Single-Center Retrospective Analysis of Acute Type A Aortic Dissection Outcome and Reoperation Focusing on Extended Versus Limited Initial Repair.

Autor:	Elbayomi M; Department of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Germany. elbayomimohamed3@gmail.com., Weyand M; Department of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Germany. mohamed.elbayomi@uk-erlangen.de., Pathare P; Department of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Germany. mohamed.elbayomi@uk-erlangen.de., Nooh E; Department of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Germany. mohamed.elbayomi@uk-erlangen.de., Harig F; Department of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Germany. mohamed.elbayomi@uk-erlangen.de.
Jazyk:	angličtina
Zdroj:	The heart surgery forum [Heart Surg Forum] 2023 Mar 03; Vol. 26 (2), pp. E164-E169. Date of Electronic Publication: 2023 Mar 03.
DOI:	10.1532/hsf.5345
Abstrakt:	Background: The optimal management strategy for acute aortic type A dissection remains controversial. Whether a limited primary (index) repair would increase the need for late aortic reintervention is still an open debate. Methods: A total of 393 consecutive adult patients with acute type A aortic dissection who underwent cardiac surgery were analyzed. Our research hypothesis was whether limited aortic index repair (i.e., isolated aorta ascending replacement without an open distal anastomosis with and without a concomitant aortic valve replacement, including hemiarch replacement procedure) is associated with a higher incidence of late aortic reoperation compared with extended repair (i.e., any other surgical procedure that goes beyond that limited approach). Results: Type of the initial repair had no statically significant relationship with in-hospital mortality with a P-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (P = 0.4). From the patients who survived until discharge (N = 311), 40 patients needed a reoperation on the aorta; the mean interval until reoperation was 4.5 years. The relationship between the type of the initial repair and the need for reoperation didn't reach a statically significant value (P = 0.9). In-hospitable mortality after the second operation was 10% (N = 4). Conclusion: We reached two conclusions. 1) An extended prophylactic repair in the initial operation of an acute type A aortic dissection might not lead to a lower incidence of reoperations on the aorta and could increase in-hospital mortality by increasing cross-clamp time, and 2) Reoperation on the aorta could be done safely with acceptable mortality outcomes.
Databáze:	MEDLINE
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