Influence of residual primary entry following the tear-oriented strategy for acute type A aortic dissection
Autor: | Atsushi Yamaguchi, Koji Kawahito, Hideo Adachi, Kei Aizawa, Naoyuki Kimura |
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Rok vydání: | 2021 |
Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Aorta Thoracic Lacerations Blood Vessel Prosthesis Implantation Postoperative Complications medicine.artery medicine Humans Risk factor Survival rate Retrospective Studies Aortic dissection Aorta Aortic Aneurysm Thoracic business.industry Medical record General Medicine Gold standard (test) medicine.disease Surgery Aortic Dissection Treatment Outcome Acute Disease Propensity score matching Disease Progression Tears Cardiology and Cardiovascular Medicine business |
Zdroj: | European Journal of Cardio-Thoracic Surgery. 61:1077-1084 |
ISSN: | 1873-734X 1010-7940 |
Popis: | OBJECTIVES Although a tear-oriented strategy has contributed to improving short-term surgical outcomes of acute type A aortic dissection (ATAAD), long-term clinical influences of residual entry tear in the downstream aorta have not been fully investigated. The goal of this study was to assess the long-term surgical outcomes of ATAAD with or without a residual entry tear in the downstream aorta. METHODS Medical records of 1107 patients with ATAAD who underwent emergency surgery between 1990 and 2018 were retrospectively reviewed. A tear-oriented paradigm was adopted for the baseline strategy. The 837 patients in whom the entry tears were resected comprised the resected group, and the 270 patients with a residual entry tear comprised the residual group. Of these patients, 252 in each group were analysed using propensity score matching, and long-term outcomes were compared with or without residual entry. RESULTS Hospital deaths were lower in the resected group (3.2% vs 8.3%; P = 0.020). The survival rate was not significantly different between the groups: It was 83.8% and 68.5% in the resected group and 80.2% and 66.5% in the residual group at 5 and 10 years, respectively (P = 0.600). However, residual entry in the downstream aorta affected the distal aortic event-free survival rate (90.4% and 80.6% in the resected group and 82.3% and 67.4% in the residual group at 5 and 10 years, respectively; P = 0.003). Furthermore, multivariable risk analysis of 1107 patients confirmed that a residual entry in the downstream aorta was a risk factor for distal aortic events. CONCLUSIONS The tear-oriented strategy remains the gold standard for high-risk patients; however, the extensive operation might be considered for stable patients to reduce long-term aortic events. |
Databáze: | OpenAIRE |
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