Predictors of Lethality, Remodeling, and Aorta-Related Events in Different Types of Proximal Aortic Dissection Surgery.

Autor:	Sirota DA; Head of the Research Department of Surgery on Aorta, Coronary and Peripheral Arteries, Institute of Blood Circulation Pathology; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia; Cardiovascular Surgeon, Department of Aorta and Coronary Artery Surgery; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia., Zhulkov МО; Researcher, Research Department of Surgery on Aorta, Coronary and Peripheral Arteries, Institute of Blood Circulation Pathology; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia; Cardiovascular Surgeon, Department of Aorta and Coronary Artery Surgery; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia., Khvan DS; Senior Researcher, Research Department of Surgery on Aorta, Coronary and Peripheral Arteries, Institute of Blood Circulation Pathology; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia; Cardiovascular Surgeon, Department of Aorta and Coronary Artery Surgery; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia., Caus T; Cardiovascular Surgeon; University Hospital of Amiens, Avenue René Laënnec, Salouël, Amiens, 80054, France., Kozlov BN; Head of the Cardiovascular Surgery Department; Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 111a Kievskaya St., Tomsk, 634012, Russia., Lukinov VL; Senior Researcher; Institute of Computational Mathematics and Mathematical Geophysics, Siberian Branch of the Russian Academy of Sciences, 6 Academician Lavrentyeva Prospect, Novosibirsk, 630090, Russia; Head of the Laboratory of Numerical Analysis of Stochastic Differential Equations; Institute of Computational Mathematics and Mathematical Geophysics, Siberian Branch of the Russian Academy of Sciences, 6 Academician Lavrentyeva Prospect, Novosibirsk, 630090, Russia., Lyashenko ММ; Cardiovascular Surgeon; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia; Head of the Department of Surgery on Aorta, Coronary and Peripheral Arteries; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia., Makaev AG; Resident, Cardiovascular Surgeon; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia., Protopopov AV; Resident, Cardiovascular Surgeon; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia., Agaeva KA; Cardiovascular Surgeon, Department of Surgery on Aorta, Coronary and Peripheral Arteries; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia., Fomichev AV; Senior Researcher, Research Department of Surgery on Aorta, Coronary and Peripheral Arteries, Institute of Blood Circulation Pathology; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia; Cardiovascular Surgeon, Department of Surgery on Aorta, Coronary and Peripheral Arteries; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia., Мagbulova SA; Resident, Cardiovascular Surgeon; Novosibirsk State Medical University, 52 Krasny Prospect, Novosibirsk, 630091, Russia., Limansky AD; Student; V. Zelman Institute for Medicine and Psychology, Novosibirsk State University, 1 Pirogova St., Novosibirsk, 630090, Russia., Chernyavsky AМ; Professor, Correspondent Member of the Russian Academy of Sciences, General Director; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia.
Jazyk:	angličtina
Zdroj:	Sovremennye tekhnologii v meditsine [Sovrem Tekhnologii Med] 2023; Vol. 15 (1), pp. 38-50. Date of Electronic Publication: 2023 Jan 28.
DOI:	10.17691/stm2023.15.1.05
Abstrakt:	The aim of the study is to analyze predictors of lethality, false lumen thrombosis, enlargement of aortic diameter, and frequency of aorta-related events in the early and remote postoperative periods for various types of proximal aortic dissection surgery using the logistic regression method. Materials and Methods: A retrospective observational comparison of the results of surgical treatment of 213 patients with the diagnosis of "DeBakey type I aortic dissection" has been carried out. The participants were divided into three groups: group 1 underwent classic aortic arch reconstruction using hemiarch technique or total reconstruction of the aortic arch with a multiple-branch prosthesis (n=121); group 2 was subjected to the hemiarch technique and implantation of bare-metal (uncoated) stents (n=55); in group 3, the "frozen elephant trunk" correction technique was used (n=37). The diagnosis of all patients included into the study was preoperatively confirmed by ultrasound and tomographic examination. Predictors of negative events have been identified by building the models of logistic regressions. Results: The multivariate model of logistic regression has revealed multiplicative significant predictors of lethality: postoperative neurological complications increased the probability of lethality by 3.39 (1.24-9.18) times and presence of a patent false lumen by 4.17 (1.49-13.68) times.Among the predictors of aorta-related events, the most important were connective tissue diseases (the probability increased by 6.68 (2.98-15.62) times), presence of partial thrombosis of the false lumen (the probability of event development increased by 2.39 (1.07-5.44) times), and aortic valve repair (the probability aorta-event occurrence increased by 2.84 (1.13-7.17) times).Hybrid prosthesis implantation appeared to be the most significant predictor of false lumen thrombosis increasing its probability by 4.19 (1.90-9.44) times among aortic repair methods, while a bare-metal stent implantation in contrast reduced the likelihood of false lumen thrombosis by 0.17 (0.03-0.62) times. Eventually, the type of repair had not any significant impact on the aorta-related events and lethality in the long-term period. Competing Interests: Conflicts of interest. The authors have no conflicts of interest to declare.
Databáze:	MEDLINE
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