Current Outcome after Surgery for Type A Aortic Dissection.

Autor:	Biancari F; Heart and Lung Center, Helsinki University Hospital, Helsinki.; Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta., Juvonen T; Heart and Lung Center, Helsinki University Hospital, Helsinki.; Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland., Fiore A; Department of Cardiac Surgery., Perrotti A; Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon., Hervé A; Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon., Touma J; Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris., Pettinari M; Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium., Peterss S; LMU University Hospital, Ludwig Maximilian University.; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich., Buech J; LMU University Hospital, Ludwig Maximilian University., Dell'Aquila AM; Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster., Wisniewski K; Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster., Rukosujew A; Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster., Demal T; Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany., Conradi L; Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany., Pol M; Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic., Kacer P; Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic., Onorati F; Division of Cardiac Surgery, University of Verona Medical School, Verona., Rossetti C; Division of Cardiac Surgery, University of Verona Medical School, Verona., Vendramin I; Cardiothoracic Department, University Hospital, Udine., Piani D; Cardiothoracic Department, University Hospital, Udine., Rinaldi M; Cardiac Surgery, Molinette Hospital, University of Turin, Turin., Ferrante L; Cardiac Surgery, Molinette Hospital, University of Turin, Turin., Quintana E; Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Spain., Pruna-Guillen R; Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Spain., Rodriguez Lega J; Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain., Pinto AG; Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain., Acharya M; Department of Cardiac Surgery, Glenfield Hospital, Leicester., El-Dean Z; Department of Cardiac Surgery, Glenfield Hospital, Leicester., Field M; Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK., Harky A; Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK., Nappi F; Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris., Gerelli S; Centre Hospitalier Annecy Genevois, France., Di Perna D; Centre Hospitalier Annecy Genevois, France., Gatti G; Division of Cardiac Surgery, Cardiothoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste., Mazzaro E; Division of Cardiac Surgery, Cardiothoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste., Rosato S; Center for Global Health, National Health Institute, Rome, Italy., Raivio P; Heart and Lung Center, Helsinki University Hospital, Helsinki., Jormalainen M; Heart and Lung Center, Helsinki University Hospital, Helsinki., Mariscalco G; Department of Cardiac Surgery, Glenfield Hospital, Leicester.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2023 Oct 01; Vol. 278 (4), pp. e885-e892. Date of Electronic Publication: 2023 Mar 13.
DOI:	10.1097/SLA.0000000000005840
Abstrakt:	Objective: The aim of this study was to evaluate the outcomes of different surgical strategies for acute Stanford type A aortic dissection (TAAD). Summary Background Data: The optimal extent of aortic resection during surgery for acute TAAD is controversial. Methods: This is a multicenter, retrospective cohort study of patients who underwent surgery for acute TAAD at 18 European hospitals. Results: Out of 3902 consecutive patients, 689 (17.7%) died during the index hospitalization. Among 2855 patients who survived 3 months after surgery, 10-year observed survival was 65.3%, while country-adjusted, age-adjusted, and sex-adjusted expected survival was 81.3%, yielding a relative survival of 80.4%. Among 558 propensity score-matched pairs, total aortic arch replacement increased the risk of in-hospital (21.0% vs. 14.9%, P =0.008) and 10-year mortality (47.1% vs. 40.1%, P =0.001), without decreasing the incidence of distal aortic reoperation (10-year: 8.9% vs. 7.4%, P =0.690) compared with ascending aortic replacement. Among 933 propensity score-matched pairs, in-hospital mortality (18.5% vs. 18.0%, P =0.765), late mortality (at 10-year: 44.6% vs. 41.9%, P =0.824), and cumulative incidence of proximal aortic reoperation (at 10-year: 4.4% vs. 5.9%, P =0.190) after aortic root replacement was comparable to supracoronary aortic replacement. Conclusions: Replacement of the aortic root and aortic arch did not decrease the risk of aortic reoperation in patients with TAAD and should be performed only in the presence of local aortic injury or aneurysm. The relative survival of TAAD patients is poor and suggests that the causes underlying aortic dissection may also impact late mortality despite surgical repair of the dissected aorta. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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