Early and late outcomes of repaired acute DeBakey type I aortic dissection after graft replacement

Omura, Atsushi; Miyahara, Shunsuke; Yamanaka, Katsuhiro; Sakamoto, Toshihito; Matsumori, Masamichi; Okada, Kenji; Okita, Yutaka

doi:10.1016/j.jtcvs.2015.03.068

Cited by 129 publications

(132 citation statements)

References 23 publications

(26 reference statements)

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“…We have excluded studies with an NOS score of less than seven due to risk of substantial bias. Our up to date search strategy resulted in six more key and balanced studies (12,(18)(19)(20)(21)(22) comparing conservative versus extensive arch replacement, resulting in comparison of 1,435 conservative hemiarch replacement and 786 extensive total arch replacement as opposed to 1,236 proximal and 646 extensive replacement in the earlier published review. The estimates provided by our review for long-term follow-up data are more robust due to inclusion of more follow-up studies and time-to-event analysis of freedom from aortic re-operation, in addition to initial published studies.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with an intimal tear localized along the greater curvature close to the supra-aortic vessels, total arch replacement was performed. Concomitant stent graft was deployed in eight studies (4,10,13,17,18,(20)(21)(22). In total arch replacement with frozen elephant trunk, the deployment of stent graft was described differently between studies.…”

Section: Surgical Techniquementioning

confidence: 99%

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Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

Poon

Theologou

Harrington

et al. 2016

Ann. Cardiothorac. Surg.

124

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Background: Despite recent advances in aortic surgery, acute type A aortic dissection remains a surgical emergency associated with high mortality and morbidity. Appropriate management is crucial to achieve satisfactory outcomes but the optimal surgical approach is controversial. The present systematic review and meta-analysis sought to access cumulative data from comparative studies between hemiarch and total aortic arch replacement in patients with acute type A aortic dissection.Methods: A systematic review of the literature using six databases. Eligible studies include comparative studies on hemiarch versus total arch replacement reporting short, medium and long term outcomes. A meta-analysis was performed on eligible studies reporting outcome of interest to quantify the effects of hemiarch replacement on mortality and morbidity risk compared to total arch replacement. There was no significant difference in terms of in-hospital mortality between the two groups (RR =0.84; 95% CI: 0.65-1.09; P=0.20; I 2 =0%). Cardiopulmonary bypass, aortic cross clamp and circulatory arrest times were significantly longer in total arch replacement. During follow up, no significant difference was reported from current studies between the two operative approaches in terms of aortic re-intervention and freedom from aortic reoperation.Conclusions: Within the context of publication bias by high volume aortic centres and non-randomized data sets, there was no difference in mortality outcomes between the two groups. This analysis serves to demonstrate that for those centers doing sufficient total aortic arch activity to allow for publication, excellent and equivalent outcomes are achievable. Conclusions on differences in longer term outcome data are required. We do not, however, advocate total arch as a primary approach by all centers and surgeons irrespective of patient characteristics, but rather, a tailored approach based on surgeon and center experience and patient presentation.

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

Poon

Theologou

Harrington

et al. 2016

Ann. Cardiothorac. Surg.

124

View full text Add to dashboard Cite

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“…This was due to a high proportion of patients who presented with lifethreatening complications, especially end stage organ malperfusion (P=0.03). This well-known bias has already been encountered in previous studies that proposed an extensive surgical repair of acute DeBakey I aortic dissection (13). On the other hand, the risk of devicerelated death, which remained rare in this series, might have been balanced by potentially life-saving stenting of the descending aorta (14,15).…”

Section: Discussionmentioning

confidence: 61%

Associated bare stenting of distal aorta with a Djumbodis® system versus conventional surgery in type A aortic dissection

Caus¹,

Сирота²,

Nader³

et al. 2016

Ann. Cardiothorac. Surg.

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Background: The effectiveness of additional stenting of the distal aorta as compared to conventional surgery alone in type A aortic dissection (TAD) has yet to be proven. Methods:We conducted this multicenter comparative study to evaluate the effects of antegrade bare stenting of the dissected aorta beyond the distal anastomosis with a Djumbodis ® device system (DDS).Outcomes that were measured included early outcomes, overall mortality from aortic cause and late aortic events including re-interventions. A consecutive series of 134 patients operated on in two participating centers were distributed into study and control groups according to the treatment received: conventional surgery with DDS (DJ group, n=42) or without (control group, n=92).Results: Operative mortality was 21.4% and 17.6% in the DJ and control groups, respectively (P=0.9), and was within pre-specified alarm lines for both groups. In multivariate analysis, the only independent predictor of operative mortality was the presence of any complication (cardiac tamponade or malperfusion, P=0.05), which occurred more in the DJ group (OR =1.3; non-significant). Sixty patients were included into the matched survivors cohorts study (propensity scoring). The aortic event-free survival at 7 years for early survivors was 77%±10% and 48%±11% in the matched DJ group and control group, respectively (HR =0.66). Late mortality from an aortic cause was 10% and 20% in the matched DJ group and control group, respectively (RR =0.5). Actuarial freedom from aortic or vascular interventions was 71%±10% and 67%±9% in the matched DJ and control group, respectively. Operative mortality was not influenced by the use of DDS as compared to conventional surgery alone for TAD. Conclusions:We observed a trend towards better organ perfusion in the DJ group postoperatively, and more aortic events and deaths of aortic cause in the control group during follow-up.

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“…A leading hospital treating aortic pathology reported that the mortality rate following type A AAD reached approximately 10% (5). Miscellaneous factors could contribute to improved outcomes, such as management of preoperative malperfusion syndrome, safe brain protection, and improved surgical skills.…”

Section: Surgical or Medical Outcomesmentioning

confidence: 99%

“…For patients with brain malperfusion secondary to type A AAD, case reports have described the successful use of a simple bypass circuit to maintain brain blood supply, with minimal postoperative neurologic sequelae (7). As a brain protection technique, the safety of antegrade cerebral perfusion during circulatory arrest has been verified (5,8). Endovascular repair techniques are not generally used in type A AAD.…”

Section: Surgical or Medical Outcomesmentioning

confidence: 99%

Evolution of diagnosis and clinical outcomes in acute aortic dissection: data from the International Registry of Acute Aortic Dissection

Fukunaga¹,

Koyama²

2016

J. Thorac. Dis.

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Early and late outcomes of repaired acute DeBakey type I aortic dissection after graft replacement

Cited by 129 publications

References 23 publications

Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

Associated bare stenting of distal aorta with a Djumbodis® system versus conventional surgery in type A aortic dissection

Evolution of diagnosis and clinical outcomes in acute aortic dissection: data from the International Registry of Acute Aortic Dissection

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