Long-Term Results After Repair of Type A Acute Aortic Dissection According to False Lumen Patency

Fattouch, Khalil; Sampognaro, Roberta; Navarra, Emiliano; Caruso, Marco; Pisano, Calogera; Coppola, Giuseppe; Saglio, Giuseppe; Ruvolo, Giovanni

doi:10.1016/j.athoracsur.2009.06.055

Cited by 209 publications

(169 citation statements)

References 23 publications

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“…Second, WATAS data stem from only two tertiary care centers with limited patient numbers, and more data appear mandatory to underpin study results. Further, WATAS identified an aortic cause of death in 13% of late deaths, which was in line with 12% (33) and 24% (32) reported in the literature. However, the cause of death remained unknown in a large number of fatalities.…”

Section: Limitationssupporting

confidence: 72%

“…Interestingly, WATAS identified a univariate association of male sex with late aortic events, where another study confirmed such univariate association of male sex with late aortic reoperation after AAAD repair (31). Finally, WATAS identified a marginal association of Marfan syndrome with late aortic events, but other studies established Marfan syndrome as an independent predictor of late aortic events (22,32). In sum, besides novel predictors, WATAS corroborated classical predictors of late death and late aortic events in AAAD.…”

Section: Other Clinical Predictors Of Late Outcomesupporting

confidence: 58%

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Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Kodolitsch¹,

Wilson²,

Schuler³

et al. 2017

Cardiovasc. Diagn. Ther.

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Background: Early survivors of acute type A aortic dissection (AAAD) remain at risk for late death and late aortic events. However, the frequency and long-term effects of warfarin anticoagulation on long-term outcome in post-surgical AAAD survivors have not been elucidated. Methods:Two tertiary care centers performed a retrospective observational cohort study of warfarin anticoagulation in AAAD in 243 persons with early survival of surgical repair (WATAS). Serial postoperative tomographic imaging was available in 106 persons.Results: A total of 88 postoperative AAAD survivors (36%) were on long-term warfarin anticoagulation.The indication for anticoagulation was a mechanical aortic prosthesis in 46 (52%), atrial fibrillation in 33 (38%), stroke in 7 (8%), and pulmonary embolism in 1 (1%). The indication for anticoagulation remained unclear in 1 person (1%). Survival and aortic event free survival were 98.3±0.01 and 98.7±0.01 at 1 year, and 76.4±0.03 and 91.8±0.02 at 5 years, respectively, with no differences irrespective of warfarin anticoagulation. Multivariate Cox regression analysis established higher age (P<0.001), and operation extending into the descending aorta (P=0.030) as independent predictors of late death. Follow-up without tomographic imaging independently predicted increased long-term mortality (P<0.001) and lower rates of documented aortic events (P=0.003). Kaplan-Meyer analysis showed a relationship of aortic diameter growth ≥0.5 cm per year with late death (P=0.041) and with late aortic events (P<0.001). However, rapid aortic growth did not relate to warfarin anticoagulation.Conclusions: Warfarin anticoagulation is frequent in postsurgical AAAD and it is administered for vital indications. Warfarin anticoagulation does not relate to late mortality or to late aortic events. Rapid aortic growth predicts late mortality and late aortic events, but warfarin anticoagulation is not associated with aortic growth. Follow-up tomographic imaging is mandatory for long-term survival after surgical repair of AAAD. von Kodolitsch et al. Warfarin in aortic dissection

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Section: Limitationssupporting

confidence: 72%

Section: Other Clinical Predictors Of Late Outcomesupporting

confidence: 58%

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Kodolitsch¹,

Wilson²,

Schuler³

et al. 2017

Cardiovasc. Diagn. Ther.

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“…Avoidance of a valve replacement, in the setting of normal cusps, significantly reduces the likelihood of reintervention on the aortic valve or the need for lifelong anticoagulation, as is the case with implantation of a bioprosthetic or mechanical valve. The elimination of anticoagulation in patients with TAAD may promote false lumen thrombosis, reduce the need for reintervention on the distal aorta, and improve long-term survival (2,3).…”

Section: Aortic Root Repairmentioning

confidence: 99%

When and how to replace the aortic root in type A aortic dissection

Leshnower

Chen

2016

Ann. Cardiothorac. Surg.

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Management of aortic root pathology during repair of acute type A aortic dissection (TAAD) requires a comprehensive evaluation of the patient's anatomy, demographics, comorbidities and physiologic status at the time of emergent operative intervention. Surgical options include conservative repair of the root (CRR) (with or without replacement of the aortic valve), replacement of the native valve and aortic root using a composite valve-conduit and valve sparing root replacement (VSRR). The primary objective of this review is to provide data for surgeons to aid in their decision-making process regarding management of the aortic root during repair of TAAD. No time or language restrictions were imposed and references of the selected studies were checked for additional relevant citations. Multiple retrospective reviews have demonstrated equivalent operative mortality between aortic root repair and replacement during TAAD. There is a higher incidence of aortic root reintervention with aortic root repair compared to aortic root replacement (ARR). Experienced, high-volume aortic centers have demonstrated the safety of VSRR in young, hemodynamically stable patients presenting with TAAD. In conclusion, aortic root repair can safely be performed in the vast majority of patients with TAAD. Despite the increased surgical complexity, ARR does not increase operative mortality and improves the freedom from root reintervention. VSRR can be performed in highly selected populations of patients with TAAD with durable mid-term valve function.

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“…7) The late reoperations are related to the fate of residual dissection of the arch or thoracoabdominal aorta and residual false lumen patency due to proximal unresected intimal tears and reentry in the distal aorta. 8) The effectiveness of TEVAR procedure using stent-graft to cover-seal the proximal entry and induce favorable aortic remodeling in type B dissection is well demonstrated. 9,10) The stent-graft enhanced the true lumen re-expansion and promoted the false lumen thrombosis and regression in proportion to the extent of stentgraft coverage over the descending aorta.…”

Section: Discussionmentioning

confidence: 99%

Initial Experience of Modified Four-Branched Graft Technique and Antegrade TEVAR in Acute Type A Aortic Dissection

Chou

Lo²,

Chua³

et al. 2015

ATCS

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IntroductionTotal aortic arch repair represents a high-risk operation and may compromise the surgical decision due to the increased mortality and cerebral complications. The arch first technique with retrograde cerebral perfusion or selective antegrade cerebral perfusion was introduced to extend the safety period from cerebral ischemia during deep hypothermic circulatory arrest. However, profound hypothermia prolonged the myocardial ischemic time and cardiopulmonary bypass (CPB) time, and induced coagulopathy which resulted in deteriorated myocardial function, end-organs dysfunction and excessive postoperative bleeding, 1) and the complex manipulation of antegrade cerebral perfusion may release debris from endo-clamping or snaring of arch vessels and the clustered tubes interrupted the operative field. Our modified four-branched graft technique for arch surgery had been reported in 2012, with advantages to evade selective antegrade cerebral perfusion and deep hypothermia.

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Long-Term Results After Repair of Type A Acute Aortic Dissection According to False Lumen Patency

Cited by 209 publications

References 23 publications

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

When and how to replace the aortic root in type A aortic dissection

Initial Experience of Modified Four-Branched Graft Technique and Antegrade TEVAR in Acute Type A Aortic Dissection

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