Impact of Different Aortic Entry Tear Sites on Early Outcomes and Long-Term Survival in Patients with Stanford A Acute Aortic Dissection

Merkle, Julia; Sabashnikov, Anton; Deppe, A.-C.; Weber, Siegfried; Mader, Navid; Choi, Yeong‐Hoon; Liakopoulos, Oliver J.; Kuhn‐Régnier, Ferdinand; Wahlers, Thorsten

doi:10.1055/s-0038-1649511

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…Selecting ascending or hemiarch replacement without sticking to the entry resection and shortening the operative time may contribute to the surgical outcomes in the older patients with acute type A aortic dissection; the location of the primary entry tear significantly influences early outcomes and short-and long-term survival of patients [ 24 ]. In general, intimal tears are frequently found in the segments exposed to the greatest shear stress, namely the ascending aorta’s right lateral wall (opposite the main pulmonary artery) or descending aorta’s proximal segment [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of limited repair and conservative approaches in older patients with acute type A aortic dissection

Maze

Tokui

Murakami

et al. 2022

J Cardiothorac Surg

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Background Surgical indication and the selection of surgical procedures for acute type A aortic dissection in older patients are controversial; therefore, we aimed to examine the surgical outcomes of acute type A aortic dissection in older patients. Methods From January 2012 through December 2019, 174 patients underwent surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the older (≥ 80 years old) and below-80 (≤ 79 years old) age groups. Additionally, we compared the outcomes between the surgical and conservative treatment groups. Results The primary entry was found in the ascending aorta in 51.6% and 32.8% of the older and below-80 groups, respectively (p = 0.049). Ascending or hemiarch replacement was performed in all older group patients and 57.3% of the below-80 group patients (total arch replacement was performed in the remaining 42.7%; p < 0.001). Hospital mortality rates were similar in both groups. The significant risk factors for hospital mortality were age, preoperative intubation, cardiopulmonary bypass time, and postoperative stroke. The 5-year survival rates were 48.4% ± 10.3% (older group) and 86.7% ± 2.9% (below-80 group; p < 0.001). The rates of freedom from aortic events at 5 years were 86.9% ± 8.7% (older group) and 86.5% ± 3.9% (below-80 group; p = 0.771). The 5-year survival rate of the conservative treatment subgroup was 19.2% ± 8.0% in the older group, which was not significantly different from that of the surgical treatment subgroup (p = 0.103). Conclusion The surgical approach did not achieve a significant survival advantage over conservative treatment and may not always be a reasonable treatment of choice for older patients.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of limited repair and conservative approaches in older patients with acute type A aortic dissection

Maze

Tokui

Murakami

et al. 2022

J Cardiothorac Surg

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“…This may have important implications for the initiation of the entry tear in aortic dissection at particularly weak locations of the aortic wall. The circumferential orientation of entry tears has been minimally reported in the literature, whilst a considerable focus on tear site up the aortic progression (root, ascending, arch) is clinically relevant [ 19 ], as well as tear size [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Regional variation in biomechanical properties of ascending thoracic aortic aneurysms

Salmasi

Sasidharan

Frattolin

et al. 2022

European Journal of Cardio-Thoracic Surgery

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Objective This study aims to characterise the material properties of ascending thoracic aortic aneurysmal tissue, using regional biomechanical assessment of both tensile and dissection propagation peel strength. Methods Thirty-four aneurysm specimens (proximal thoracic aorta) were harvested en-bloc from patients undergoing surgery for aneurysm replacement. Specimens were processed into regional samples of similar shapes covering the whole aneurysm isosurface, according to a structured protocol, in both orientations (longitudinal and circumferential). Thickness mapping, uniaxial tensile and peel tests were conducted, enabling calculation of the following parameters: true stress/strain, tangential modulus, tensile strength, peeling force and dissection energy. Two constitutive material models were used (hyperelastic models of Delfino and Ogden) to fit the data. A circumferential strip of tissue was also obtained for computational histology (regional quantification of i) elastin, ii) collagen, iii) smooth muscle cells). Results The aortic wall was thinner on the outer curve (2.21, SD 0.4 mm vs inner curve 2.50, SD 0.12 mm). Advanced patient age and higher pulse wave velocity (externally measured) were predictors of increased aortic wall thickness. Tensile strength was higher in the circumferential vs longitudinal direction when analysed according to anatomical regions. Both peel force (35.5, 22 N/m) and dissection energy (88.5, 69 J/m2) were on average lowest at the outer curve of the aneurysm in the longitudinal orientation. Delfino and Ogden model constants varied throughout anatomical regions, with the outer curve being associated a higher ɑ constant (Delfino), and lower µ1 constant (Ogden) (p < 0.05) indicating increased stiffness. Histologically, collagen abundance was significantly related to circumferential and longitudinal strength (p = 0.010), whilst smooth muscle cell count had no relation with any mechanical property (p > 0.05). Conclusions Our results suggest that the outer aortic curve is more prone to dissection propagation and perhaps less prone to rupturing than the inner aortic curve. This strengthens the notion of disease heterogeneity in ascending thoracic aortic aneurysms and has implications for the pathogenesis of aortic dissection.

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“…The location of the primary entry tear in patients with acute type A aortic dissection signi cantly in uences early outcomes, short and long-term survival of patients [24]. In general, the intimal tear is frequently found in segments exposed to the greatest shear stress, namely the right lateral wall (opposite the main pulmonary artery) of the ascending aorta or in the proximal segment of the descending aorta [25].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Limited-repair Strategy and Conservative Approach for the Elderly With Acute Type A Aortic Dissection

Maze

Tokui

Murakami

et al. 2021

Preprint

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BackgroundThere is controversy regarding surgical indication and surgical procedure of acute type A aortic dissection for the elderly. We examined surgical outcomes for the elderly.MethodsFrom January 2012 to December 2019, 174 patients underwent surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the elderly group (≧80 years old) and the non-elderly group (≦79 years old). Additionally, we compared the surgical treatment group with the conservative treatment group.ResultsThe primary entry was found in the ascending aorta in 51.6% of the elderly group and in 32.8% of the non-elderly group (p= 0.049). In the elderly group, ascending or hemiarch replacement was performed in all cases, while in the non-elderly group, ascending or hemiarch replacement was performed in 57.3% (p<0.001). The hospital mortality was similar in both groups. The 5-year survival rate was 48.4±10.3% in the elderly group and 86.7±2.9% in the non-elderly group (p<0.001). The rates of freedom from aortic event at 5 years was 86.9±8.7% in the elderly group and 86.5±3.9% in the non-elderly group (p=0.771). The 5-year survival rate of conservative treatment group was 19.2±8.0% in the elderly. There was no significant difference from the surgical treatment group (p=0.103).ConclusionsThe surgical approach may not always be the reasonable treatment of choice for the elderly because the significant survival merit was not achieved compared with the conservative approach.

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Impact of Different Aortic Entry Tear Sites on Early Outcomes and Long-Term Survival in Patients with Stanford A Acute Aortic Dissection

Cited by 5 publications

References 20 publications

Clinical outcomes of limited repair and conservative approaches in older patients with acute type A aortic dissection

Clinical outcomes of limited repair and conservative approaches in older patients with acute type A aortic dissection

Regional variation in biomechanical properties of ascending thoracic aortic aneurysms

Clinical Outcomes of Limited-repair Strategy and Conservative Approach for the Elderly With Acute Type A Aortic Dissection

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