Recurrent aortic insufficiency after emergency surgery for acute type A aortic dissection with aortic root preservation.

Autor:	Bojko MM; College of Medicine, Drexel University, Philadelphia, Pa., Habertheuer A; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa., Bavaria JE; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa., Suhail M; Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY., Hu RW; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa., Harmon J; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa., Desai ND; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa., Milewski RK; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa., Williams ML; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa., Szeto WY; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa., Mossey J; Dornsife School of Public Health, Drexel University, Philadelphia, Pa., Vallabhajosyula P; Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn. Electronic address: prashanth.vallabhajosyula@yale.edu.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2021 Jun; Vol. 161 (6), pp. 1989-2000.e6. Date of Electronic Publication: 2020 Apr 18.
DOI:	10.1016/j.jtcvs.2020.01.116
Abstrakt:	Objective: Patients with acute type A aortic dissection demonstrate a wide range of aortic insufficiency. Outcomes after valve resuspension and root repair are not well studied in the long term. We evaluated the long-term effects of preoperative aortic insufficiency in patients undergoing emergency root-preserving surgery for acute type A aortic dissection. Methods: From 2002 to 2017, 558 of 776 patients with acute type A aortic dissection underwent native aortic valve resuspension and root reconstruction. Patients were stratified into 4 groups by preoperative aortic insufficiency grade (n = 539): aortic insufficiency less than 2+ (n = 348), aortic insufficiency = 2+ (n = 72), aortic insufficiency = 3+ (n = 49), and aortic insufficiency = 4+ (n = 70). Multivariable ordinal longitudinal mixed effects and multi-state transition models were used to assess risk factors for recurrent aortic insufficiency. Results: The prevalence of cardiogenic shock in patients presenting with preoperative aortic insufficiency less than 2+, 2+, 3+, and 4+ was 53 of 348 (15.2%), 12 of 72 (16.7%), 10 of 49 (20.4%), and 24 of 70 (34.3%), respectively (P = .002). Postoperatively, 94.0% of patients had aortic insufficiency 1+ or less at discharge. Operative mortality was 34 of 348 (9.8%), 10 of 72 (13.9%), 6 of 49 (12.2%), and 12 of 70 (17.1%) (P = .303). In an ordinal mixed effects model, preoperative aortic insufficiency was associated with more severe postoperative aortic insufficiency. The multi-state transition model demonstrated that severe aortic insufficiency was associated with progression from no to mild aortic insufficiency (hazard ratio, 2.14; 95% confidence interval, 1.35-3.38), and progression from mild to moderate aortic insufficiency (hazard ratio, 5.70; 95% confidence interval, 1.88-17.30). Conclusions: Preoperative aortic insufficiency is an important predictor of recurrent aortic insufficiency in patients undergoing valve resuspension with root reconstruction for emergency acute type A aortic dissection repair. Increased echocardiographic surveillance for recurrent aortic insufficiency may be warranted in this cohort. (Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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