Late Outcome after Surgery for Type-A Aortic Dissection

Abstract

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.

Incidence and Transition of Acute Kidney Injury, Acute Kidney Disease to Chronic Kidney Disease after Acute Type A Aortic Dissection Surgery

“…Acute type A aortic dissection (type A AAD) is a medical emergency with high in-hospital mortality ranging from 22 to 31% [ 1 , 2 , 3 ]. Postoperative acute kidney injury (AKI) is a common complication with a high odds ratio of 3.49 for 30-day mortality after operation [ 4 ].…”

Progression of aortic root based on long‐term imaging studies after acute type A dissection repair

“…The pervasive idea among many surgeons is that the rate of reoperation of the thoracic aorta after initial repair/replacement reflects progression/reoccurrence of aortic pathology, such as root aneurysm. 2,6,7 However, as shown in our study, the reoperation rate may not truly reflect the progression of the aortic root after ATAAD repair because patients may not have had reoperation for various reasons such as minimal growth of their aortic aneurysm or high mortality risk precluding them from reoperation, among others. Also, some patients could have had reoperation at out-of-network hospitals thus impacting the true reoperation rate at index hospital.…”

“…[1][2][3] However, patients with ATAAD have a risk of developing aortic root aneurysm or coronary button aneurysms after aortic root repair or replacement, especially those with connective tissue disease. 4,5 Most studies use the reoperation rate to reflect the progression of the aortic root, 2,6,7 however, this may not truly reflect the progression of the aortic root after ATAAD repair. Patients may not have had reoperation for many reasons including preoperative mortality risk, patient preference, among others.…”

A systematic review and meta-analysis of retrograde type A aortic dissection after thoracic endovascular aortic repair in patients with type B aortic dissection

“…Early RTAD or early mortality was considered if occurred within the first 3 months from the TEVAR procedure, while late RTAD or late mortality occurred after 3 months from the TEVAR procedure. [ 23 , 24 ]…”