Survival and reinterventions after isolated proximal aortic repair in acute type A aortic dissection

Dohle, Daniel-Sebastian; Beyrouti, Hazem El; Brendel, L.; Pfeiffer, P.; El-Mehsen, Mohammed; Vahl, Christian‐Friedrich

doi:10.1093/icvts/ivz011

Cited by 14 publications

(7 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ATAAD can be divided into DeBakey type I (D1) and type II (D2) based on whether the dissected aorta is confined to the ascending portion only or extends to the aortic arch and descending aorta. In previous studies, D1-AAD was usually associated with inferior survival rates and a higher aortic reintervention probability compared to D2-AAD [ 6 , 7 ]. However, disparities in regard to clinical presentation, preoperative condition, and aortic repair procedures commonly exist between patients with D1-AAD and D2-AAD owing to the different complexities of aortic anatomy and involved end-organs.…”

Section: Introductionmentioning

confidence: 99%

Surgical outcomes of DeBakey type I and type II acute aortic dissection: a propensity score-matched analysis in 599 patients

Lin

Tung

et al. 2021

J Cardiothorac Surg

View full text Add to dashboard Cite

Background The DeBakey classification divides Stanford acute type A aortic dissection (ATAAD) into DeBakey type I (D1) and type II (D2) according to the extent of acute aortic dissection (AAD). This retrospective study aimed to compare the early and late outcomes of D1-AAD and D2-AAD through a propensity score-matched analysis. Methods Between January 2009 and April 2020, 599 consecutive patients underwent ATAAD repair at our institution, and were dichotomized into D1 (n = 543; 90.7%) and D2 (n = 56; 9.3%) groups. Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 56 patients per group. The clinical features, postoperative complications, 5-year cumulative survival and freedom from reoperation rates were compared. Results In the overall cohort, the D1 group had a lower rate of preoperative shock and more aortic arch replacement with longer cardiopulmonary bypass time. The D1 group had a higher in-hospital mortality rate than the D2 group in overall (15.8% vs 5.4%; P = 0.036) and matched cohorts (19.6% vs 5.4%; P = 0.022). For patients that survived to discharge, the D1 and D2 groups demonstrated similar 5-year survival rates in overall (77.0% vs 85.2%; P = 0.378) and matched cohorts (79.1% vs 85.2%; P = 0.425). The 5-year freedom from reoperation rates for D1 and D2 groups were 80.0% and 97.1% in overall cohort (P = 0.011), and 93.6% and 97.1% in matched cohort (P = 0.474), respectively. Conclusions Patients with D1-AAD had a higher risk of in-hospital mortality than those with D2-AAD. However, for patients who survived to discharge, the 5-year survival rates were comparable between both groups.

show abstract

Section: Introductionmentioning

confidence: 99%

Surgical outcomes of DeBakey type I and type II acute aortic dissection: a propensity score-matched analysis in 599 patients

Lin

Tung

et al. 2021

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…Furthermore, most studies demonstrated that aortic arch repair with or without the use of frozen elephant trunk technique seems not to decrease the risk of distal aortic reoperation [ 6 , 7 , 8 , 9 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], whose freedom rates at 10 years may range from 78.0% to 92.9% [ 17 , 21 ]. We recognize that there are also studies from series including mostly ascending aorta/hemiarch repairs reporting 10-year freedom from reoperation as low as 61% to 78% [ 15 , 23 ], and decreased aortic reoperations after total arch replacement [ 15 , 24 ]. Still, the present findings suggested that a strategy of primary surgical repair limited to the aortic segment involving the intimal tear was associated with a rather low operative mortality without having jeopardized the durability of the aortic repair.…”

