Outcomes of hemi- vs. total arch replacement in acute type A aortic dissection: A systematic review and meta-analysis

Ma, Likang; Chai, Tianci; Yang, Xiao‐Jun; Zhuang, Xinghui; Wu, Qingsong; Qiu, Zhihuang

doi:10.3389/fcvm.2022.988619

Cited by 9 publications

(4 citation statements)

References 32 publications

(19 reference statements)

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“…A meta‐analysis found that hemiarch replacement might have a lower early mortality rate, but the long‐term mortality rate was significantly higher in patients who underwent hemiarch replacement than in those underwent total arch surgery. 17 To adjust for the effects of other possible influencing factors, we conducted a univariable Cox regression analysis on all factors that may affect early mortality of patients, including total arch replacement. Factors with P <0.05 were included in the multivariable analysis.…”

Section: Discussionmentioning

confidence: 99%

Effect of Asymptomatic Common Carotid Artery Dissection on the Prognosis of Patients With Acute Type A Aortic Dissection

Jia,

Wang,

Liu

et al. 2024

JAHA

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Background Acute type A aortic dissection can extend upwards to involve the common carotid artery. However, whether asymptomatic common carotid artery dissection (CCAD) requires surgical repair remains controversial. This study aimed to explore the effect of asymptomatic CCAD without surgical intervention on the prognosis of patients who underwent surgery for acute type A aortic dissection. Methods and Results Between January 2015 and December 2017, 485 patients with no neurological symptoms who underwent surgery for acute type A aortic dissection were enrolled in this retrospective cohort study. The patients were divided into 2 groups based on the exposure factor of CCAD. CCAD was detected in 111 patients (22.9%), and after adjusting baseline data (standardized mean difference <0.1), the 30‐day mortality (17.1% versus 6.0%, P <0.001) and incidence of fatal stroke (7.7% versus 1.6%, P =0.001) were significantly higher in the group with CCAD. Univariable and multivariable Cox regression analyses found CCAD as an independent risk factor for 30‐day mortality (hazard ratio [HR], 2.8 [95% CI, 1.5–5.2]; P =0.001). At a median follow‐up of 6.2 years (interquartile range, 5.6–6.9 years), landmark analysis with a cutoff value of 1 month postoperatively showed a significant increase in mortality in the group with CCAD, especially in the first month (log‐rank P =0.002) and no significant difference in survival after the first month postoperatively between the 2 groups (log‐rank P =0.955). Conclusions Asymptomatic CCAD increased the risk of early fatal stroke and death in patients with acute type A aortic dissection after surgery but did not affect midterm survival in patients who survived the early postoperative period.

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Section: Discussionmentioning

confidence: 99%

Effect of Asymptomatic Common Carotid Artery Dissection on the Prognosis of Patients With Acute Type A Aortic Dissection

Jia,

Wang,

Liu

et al. 2024

JAHA

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“…Conservative treatment is associated with a significant mortality risk. Patients often succumb to organ dysfunction resulting from aortic dissection rupture, pericardial tamponade, inadequate blood supply to the aortic branches (such as acute myocardial infarction and intestinal ischemic necrosis), acute renal insufficiency, and other complications ( 8 , 9 ). The mortality rate is approximately 50% within 48 h of onset and 70% within one month.…”

Section: Discussionmentioning

confidence: 99%

Aortic arch branch-prioritized reconstruction for type A aortic dissection surgery

Gao,

Yan,

Duan

et al. 2024

Front. Cardiovasc. Med.

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BackgroundAcute Stanford type A aortic dissection (STAAD) is a fatal condition requiring urgent surgical intervention. Owing to the complexity of the surgical process, various complications, such as neurological disorders, are common. In this study, we prioritized the reconstruction of aortic arch branches during surgery and investigated the association between prioritizing the branches and the postoperative outcomes of patients with STAAD.MethodsNinety-seven patients were included in the observational study and underwent total arch replacement and frozen elephant trunk technique between January 2018 and June 2021. Of these, 35 patients underwent the branch-priority technique, and 62 patients underwent the classic technique. By analyzing the perioperative outcomes, we compared the differences between the two techniques.ResultsThe branch priority group had significantly shorter cardiopulmonary bypass and ventilator times and earlier postoperative wake-up times than the classic group. Additionally, the ICU stay time was shorter, with a significant decrease in neurological complications and 24 h drainage in the branch priority group compared to the classic group.ConclusionThe branch priority technique can effectively provide better brain protection, resulting in earlier awakening of patients after surgery, reduced neurological complications, shorter ventilation time and decreased ICU hospitalization time. Therefore, it is recommended for use in aortic dissection surgeries.

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“…(14)(15)(16)(17)(18) However, while technology has advanced, there are still concerns regarding the technical complexity, duration of cardiopulmonary bypass (CPB), and circulatory arrest. Furthermore, there is evidence of wide variability in outcomes from center to center, and a recent meta-analysis suggested that EAR approaches may be associated with increased perioperative mortality (13)(14)(15)(16)(17)(18)(22)(23)(24). It is important to acknowledge these issues and work towards finding solutions that benefit all parties involved.…”

Section: Introductionmentioning

confidence: 99%

Aortic Arch registry of type A aortic dissection (AoArch) - rationale, design and definition criteria

Nappi,

Schoell,

Singh

et al. 2024

Preprint

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Background: Type A acute aortic dissection (TAAAD) is a deadly condition that demands immediate surgery, because it involves a patient in critical, unstable condition. The mortality and morbidity associated with it are significant, and it is vital that the patient's conditions and treatment strategies are fully understood to ensure the appropriate management of TAAAD. This study will definitively answer whether hemiarch repair (HAR) versus extended arch repair (EAR) with or without descending aortic intervention results in better perioperative and late outcomes for patients with TAAAD. Methods: Four leading centers of cardiac surgery from two European countries have joined forces to create a groundbreaking multicenter observational registry (AoArch). This registry will enroll consecutive patients who underwent surgery for TAAAD from January 2005 to March 2024. We will analyze how patient comorbidities, referral conditions, and surgical strategies involving hemiarch repair (HAR) and extended arch repair (EAR) impact early and late adverse events. We have developed a procedure urgency algorithm based on the severity of preoperative hemodynamic conditions and malperfusion due to TAAAD, and we will use it to assess the primary clinical outcomes: in-hospital mortality, late mortality, and reoperations on the aorta. We will define secondary outcomes as permanent neurologic deficit, the need for new dialysis, respiratory failure, a composite of major adverse events (myocardial infarction, cerebrovascular accidents, the need for dialysis, or the need for tracheostomy), and a composite of major adverse pulmonary events (intubation over 48 hours, pneumonia, reintubation, tracheostomy), and reoperation due to bleeding. Discussion: This multicenter registry will definitively determine the prognostic significance of critical preoperative conditions and the efficacy of extended arch interventions and hemiarch repair in reducing the risk of early adverse events after surgery for TAAAD. This registry will provide insights into the long-term durability of different strategies of surgical repair for TAAAD.

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Outcomes of hemi- vs. total arch replacement in acute type A aortic dissection: A systematic review and meta-analysis

Cited by 9 publications

References 32 publications

Effect of Asymptomatic Common Carotid Artery Dissection on the Prognosis of Patients With Acute Type A Aortic Dissection

Effect of Asymptomatic Common Carotid Artery Dissection on the Prognosis of Patients With Acute Type A Aortic Dissection

Aortic arch branch-prioritized reconstruction for type A aortic dissection surgery

Aortic Arch registry of type A aortic dissection (AoArch) - rationale, design and definition criteria

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