Proximal versus extensive repair in acute type A aortic dissection: an updated systematic review and meta-analysis

Tasoudis, Panagiotis; Magouliotis, Dimitrios; Varvoglis, Dimitrios N.; Ziogas, Ioannis A.; Salmasi, Mohammad Yousuf; Σπανός, Κωνσταντίνος; Kourliouros, Antonios; Matsagkas, Miltiadis; Giannoukas, Athanasios D.; Athanasiou, Thanos

doi:10.1007/s11748-022-01792-9

Cited by 6 publications

(4 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These surgical approaches differ significantly in terms of technical complexity, need for strategies for prolonged cerebral protection and, to some extent, risk of early postoperative adverse events. Indeed, four pooled analyses confirmed that ascending aortic repair is associated with a significantly lower risk of early mortality compared to extensive aortic arch repair 1 , 9–11 . On the contrary, these studies reported equivocal results regarding the incidence of late aortic reoperations and mortality after proximal compared to extended aortic surgery 1 , 9–11 .…”

Section: Discussionmentioning

confidence: 91%

“…Indeed, four pooled analyses confirmed that ascending aortic repair is associated with a significantly lower risk of early mortality compared to extensive aortic arch repair 1 , 9–11 . On the contrary, these studies reported equivocal results regarding the incidence of late aortic reoperations and mortality after proximal compared to extended aortic surgery 1 , 9–11 . However, these pooled survival analyses suffer from methodological limitations related to the lack of results adjusted for confounders and of cumulative incidences of aortic reoperations estimated by competing risk analysis and methods not addressing the time-to-event nature of survival analyses.…”

Section: Discussionmentioning

confidence: 91%

“…Surgical and perfusion strategies for acute type A aortic dissection (TAAD) are topics of intense clinical research aiming to identify strategies to improve early postoperative outcomes and to guarantee the long-term durability of the operation 1 . TAAD involving the aortic arch, that is DeBakey type 1 aortic dissection, poses the dilemma of whether to perform a complete resection of the aortic arch with or without repair of the proximal part of the descending thoracic aorta with hybrid prostheses.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

Biancari,

Lega,

Mariscalco

et al. 2024

BJS Open

View full text Add to dashboard Cite

Background Extended aortic repair is considered a key issue for the long-term durability of surgery for DeBakey type 1 aortic dissection. The risk of aortic degeneration may be higher in young patients due to their long life expectancy. The early outcome and durability of aortic surgery in these patients were investigated in the present study. Methods The subjects of the present analysis were patients under 60 years old who underwent surgical repair for acute DeBakey type 1 aortic dissection at 18 cardiac surgery centres across Europe between 2005 and 2021. Patients underwent ascending aortic repair or total aortic arch repair using the conventional technique or the frozen elephant trunk technique. The primary outcome was 5-year cumulative incidence of reoperation on the distal aorta. Results Overall, 915 patients underwent surgical ascending aortic repair and 284 patients underwent surgical total aortic arch repair. The frozen elephant trunk procedure was performed in 128 patients. Among 245 propensity score–matched pairs, total aortic arch repair did not decrease the rate of distal aortic reoperation compared to ascending aortic repair (5-year cumulative incidence, 6.7% versus 6.7%, subdistributional hazard ratio 1.127, 95% c.i. 0.523 to 2.427). Total aortic arch repair increased the incidence of postoperative stroke/global brain ischaemia (25.7% versus 18.4%, P = 0.050) and dialysis (19.6% versus 12.7%, P = 0.003). Five-year mortality was comparable after ascending aortic repair and total aortic arch repair (22.8% versus 27.3%, P = 0.172). Conclusions In patients under 60 years old with DeBakey type 1 aortic dissection, total aortic arch replacement compared with ascending aortic repair did not reduce the incidence of distal aortic operations at 5 years. When feasible, ascending aortic repair for DeBakey type 1 aortic dissection is associated with satisfactory early and mid-term outcomes. Trial registration ClinicalTrials.gov Identifier: NCT04831073.

show abstract

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

Biancari,

Lega,

Mariscalco

et al. 2024

BJS Open

View full text Add to dashboard Cite

show abstract

“…These reinterventions intend to prevent late rupture of the dissected aorta but remain challenging cases since RAD involves the aortic arch. Indeed, currently in aortic centers around the world, hemiarch replacement at the acute phase is the most common repair [ 12 ], with long-term survival in favor of proximal repair versus extensive repair [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years

Porto

Omnès

Bartoli

et al. 2023

JCM

View full text Add to dashboard Cite

Background After a type A aortic dissection repair, a patent false lumen in the descending aorta is the most common situation encountered, and is a well-known risk factor for aortic growth, reinterventions and mortality. The aim of this study was to analyze the long-term results of residual aortic dissection (RAD) at a high-volume aortic center with prospective follow-up. Methods In this prospective single-center study, all patients operated for type A aortic dissection between January 2017 and December 2022 were included. Patients without postoperative computed tomography scans or during follow-up at our center, and patients without RAD were excluded. The primary endpoint was all-cause mortality during follow-up for patients with RAD. The secondary endpoints were perioperative mortality, rate of distal aneurysmal evolution, location of distal aneurysmal evolution, rate of distal reinterventions, outcomes of distal reinterventions, and aortic-related death during follow-up. Results In total, 200 survivors of RAD comprised the study group. After a mean follow-up of 27.2 months (1–66), eight patients (4.0%) died and 107 (53.5%) had an aneurysmal progression. The rate of distal reintervention was 19.5% (39/200), for malperfusion syndrome in seven cases (3.5%) and aneurysmal evolution in 32 cases (16.0%). Most reinterventions occurred during the first 2 years (82.1%). Twenty-seven patients were treated for an aneurysmal evolution of RAD including aortic arch with hybrid repair in 21 cases and branched aortic arch endoprosthesis in six cases. In the hybrid repair group, there was no death, and the rate of morbidity was 28.6% (6/21) (one minor stroke, one pulmonary complication, one recurrent paralysis with complete recovery and three major bleeding events). In the branched endograft group, there was no death, no stroke, and no paraplegia. There was one case (16.7%) of carotid dissection. Complete aortic remodeling or complete FL thrombosis on the thoracic aorta was found in 18 cases (85.7%) and in five cases (83.3%) in the hybrid and branched endograft groups, respectively. Conclusions: Despite a critical course in most cases of RAD, with a high rate of aneurysmal evolution and reintervention, the long-term mortality rate remains low with a close follow-up and a multidisciplinary management in an expert center.

show abstract

Proximal vs Extensive Repair in Acute Type A Aortic Dissection Surgery

Liu¹,

Zhang²,

Ding³

et al. 2023

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

Proximal versus extensive repair in acute type A aortic dissection: an updated systematic review and meta-analysis

Cited by 6 publications

References 51 publications

Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years

Proximal vs Extensive Repair in Acute Type A Aortic Dissection Surgery

Contact Info

Product

Resources

About