Type A acute aortic dissection with ≥40-mm aortic root: results of conservative and replacement strategies at long-term follow-up
| Autor: | Igor Vendramin, Francesco Onorati, Annarita Tullio, Andrea Lechiancole, Laura Deroma, Sandro Sponga, Ugolino Livi, Uberto Bortolotti, Aldo Milano, Daniela Piani |
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| Rok vydání: | 2020 |
| Předmět: |
Reoperation
Pulmonary and Respiratory Medicine Aortic valve medicine.medical_specialty 030204 cardiovascular system & hematology 03 medical and health sciences Aortic aneurysm Pseudoaneurysm 0302 clinical medicine medicine.artery Ascending aorta medicine Humans Aortic root Cumulative incidence Modified Bentall procedure Aorta Acute aortic dissection Aged Retrospective Studies Aortic dissection business.industry Hazard ratio General Medicine Middle Aged medicine.disease Aortic Aneurysm Surgery Aortic Dissection Treatment Outcome medicine.anatomical_structure 030228 respiratory system Aortic Valve Acute Disease Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 59:1115-1122 |
| ISSN: | 1873-734X 1010-7940 |
| DOI: | 10.1093/ejcts/ezaa456 |
| Popis: | OBJECTIVESWe evaluated the long-term results of aortic root (AR) preservation and replacement in patients operated on for acute type A aortic dissection.METHODSOut of 302 patients discharged after repair of acute aortic dissection (1977–2019), 124 patients had an AR ≥40 mm, which was preserved in 84 (68%, group A) patients and replaced in 40 (32%, group B) patients. Group B patients were younger (mean age 57 ± 12 vs 62 ± 11 years, P = 0.07), with a mean AR of 47 vs 43 mm and ≥moderate aortic insufficiency in 65% vs 30%. Survival, causes of death and reoperations were analysed at mean follow-up of 9 ± 8 years (6 months to 40 years).RESULTSActuarial survival of discharged patients at 5, 10 and 15 years was 97% (0.89–0.99), 78% (0.67–0.90) and 75% (0.64–0.88) in group A, and 85% (0.71–0.95), 62% (0.44–0.78) and 57% (0.39–0.76) in group B (log-rank test P = 0.2). Nine patients in group A (7 patients for aortic insufficiency and dilatation of the root and 2 patients for pseudoaneurysm) and 1 patient of group B (pseudoaneurysm of the right coronary button) required proximal reoperation without deaths. At 5, 10 and 15 years, the cumulative incidence of proximal aortic reoperations was 5%, 9% and 25% in group A, and 0%, 3% and 3% in group B (P = 0.02). At multivariable analysis AR >45 mm [hazard ratio (HR) 6.8, P = 0.026] and age (HR 0.9, P = 0.016) were independently associated with proximal reoperation.CONCLUSIONSAR preservation in acute type A dissection showed acceptable long-term outcomes. Nevertheless, a more aggressive approach appears a valid option, especially in patients with AR diameter >45 mm. |
| Databáze: | OpenAIRE |
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