Analysis of early and long-term outcomes of acute type A aortic dissection according to the new international aortic arch surgery study group recommendations

Colli, Andrea; Carrozzini, Massimiliano; Galuppo, Marco; Comisso, Marina; Toto, Francesca; Gregori, Darío; Gerosa, Gino

doi:10.1007/s00380-015-0770-1

Cited by 13 publications

(8 citation statements)

References 36 publications

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“…In addition to our findings Colli and colleagues stated that the incidence of postoperative complications of patients with Stanford A AAD was related to older age and longer cross-clamp time. 35 In their 33-year follow up Russo and colleagues focused on early and especially long-term outcomes of patients suffering from Stanford A AAD comparable to our results for a 9-year follow up. 36 In addition, he found severe aortic regurgitation at the time of surgery to be a significant risk factor for reintervention during follow up suggesting the need for a thorough debate on surgical options and assessment.…”

Section: Discussionsupporting

confidence: 76%

“…Latest studies published by Colli and colleagues in 2018 and 2016 34,35 and by Russo and colleagues 37 revealed that despite substantial progress in surgical techniques and perioperative management, the best surgical approach for patients suffering from Stanford A dissection is still controversial and outcomes highly dependent on perioperative risk factors.…”

Section: Discussionmentioning

confidence: 99%

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Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection

Merkle

Sabashnikov

Deppe

et al. 2018

Therapeutic Advances in Cardiovascular Disease

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Background: Stanford A acute aortic dissection (AAD) is a life-threatening emergency associated with major morbidity and mortality. The aim of this study was to compare outcomes of three different surgical approaches in patients with Stanford A AAD. Methods: From January 2006 to March 2015 a total of 240 consecutive patients with diagnosed Stanford A AAD underwent elective, isolated surgical aortic repair in our centre. Patients were divided into three groups according to the extent of surgical repair: isolated replacement of the ascending aorta, hemiarch replacement and total arch replacement. Patients were followed up for up to 9 years. After univariate analysis multinomial logistic regression was performed for subgroup analysis. Baseline characteristics and endpoints as well as long-term survival were analysed. Results: There were no statistically significant differences among the three groups in terms of demographics and preoperative baseline and clinical characteristics. Incidence of in-hospital stroke (p = 0.034), need for reopening due to bleeding (p = 0.031) and in-hospital mortality (p = 0.017) increased significantly with the extent of the surgical approach. There was no statistical difference in terms of long-term survival (p = 0.166) among the three groups. Applying multinomial logistic regression for subgroup analysis significantly higher odds for stroke (p = 0.023), reopening for bleeding (p = 0.010) and in-hospital mortality (p = 0.009) for the arch surgery group in comparison to the ascending aorta surgery group as well as significantly higher odds for stroke (p = 0.029) for the total arch surgery group in comparison to the hemiarch surgery group were identified. Conclusions: With Stanford A AAD the incidence of perioperative complications increased significantly with the extent of the surgical approach. Subgroup analysis and long-term follow up in patients undergoing isolated ascending or hemiarch surgery showed a lower incidence of cerebrovascular events compared with surgery for total arch replacement.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection

Merkle

Sabashnikov

Deppe

et al. 2018

Therapeutic Advances in Cardiovascular Disease

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“…Our total follow-up was more than 30 years longer and the survival rate was higher. In addition, the perioperative and initial 30-day mortality of aortic dissections are also comparable with a previous study [ 17 ].…”

Section: Discussionsupporting

confidence: 84%

Early and late outcomes after open ascending aortic surgery: 47-year experience in a single centre

et al. 2017

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The aims of the study are to describe the long-term survival of patients undergoing primary open ascending aortic surgery and to portray the evolution of aortic surgery during six decades in a single centre. Included were all 614 patients who underwent primary ascending aortic surgery in 1968–2014 at one Nordic university hospital. Patients were identified and data were collected from patient records and surgical logs. Mortality data were acquired from the national registry. Median follow-up was 11.2 years using reverse Kaplan–Meier method. Overall 30-day survival was 91.2% and for 30-day survivor rates were 86.9, 77.6, 52.1, 38.3 and 26.7% at 5, 10, 20, 30 and 40 years. There was no significant difference in long-term survival for 30-day survivors (p = 0.105) between patients treated emergently for dissection/rupture and electively (mainly ascending aortic aneurysms). On Cox regression era of surgery (p = 0.006), increasing age (p < 0.001) and indication (p < 0.001) were predictors of 30-day mortality. Arch involvement indicated twofold risk (HR 2.09, p = 0.05) compared to non-arch involved. Only increasing age (p < 0.001) predicted long-term mortality. There was a sixfold risk of 30-day mortality in the earliest era compared to the latest (p = 0.03). After the early postoperative phase following ascending aortic surgery, the surgical indication and urgency of the index operation have no significant impact on long-term survival. The very long term survival after ascending aortic surgery is excellent for 30-day survivors and improved through the era. Surgical treatment has improved and perioperative mortality has decreased significantly in 47 years.

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“…Within our cohort younger age and Marfan syndrome were identified as risk factors for redo operation. The estimated 5-year survival within our cohort was 78% after redo operation and is comparable to the results of recent publications [25, 26]. The question for the best AVS technique in AADA, Yacoub or David technique, has not been answered yet.…”

Section: Discussionsupporting

confidence: 84%

Extensive aortic surgery in acute aortic dissection type A on outcome – insights from 25 years single center experience

Dib

Seppelt

Arif

et al. 2019

J Cardiothorac Surg

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BackgroundThis single center study compares the different surgical techniques used in the treatment of acute aortic dissection type A (AADA) analyzing the influence of the extent of the surgical approach on outcome.MethodsFrom 1988 to 2012, 407 patients were operated for AADA. The cohort was divided into subgroups according to the surgical approach. These groups were compared with the supracommissural replacement group (SCR; n = 141). Groups included aortic valve sparing techniques (AVS; n = 29), Composite replacement (COMP; n = 119), COMP with total arch replacement (COMP+TAR; n = 27) and SCR with TAR (n = 75).ResultsCompared to SCR alone, operation (p = 0.005), bypass-, cross-clamp and circulatory arrest times were longer in SCR + TAR (all p < 0.001). Moreover, operation, bypass and cross clamp times were longer in COMP+TAR (p = 0.003, p = 0.002 and p < 0.001 respectively). COMP alone and AVS required longer cross-clamp time, too (p < 0,001 and p = 0.002, respectively). Overall 30-day mortality was 21% with the observed lowest rate after AVS (14%, SCR 18%, COMP 25%) but differences in 30-day mortality were not statistically significant. The estimated 10-year survival was 42%, especially AVS demonstrated a good 10-year survival (69%). David technique was superior to Yacoub technique concerning incidence of redo interventions (p = 0.036). Risk factors for early mortality included age, circulatory arrest, general malperfusion, bypass and operation time. Circulatory arrest per se was revealed as risk factor for long-term survival.ConclusionsWithin our single center retrospective study concomitant aortic root repair or aortic arch replacement for AADA demonstrated acceptable early and long-term survival. Circulatory arrest, long bypass and operation times per se might be important risk factors for early mortality. AVS techniques can be performed safely and have good outcomes in acute aortic dissection repair.

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Analysis of early and long-term outcomes of acute type A aortic dissection according to the new international aortic arch surgery study group recommendations

Cited by 13 publications

References 36 publications

Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection

Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection

Early and late outcomes after open ascending aortic surgery: 47-year experience in a single centre

Extensive aortic surgery in acute aortic dissection type A on outcome – insights from 25 years single center experience

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