| Autor: |
Luthra S; Division of Cardiac Surgery, Wessex Cardiothoracic Centre University Hospital Southampton, Southampton SO16 6YD, UK.; Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK., Malvindi PG; Division of Cardiac Surgery, Wessex Cardiothoracic Centre University Hospital Southampton, Southampton SO16 6YD, UK.; Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, 60121 Ancona, Italy., Leiva-Juárez MM; Department of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA., Masraf H; Kingston Hospital NHS Foundation Trust, Kingston upon Thames KT2 7QB, UK., Sef D; Department of Cardiac Surgery, University Hospital Leicester NHS Trust, Leicester LE5 4PW, UK., Miskolczi S; Division of Cardiac Surgery, Wessex Cardiothoracic Centre University Hospital Southampton, Southampton SO16 6YD, UK., Velissaris T; Division of Cardiac Surgery, Wessex Cardiothoracic Centre University Hospital Southampton, Southampton SO16 6YD, UK. |
| Abstrakt: |
Background and Objectives: This is a propensity-matched, single-center study of limited versus extended resection for type A acute aortic dissection (AAAD). Materials and Methods : This study collected retrospective data for 440 patients with acute type A aortic dissection repairs (limited resection, LR-215; extended resection, ER-225), of which 109 pairs were propensity-matched to LR versus ER. Multivariate analysis was performed for inpatient death, long-term survival and the composite outcome of inpatient death/TIA/stroke. Kaplan-Meier survival curves were compared at 1, 3, 5, 10 and 15 years using the log-rank test. Results : Mean age was 66.9 ± 13 years and mean follow-up was 5.3 ± 4.7 years. A total of 48.9% had LR. In-hospital mortality was 10% (LR: 6% vs. ER: 13.8%, p < 0.01). ER, NYHA class, salvage surgery and additional procedures were predictors of increased mortality in unmatched data. Propensity-matched data showed no difference in TIA/stroke rates, LOS, inpatient mortality or composite outcomes. LR had better survival (LR: 77.1% vs. ER: 51.4%, p < 0.001). ER (OR: 1.97, 95% CI: 1.27, 3.08, p = 0.003) was a significant predictor of worse long-term survival. At 15 years, aortic re-operation was 17% and freedom from re-operation and death was 42%. Conclusions : Type A aortic dissection repair has high mortality and morbidity, although results have improved over two decades. ER was a predictor of worse perioperative results and long-term survival. |
