Hemiarch and Total Arch Surgery in Patients With Previous Repair of Acute Type I Aortic Dissection

Preventza, Ourania; Price, Matt D.; Simpson, Keith; Cooley, Denton A.; Pocock, Elizabeth; Cruz, Kim I. de la; Green, Susan Y.; LeMaire, Scott A.; Rosengart, Todd K.; Coselli, Joseph S.

doi:10.1016/j.athoracsur.2015.03.095

Cited by 25 publications

(37 citation statements)

References 23 publications

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“…Disease progression after conservative repair does not occur immediately (18,21,22). Aortic growth is usually gradual and takes several years before re-operation: 3.5 years in our series, 4.7 years in Concistre's, 5.9 years in Kobuch's, and 7.7 years in Preventza's report (18,21,22). There were more extensive distal repairs in our re-operations group.…”

Section: Primary Repair and Reoperationmentioning

confidence: 66%

“…Leaving residual dissected aorta within the ascending and arch segments in situ will lead to late aneurysmal degeneration (19,20). Disease progression after conservative repair does not occur immediately (18,21,22). Aortic growth is usually gradual and takes several years before re-operation: 3.5 years in our series, 4.7 years in Concistre's, 5.9 years in Kobuch's, and 7.7 years in Preventza's report (18,21,22).…”

Section: Primary Repair and Reoperationmentioning

confidence: 74%

“…Patient's hemodynamic stability, extent of dissection, level of the planned distal repair and surgeon's preference are some of the selection variables that determine the choice (9,22,23).…”

Section: Cannulation Techniquementioning

confidence: 99%

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Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Cabasa¹,

Pochettino²

2016

Ann. Cardiothorac. Surg.

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Background: Type A aortic dissection (TAAD) is a complex cardiovascular disease that is associated with high perioperative morbidity and mortality. The most effective approach is still being debated-such as the best cannulation technique, and conservative versus extensive initial surgery. We reviewed our experience over the last 20 years and examined for variables that correlated with observed outcomes.Methods: All patients who underwent TAAD repair were reviewed. Chi-Square tests, Fisher Exact tests and Wilcoxon tests were performed where appropriate. Survival and freedom from reoperations were analyzed with the Kaplan-Meier actuarial method.Results: Acute TAAD was associated with a higher incidence of permanent stroke (P=0.010), renal failure (P=0.025), prolonged mechanical ventilator support (P=0.004), higher operative mortality (P=0.039) and higher 30-day mortality (P=0.003) compared to chronic TAAD. There was a trend towards higher risk for transient neurologic events among patients who were reoperated on (P=0.057). Extensive proximal repair led to longer perfusion and cross clamp times (P<0.001) and the need for temporary mechanical support postoperatively (P=0.011). More patients that had extensive distal repair underwent circulatory arrest (P=0.009) with no significant differences in the incidence of peri-operative complications, early, middle and long-term survival compared to the conservative management group. Overall survival in our series was 66.73% and 46.30% at 5 and 10 years respectively (median survival time: 9.38 years). There was a significant improvement in operative mortality (P=0.002) and 30-day mortality (P=0.033) in the second decade of our study.Conclusion: TAAD is a complex disease with several options for its surgical management. Each technique has its own advantages and complications and surgical management should be individualized depending on the clinical presentation. We propose our present approach to maximize benefits in both the short and long term.

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Section: Primary Repair and Reoperationmentioning

confidence: 66%

Section: Primary Repair and Reoperationmentioning

confidence: 74%

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Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Cabasa¹,

Pochettino²

2016

Ann. Cardiothorac. Surg.

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“…The overall rates of these procedures (39% aortic root and 30% arch repair) are similar to IRAD reported rates of aortic root (32%) and arch (35%) replacement (21). The increasing extent of surgery is supported by evidence that residual dissection will lead to late aneurysmal degeneration (11, 23–25). The increasing rates of arch replacement mirrors current research demonstrating improved neurologic outcomes, although the exact method remains controversial (11).…”

Section: Commentmentioning

confidence: 99%

Regional Practice Patterns and Outcomes of Surgery for Acute Type A Aortic Dissection

Hawkins

Mehaffey

Downs

et al. 2017

The Annals of Thoracic Surgery

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Background The surgical management of acute Type A aortic dissection is evolving and many aortic centers of excellence are reporting superior outcomes. We hypothesize that similar trends exist in a multi-institutional regional consortium. Methods Records for 884 consecutive patients who underwent aortic operations (2003 to 2015) for acute Type A aortic dissection were extracted from a regional Society of Thoracic Surgeons database. Patients were stratified into three equal operative eras. Differences in outcomes and risk factors for morbidity and mortality were determined. Results Surgery for Type A aortic dissection is increasing in extent and complexity. Aortic root repair was performed in 16% of early era cases compared to 67% currently (p<0.0001). Similarly, aortic arch repair increased from 27% to 37% cases (p<0.0001). Cerebral perfusion is currently utilized in 85% of circulatory arrest cases, most frequently antegrade (57%). Total circulatory arrest times increased (29 vs 31 vs 36 min, p=0.005), but times without cerebral perfusion were stable (12 vs 6 min, p=0.68). While operative mortality remained stable at 18.9% during the 3 operative eras, there were significant decreases in pneumonia and reoperations (p<0.05). Predictors of operative mortality and major morbidity are age (OR=1.04; p<0.0001), prior stroke (OR=2.09; p=0.03), and elevated creatinine (OR 1.31, p=0.01). Importantly, extent of aortic operation did not increase risk for morbidity or mortality. Conclusions Operative morbidity and mortality remains significant for Type A aortic dissection, but lower than historical outcomes. Extent of aortic surgery has increased resulting in adaptive cerebral protection changes in contemporary “real-world” practice.

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“…Леталь-ность при таких операциях составляет 3,3-26% [3,4]. Ле-тальность возрастает при протезировании дуги у пациен-тов, перенесших ранее вмешательства по поводу расслое-ния аорты А типа [9]. В качестве альтернативы традици-онной хирургии предлагается эндоваскулярное лечение -использование многобраншевых, фенестрированных стент-графтов, chimney-техника.…”

Section: Discussionunclassified

Sun’s procedure for aortic arch replacement using multi-branched prosthesis

Комаров¹,

Belov²,

Karavaykin³

et al. 2015

Kardiol. serdechno-sosud. khir.

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Hemiarch and Total Arch Surgery in Patients With Previous Repair of Acute Type I Aortic Dissection

Cited by 25 publications

References 23 publications

Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Regional Practice Patterns and Outcomes of Surgery for Acute Type A Aortic Dissection

Sun’s procedure for aortic arch replacement using multi-branched prosthesis

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