Early and midterm outcomes of hemiarch replacement combined with stented elephant trunk in the management of acute DeBakey type I aortic dissection: Comparison with total arch replacement

Shi, Enyi; Gu, Tingting; Yu, Yang; Yu, Lei; Wang, Chun; Qin, Fang; Zhang, Yuhai

doi:10.1016/j.jtcvs.2013.10.058

Cited by 45 publications

(39 citation statements)

References 30 publications

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“…Whether or not, and to what extent the aortic arch should be replaced is an ongoing debate. Current evidence indicates that the dissection process frequently extends through the arch in most patients and that an aortic arch repair is warranted (23 (10,12,16). If the tear is localized in the root, ascending or proximal aorta, hemiarch replacement is usually adequate to save a patient life.…”

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

show abstract

“…Existing studies comparing extensive and limited index repair for acute type A dissection have yielded conflicting results and recommendations, likely due to heterogeneous patient populations and diverse clinical profiles. Some studies have shown comparable mortality rates between limited and extensive index repair, whereas others have reported higher operative risk associated with extensive repair . Specifically, the reported 30‐day or in‐hospital mortality of extensive repair ranges widely from 4.7% to 29% .…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, the reported 30‐day or in‐hospital mortality of extensive repair ranges widely from 4.7% to 29% . In general, studies reporting lower mortality rates had younger patients (mean ages of 45, 46, and 54 years for the lowest mortality rates of 4.7%, 5.7%, and 5.9%, respectively), a known strong independent predictor of mortality . Most studies also had small numbers of patients who underwent extensive repair (range: 14–140), limiting the statistical power and generalizability of the results.…”

Section: Discussionmentioning

confidence: 99%

“…Arguments in favor of limited index repair primarily include lower surgical risk compared with extensive repair—the “live to fight another day” philosophy . In addition, some studies have suggested that limited repair has late outcomes similar to extensive repair, including the development of late aortic dilatation, need for reoperation, and overall survival . Arguments in favor of extensive index repair focus primarily on the potentially decreased need for late aortic reoperation, operations that are frequently viewed as complex and with much higher risks.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy

Wang

Wagner

Benrashid

et al. 2017

JAHA

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BackgroundThe optimal surgical approach for management of acute type A aortic dissection remains controversial. This study aimed to assess outcomes of reoperation after acute type A dissection repair to help guide decision making around index operative strategy.Methods and ResultsAll aortic reoperations (n=129) at a single referral institution from August 2005 to April 2016 after prior acute type A dissection repair were reviewed. The primary outcome was 30‐day or in‐hospital mortality. Secondary outcomes included organ‐specific morbidity and 1‐ and 5‐year outcomes as estimated using the Kaplan–Meier method. The majority of initial reoperations were proximal aortic (aortic valve, aortic root, or ascending) or aortic arch procedures (62.5%, n=55); most initial reoperations were performed in the elective setting (83.1%, n=74). Additional nonstaged second or more reoperations were required in 21 patients (23.6%) after the initial reoperation, during a median follow‐up of 2.5 years after the initial reoperation. Thirty‐day or in‐hospital mortality for all reoperations was 7.0% (elective: 6.3%; nonelective: 11.1%) with acceptable rates of organ‐specific morbidity, given the procedural complexity. One‐ and 5‐year overall survival after initial reoperation was 85.9% and 64.9%, respectively, with aorta‐specific survival of 88% at 5 years.ConclusionsReoperation after acute type A aortic dissection repair is associated with low rates of mortality and morbidity. These data support more limited index repair for acute type A dissection, especially for patients undergoing index repair in lower volume centers without expertise in extensive repair, because reoperations, if needed, can be performed safely in referral aortic centers.

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Ascending Aortic Dissection, Penetrating Aortic Ulcer, and Intramural Hematoma

Pinnelas

Vaishnava

Eagle

2019

Diseases of the Aorta

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Early and midterm outcomes of hemiarch replacement combined with stented elephant trunk in the management of acute DeBakey type I aortic dissection: Comparison with total arch replacement

Cited by 45 publications

References 30 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

Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy

Ascending Aortic Dissection, Penetrating Aortic Ulcer, and Intramural Hematoma

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