Predictors for outcome in type A aortic dissection: A focus on false lumen

Santamaria, Valeria; Schirone, Leonardo; Vinciguerra, Mattia; Bellis, Antonio De; Greco, Ernesto

doi:10.1016/j.circv.2020.10.010

Cited by 3 publications

(4 citation statements)

References 20 publications

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“…Of the two studies that did not publish Kaplan-Meier curves for survival, Chen and colleagues reported no significant differences between male and female patients in all-cause mortality [35.3% vs. 34.7%; odds ratio (OR), 0.99; 95% CI: 0.88, 1.10] across a mean follow up of 2.8±2.7 years ( 17 ). Meanwhile, Santamaria and colleagues reported worse long-term survival in female patients (47% vs. 24%, P=0.005) across a mean follow-up of 3.25±3 years ( 29 ).…”

Section: Resultsmentioning

confidence: 99%

“…Across the 15 included studies, there were 7,608 male and 3,989 female patients. Of these, 12 reported single-center retrospective data (10,11,19,(26)(27)(28)(29)(30)(31)(32)(33)(34), one reported multi-center data 35, and two reported on large multi-center national or international datasets (9,17). A total of 13 studies published Kaplan-Meier curves for survival (9)(10)(11)19,(26)(27)(28)(30)(31)(32)(33)(34)(35) and four studies published curves for reoperation (9,17,19,28) and were subsequently included in the respective pooled Kaplan-Meier analyses.…”

Section: Quantity and Quality Of Evidencementioning

confidence: 99%

“…The NOS evaluation is displayed in Table 2. Nine of 16 studies included were scored eight or nine points suggesting they have good quality (9,11,17,19,(26)(27)(28)(29)32). Three studies scored less than six points which was due to no description of comparability of cohorts, or lack of information about the method for outcomes ascertainment and assessment (10,30,33).…”

Section: Quantity and Quality Of Evidencementioning

confidence: 99%

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Sex differences in long-term outcomes following surgery for acute type A aortic dissection: a systematic review and meta-analysis

Bhatt,

Rocha,

Foroutan

et al. 2023

Ann Cardiothorac Surg

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Background Recent reports on sex differences in long-term outcomes after surgery for acute type A aortic dissection (ATAAD) are conflicting. We aimed to aggregate updated data on long-term survival and reoperation stratified by sex. Methods A literature search was conducted using Medline, Embase, and Cochrane Central. Studies reporting sex-stratified long-term survival and/or reoperation following surgery for ATAAD between January 1, 2000, to March 15, 2023 were included. Preoperative characteristics, intraoperative variables, and early perioperative outcomes were meta-analyzed using a random effects model and pooled risk ratio (RR) with men as the reference group. Individual patient-level data for long-term outcomes was reconstructed to generate sex-specific pooled Kaplan-Meier curves to assess long-term survival and freedom from reoperation. Results A total of 15 studies with 7,608 male and 3,989 female patients were included in this analysis. Female patients were older, had higher rates of hypertension, and had less previous cardiac surgery. Intraoperatively, women received less extensive repairs with lower rates of aortic valve replacement and total arch replacement, and higher rates of hemiarch replacement. There were no sex differences for in-hospital/30-day mortality [risk ratio (RR), 1.18; 95% confidence interval (CI): 0.96, 1.45; P=0.12], stroke (RR, 1.07; 95% CI: 0.90, 1.28; P=0.46), and early reoperation (RR, 0.90; 95% CI: 0.75, 1.09; P=0.28). Female patients had lower long-term survival overall (P<0.001) and amongst survivors at 1-year (P=0.014). Overall survival at 5-year was 82.4% in men and 78.1% in women, and at 10-year was 68.1% for men and 63.4% in women. Male patients had higher rates of long-term reoperation (P<0.001). Freedom for reoperation at 5-year was 88.4% in men vs. 93.1% in women. Conclusions Though perioperative early outcomes have equalized between the sexes following surgery for ATAAD, differences remain in long-term survival and reoperation.

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Section: Resultsmentioning

confidence: 99%

Section: Quantity and Quality Of Evidencementioning

confidence: 99%

Section: Quantity and Quality Of Evidencementioning

confidence: 99%

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Sex differences in long-term outcomes following surgery for acute type A aortic dissection: a systematic review and meta-analysis

Bhatt,

Rocha,

Foroutan

et al. 2023

Ann Cardiothorac Surg

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“…Suzuki et al (31) reported that younger age, greater diameter of the descending aorta, nonprescription of beta-blockers and primary entry in the ascending aorta were the significant predictors of patent descending aorta false lumen. Santamaria et al (32) reported the dramatic importance of aortic diameter in determining the time for complete thrombosis of the false lumen, where a larger preoperative diameter of the ascending aorta is associated with chronic partial thrombosis and a larger preoperative diameter of the descending aorta is associated with a longer time for complete thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Pursuit of the Changes of the Descending Aortic False Lumen after Surgical Repair of Acute DeBakey Type 1 Aortic Dissection

