach on 10‐year survival modestly increases with decreasing age. While younger patients have a longer life expectancy, they also have an increased risk of late distal aortic events and, eventually, require late reoperation more often, 39 which might justify a more aggressive approach initially to avoid reoperation (and its risks). Furthermore, younger age has been associated with more favorable peri‐operative results in the setting of ATAAD treated with the aggressive approach 26 .…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of total arch replacement versus proximal aortic replacement in acute type A aortic dissection: Meta‐analysis of Kaplan–Meier‐derived individual patient data

Sá

Jacquemyn

Tasoudis

et al. 2022

Journal of Cardiac Surgery

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Objectives: To evaluate the long-term outcomes of a conservative approach (with proximal aortic replacement with or without hemiarch replacement) versus an aggressive approach (with total aortic arch replacement) in the treatment of acute type A aortic dissection (ATAAD).Methods: We performed a pooled analysis of Kaplan-Meier-derived individual patient data from studies with follow-up comparing the aforementioned approaches to treat patients with ATAAD.Results: Eighteen studies met our eligibility criteria, comprising 5243 patients with follow-up (Conservative: 3676 patients; Aggressive: 1567 patients). We observed a statistically significant difference in overall survival favoring the aggressive approach (hazard ratios [HR] 0.86, 95% confidence interval [CI] 0.76-0.98, p = .022), but no statistically significant difference in the risk

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“…With the increase in the proportion of hypertension, the incidence of AAAD has been increasing year by year. At present, timely surgical treatment is the main effective method for AAAD, but the early mortality after AAAD is still as high as 8–25% [ 3 , 4 ]. Therefore, early identification of risk factors for death on admission in AAD patients is of great significance to reduce mortality and improve prognosis.…”

Section: Introductionmentioning

confidence: 99%

TG/HDL-C ratio predicts in-hospital mortality in patients with acute type A aortic dissection

Lin

Peng

et al. 2022

BMC Cardiovasc Disord

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Background In recent years, abnormalities in serum lipids and lipoproteins have been shown to be associated with cardiovascular disease risk. However, their prognostic value for acute type A aortic dissection is unclear. This study analyzed the correlation between triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio and in-hospital mortality in patients with AAAD, and aimed to investigate the clinical significance of preoperative blood lipids and lipoproteins on the prognosis of acute type A aortic dissection. Methods A total of 361 patients who underwent type A aortic dissection surgery in Fujian Cardiac Medical Center from June 2018 to March 2020 were retrospectively collected. According to the baseline TG/HDL-C ratio, the patients were divided into 3 groups according to the tertile method, the low TG/HDL-C ratio T1 group (< 1.18) and the middle TG/HDL-C ratio T2 group (1.18–1.70). T3 group with high TG/HDL-C ratio (> 1.70). Kaplan–Meier was used for survival analysis, and Cox proportional hazards regression model was used to analyze the factors affecting the prognosis of patients. The receiver operating characteristic (ROC) curve was used for the diagnostic efficacy. Results Among the 361 patients in this study, the mean age was 52.4 ± 11.3 years, 73 (20.2%) were female, and 82 (22.7%) died in hospital. Kaplan–Meier curve showed that with the increase of TG/HDL-C ratio, the risk of in-hospital death gradually increased (P < 0.001). Multivariate Cox regression analysis showed that age (HR = 1.031), body mass index (HR = 1.052), hypertension (HR = 3.491), white blood cells (HR = 1.073), TG/HDL-C ratio (HR = 1.604), MODS (HR = 1.652) was positively correlated with in-hospital mortality (P < 0.05). After adjusting for age, sex, and other risk factors, a significant association was found between the TG/HDL-C ratio and in-hospital mortality for acute type A aortic dissection (HR = 1.472, 95% CI, 1.354–3.451, P = 0.019). Conclusion Patients with type A aortic dissection have obvious abnormal blood lipid metabolism, and serum TG/HDL-C levels are positively correlated with in-hospital mortality in patients with AAAD.

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Acute type A aortic dissection repair in younger patients

Abstract: Surgical outcomes after AAAD repair for young patients were satisfactory. A patent false lumen significantly increased the need for reoperation (P = 0.002), but did not affect long-term survival. Close follow-up is mandatory after the initial repair in young patients following AAAD.

Cited by 8 publications

References 18 publications

Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

Long‐term outcomes of total arch replacement versus proximal aortic replacement in acute type A aortic dissection: Meta‐analysis of Kaplan–Meier‐derived individual patient data

TG/HDL-C ratio predicts in-hospital mortality in patients with acute type A aortic dissection

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