Section: Discussionmentioning

confidence: 99%

Late Outcome after Surgery for Type-A Aortic Dissection

Jormalainen

Raivio

Biancari

et al. 2020

JCM

View full text Add to dashboard Cite

The aim of this study was to evaluate all-cause mortality and aortic reoperations after surgery for Stanford type A aortic dissection (TAAD). We evaluated the late outcome of patients who underwent surgery for acute TAAD from January 2005 to December 2017 at the Helsinki University Hospital, Finland. We studied 309 patients (DeBakey type I TAAD: 89.3%) who underwent repair of TAAD. Aortic root repair was performed in 94 patients (30.4%), hemiarch repair in 264 patients (85.4%) and partial/total aortic arch repair in 32 patients (10.4%). Hospital mortality was 13.6%. At 10 years, all-cause mortality was 34.9%, and the cumulative incidence of aortic reoperation or late aortic-related death was 15.6%, of any aortic reoperation 14.6%, reoperation on the aortic root 6.6%, on the aortic arch, descending thoracic and/or abdominal aorta 8.7%, on the descending thoracic and/or abdominal aorta 6.4%, and on the abdominal aorta 3.8%. At 10 years, cumulative incidence of reoperation on the distal aorta was higher in patients with a diameter of the descending thoracic aorta ≥35 mm at primary surgery (cumulative incidence in the overall series: 13.2% vs. 4.0%, SHR 3.993, 95%CI 1.316–12.120; DeBakey type I aortic dissection: 13.6% vs. 4.5%, SHR 3.610, 95%CI 1.193–10.913; patients with dissected descending thoracic aorta: 15.8% vs. 5.9%, SHR 3.211, 95%CI 1.067–9.664). In conclusion, surgical repair of TAAD limited to the aortic segments involved by the intimal tear was associated with favorable survival and a low rate of aortic reoperations. However, patients with enlarged descending thoracic aorta at primary surgery had higher risk of late reoperation. Half of the distal aortic reinterventions were performed on the abdominal aorta.

show abstract

“…Currently, 80% to 90% of type A aortic dissection (TAAD) patients who make it to the hospital, survive the first 30 days following repair 1,2 . More than 10% of these patients will require surgical reintervention during follow‐up, most commonly due to adverse remodeling and dilation of the false lumen (FL) 3–5 . Recent registry data have shown that thoracic endovascular aortic repair (TEVAR) in the subacute phase following aortic dissection (2 weeks to 3 months) yields a lower mortality rate and significantly larger degree of positive aortic remodeling compared with endovascular repair in the chronic phase 6 .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 More than 10% of these patients will require surgical reintervention during follow-up, most commonly due to adverse remodeling and dilation of the false lumen (FL). [3][4][5] Recent registry data have shown that thoracic endovascular aortic repair (TEVAR) in the subacute phase following aortic dissection (2 weeks to 3 months) yields a lower mortality rate and significantly larger degree of positive aortic remodeling compared with endovascular repair in the chronic phase. 6 This difference has been attributed to thickening and stiffening of the intimal flap over time, 7 increasing the risk of endograft related complications.…”

Section: Introductionmentioning

confidence: 99%

Critical appraisal of multidimensional CT measurements following acute open repair of type A aortic dissection

et al. 2020

View full text Add to dashboard Cite

Introduction To identify patients with aneurysmal degeneration of the native aorta following type A aortic dissection (TAAD), reproducible serial measurements of aortic dimensions are critical. We used a systematic workflow for measuring aortic geometry following TAAD, using computed tomography angiography data, and test its reproducibility. Methods The workflow for aortic measurements included centerline generation, luminal diameter, and area measurement at six anatomically defined locations along the aorta and luminal volumetric measurements in the descending aorta. Two independent observers measured the aortic geometry in 20 surgically repaired TAAD patients, preoperatively and at 3 months follow‐up. To test reproducibility, intraobserver and interobserver agreement scores were analyzed using a concordance correlation coefficient (CCC). Results The interobserver agreement scores of the diameter, area, and volumetric measurements in the descending aorta were acceptable. The agreement scores of the area measurements were highest, with CCCs ranging from 0.909 to 0.984. Luminal diameter measurements scored lower than luminal area measurements and were least reproducible at the mid aortic arch (CCC < 0.886). Overall, intraobserver agreement scores were better than interobserver agreement scores (SD of mean difference was 1.89 vs 1.94 for intraobserver vs interobserver diameter measurements, and 0.61 vs 0.66 for area measurements). Conclusion Although overall reproducibility was acceptable in descending aortic measurements, our results show that it remains challenging to reliably measure luminal diameters, compared with areas. To aid identification of early adverse remodeling following acute TAAD, novel two‐ and three‐dimensional measurement techniques are needed that capture locoregional changes in the false lumen and true lumen morphology more accurately.

show abstract

Survival and reinterventions after isolated proximal aortic repair in acute type A aortic dissection

Cited by 14 publications

References 23 publications

Surgical outcomes of DeBakey type I and type II acute aortic dissection: a propensity score-matched analysis in 599 patients

Surgical outcomes of DeBakey type I and type II acute aortic dissection: a propensity score-matched analysis in 599 patients

Late Outcome after Surgery for Type-A Aortic Dissection

Critical appraisal of multidimensional CT measurements following acute open repair of type A aortic dissection

Contact Info

Product

Resources

About