2024

The Egyptian Journal of Hospital Medicine

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Background: After surgical repair of acute DeBakey type 1 aortic dissection (AIAD), most survivors suffer from persistent false lumen in the descending aorta that adversely affects the long-term prognosis, and the need for secondary intervention is prompted. Objective: This study was aimed at providing control data to determine the actual benefits of more aggressive or newer approaches by investigating the changes in the descending aortic false lumen over 1-year follow-up. Patients and Methods: This retrospective study included 83 patients with AIAD ± significant aortic incompetence (AI). On emergency basis, all the patients had undergone aggressive resection of the intimal tear and replacement of the ascending aorta ± proximal or total aortic arch replacement, and aortic valve (AV) repair, replacement, valve sparing re-implantation of the AV or composite replacement of the aortic root (depending on the encountered pathology). Multi-slice CT aortography (MSCT) at 6-months and 1-year was done for segmental analysis of the distal aortic diameter at fixed levels and false lumen status evaluation. Results: The mean age was 47.18±4.87 years. Mortality was 8(9.64%) intraoperatively, 10(12.05%) operative mortality, no late mortality and the overall 1-year survival rate was 65(78.31%). The overall hospital complications rate was 17(22.67%). The descending aortic false lumen remained patent in most [56(86.15%)] survivors. There was no dilatation of the descending aorta at 6-months. At 1-year, there was statistically significant (p<0.001) dilatation of the descending aorta of >10 mm in 24(42.86%) and <10 mm in 32(57.14%) in patients with persistent false lumen. Patients <40 years expressed statistically significant (p<0.001) total resolution of the false lumen and >10 mm dilatation of the descending aorta. Multivariable logistic regression analysis showed that the significant predictive risk factors for persistence of the false lumen in the descending aorta were age <50 year (OR: 3.10 (95% CI: 0.846-19.320); p= 0.041), Bentall operation (OR: 0.35 (95% CI: 0.026-2.087); p= 0.021) and long-term anticoagulation (OR: 0.19 (95% CI: 0.025-1.289); p= 0.043), and those for thrombosis of the false lumen were age >60 years (OR: 6.13 (95% CI: 5.123-34.162); p= 0.031) and valve-sparing aortic root reconstruction (OR: 4.23 (95% CI: 1.480-14.053); p= 0.007). Conclusion: Residual intimal tear in the distal descending aorta is the major cause of continued false lumen patency. More extensive aortic replacement and avoidance of surgical reconstruction procedures needing long-term anticoagulation could diminish the prevalence of patent false lumen and its adverse sequelae.

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Direct aortic cannulation, a safe alternative to femoral artery cannulation - 17 years of type A dissection surgery experience

Somers,

Li,

Jongenotter

et al. 2024

Vessel Plus

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Aim: Optimal cannulation strategy for acute type A aortic dissection (ATAAD) surgery remains debated. Recent guidelines have advocated antegrade systemic perfusion through right axillary artery (RAX) cannulation, instead of femoral artery (FA) cannulation. However, RAX cannulation can be technically challenging and time-consuming. On the other hand, direct (ascending) aorta (DA) cannulation is a swift procedure that also ensures downstream antegrade flow. In this regard, we assessed whether DA cannulation is a safe alternative to FA cannulation. Methods: Records of all patients undergoing ATAAD surgery between 2006-2022 at the Radboud University Medical Center were retrospectively reviewed. Results: In total, 281 patients underwent surgery for ATAAD during the investigated period. Three patients were excluded due to death before the start of extracorporeal circulation and four because of RAX cannulation. Of the remaining 274 patients, 53% (N = 145) received primary FA and 47% (N = 129) DA cannulation, with a success rate of 98% for both approaches. Surgical mortality (combined in-hospital and 30-day) was 9.9% (7.8% DA group vs. 11.7% FA group, P = 0.271). New permanent neurological damage was seen in 10.9% vs. 6.9% (P = 0.248), respectively. In multivariate analysis, cannulation strategies were not significantly associated with surgical mortality nor postoperative new permanent neurological damage. Conclusion: DA cannulation offers a safe and fast alternative to FA cannulation in ATAAD surgery. There were no significant differences in mortality and neurological complications. Future studies should focus on the differences between RAX and DA cannulation strategies on postoperative outcomes in ATAAD surgery.

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Predictors for outcome in type A aortic dissection: A focus on false lumen

Cited by 3 publications

References 20 publications

Sex differences in long-term outcomes following surgery for acute type A aortic dissection: a systematic review and meta-analysis

Sex differences in long-term outcomes following surgery for acute type A aortic dissection: a systematic review and meta-analysis

Pursuit of the Changes of the Descending Aortic False Lumen after Surgical Repair of Acute DeBakey Type 1 Aortic Dissection

Direct aortic cannulation, a safe alternative to femoral artery cannulation - 17 years of type A dissection surgery experience

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