Aortic Arch Management During Acute and Subacute Type A Aortic Syndromes
| Autor: | Parth Mukund, Patel, Andy, Dong, Edward, Chiou, Jane, Wei, Jose, Binongo, Bradley, Leshnower, Edward P, Chen |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
Adult
Pulmonary and Respiratory Medicine Aortic Aneurysm Thoracic Aorta Thoracic Middle Aged Blood Vessel Prosthesis Implantation Peripheral Arterial Disease Postoperative Complications Treatment Outcome Risk Factors Acute Disease Humans Surgery Cardiology and Cardiovascular Medicine Aged Retrospective Studies |
| Zdroj: | The Annals of Thoracic Surgery. 114:694-701 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2021.12.064 |
| Popis: | The purpose of this study was to compare the outcomes of no arch intervention, hemiarch replacement, and total arch replacement during type A aortic syndromes in a contemporary series.From 2004 to 2019, 634 patients have required acute type A dissection repair; these patients were divided into three groups based on type of arch intervention performed: no arch (n = 130), hemiarch (n = 397), and total arch (n = 107). The primary endpoint was mortality; a multivariable risk factor analysis was performed. Secondary endpoints were reoperation and early and late complications.Operative age was 55 ± 14 years for the cohort and was similar between groups (P = .34). The incidence of peripheral artery disease, heart failure, and prior coronary artery bypass graft surgery differed between the groups (P .05). Median cardiopulmonary bypass time, aortic cross-clamp time, and length of stay were longest for the total arch group (P.0001). Early mortality was 20%, 10%, and 10% for the no-arch, hemiarch, and total arch groups, respectively (P = .01). Ten-year survival was 54%, 66%, and 65% for the no-arch, hemiarch, and total arch groups, respectively (P = .01). There was no difference in incidence or timing of redo aortic interventions (P.05). For the entire cohort, risk factors for late mortality included preoperative peripheral artery disease (hazard ratio 2.3; 95% confidence interval, 1.2 to 4.4; P = .009) and preoperative dialysis (hazard ratio 2.8; 95% confidence interval, 1.3 to 6.1; P = .01).Despite longer cardiopulmonary bypass and aortic cross-clamp times, arch intervention was not associated with worse operative or long-term outcome in this series. Patients with peripheral vascular disease and preoperative renal failure remain at highest risk for mortality after type A aortic dissection repair. |
| Databáze: | OpenAIRE |
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