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Limited vs. Extended Resection of Stanford Type A Acute Aortic Dissections.

ABSTRACT: 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.

SUBMITTER: Luthra S

PROVIDER: S-EPMC11356285 | biostudies-literature | 2024 Jul

REPOSITORIES: biostudies-literature

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Limited vs. Extended Resection of Stanford Type A Acute Aortic Dissections.

Luthra Suvitesh S Malvindi Pietro G PG Leiva-Juárez Miguel M MM Masraf Hannah H Sef Davorin D Miskolczi Szabolcs S Velissaris Theodore T

Medicina (Kaunas, Lithuania) 20240731 8

<i>Background and Objectives:</i> This is a propensity-matched, single-center study of limited versus extended resection for type A acute aortic dissection (AAAD). <i>Materials and Methods</i>: 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 comp ...[more]

PMID: 39202526

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Project description:BackgroundAcute Stanford type A aortic dissection is often fatal, with a high mortality rate and requiring emergency intervention. Salvage surgery aims to keep the patient alive by addressing severe aortic regurgitation, tamponade, primary tear, and organ malperfusion and, if possible, prevent the late dissection-related complications in the proximal and downstream aorta. Unfortunately, no optimal standard treatment or technique to treat this disease exists. Total arch replacement with frozen elephant trunk technique plays an important role in treating acute type A aortic dissection. We aim to describe a modified elephant trunk technique and report its short-term outcomes.MethodsFrom February 2018 to August 2019, 16 patients diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique at Xiamen Heart Center (male/female: 9/7; average age: 56.1 ± 7.6 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch, and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge.ResultsFifteen patients (93.8%) had hypertension. The primary tears were located in the lesser curvature of the aortic arch and ascending aorta in 5 (31.3%) and 9 patients (56.3%), respectively, and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery and distal descending aorta in 14 (87.6%) and 2 patients (12.5%), respectively. The duration of cardiopulmonary bypass (CPB), cross-clamping, and antegrade cerebral perfusion were 215.8 ± 40.5, 140.8 ± 32.3, and 55.1 ± 15.2 min, respectively. Aortic valve repair was performed in 15 patients (93.8%). Bentall procedure was performed in one patient (6.3%). Another patient received coronary artery repair (6.3%). The diameters at all levels were greater on discharge than those on admission, except the aortic arch. After 3 months, the true lumen diameter distal to the frozen elephant trunk increased, indicating false lumen thrombosis and/or aortic remodeling.ConclusionsThe modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible and could be used for organ malperfusion. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

Project description:BackgroundTo investigate the seasonal, monthly, and daily distributions of the incidence of Stanford type-A acute aortic dissection (TAAAD) and identify seasonality in the duration of hospital stay and in-hospital mortality of TAAAD in south-eastern China.MethodsWe enrolled patients diagnosed with TAAAD between 1 June 2017 and 31 May 2021. Participants were divided into seasonal, monthly, and daily groups according to the need for analysis. Analysis of variance was applied to compare the number of TAAAD in different seasons, months, and days. χ2 test was used to compare in-hospital mortality among the four groups. Non-parametric methods were used for all comparisons of the duration of hospital stay. Univariate logistic and multivariable logistic regression analyses were performed to assess the duration of hospital stay.ResultsOf the 485 patients, 154 were diagnosed in winter (31.8%), 115 in spring (23.7%), 73 in summer (15.1%), and 143 in autumn (29.5%). The daily, monthly, and seasonal distributions of TAAAD were significantly different (P = 0.04, P < 0.01, and P < 0.01, respectively). This study did not identify any significant decrease in maximal, mean, or minimum temperatures between the three days before TAAAD and the day of TAAAD. No seasonal variations associated with in-hospital mortality was observed (P = 0.89). However, significant differences were observed in the seasonal distribution of the duration of hospital stay for TAAAD [winter was 17.0 (4.0-24.0) days, spring was 20.0 (14.0-29.0) days, summer was 20.0 (12.5-31.0) days, and autumn was 20.0 (13.0-30.0) days, P < 0.01]. Multiple factor analysis showed that winter was the independent risk factor for the increased duration of hospital stay. The odds ratio for winter was 2.21 (1.46, 3.33, P < 0.01).ConclusionsOur study confirmed that the incidence of TAAAD exhibits seasonal, monthly, and daily variations in south-eastern China. Moreover, the daily incidence of TAAAD is higher on weekdays than that on weekends.

Project description:BackgroundThis research aimed to evaluate the impacts of transfusing packed red blood cells (pRBCs), fresh frozen plasma (FFP), or platelet concentrate (PC) on postoperative mechanical ventilation time (MVT) in patients with acute Stanford type A aortic dissection (ATAAD) undergoing after total arch replacement (TAR).MethodsThe clinical data of 384 patients with ATAAD after TAR were retrospectively collected from December 2015 to October 2017 to verify whether pRBCs, FFP, or PC transfusion volumes were associated with postoperative MVT. The logistic regression was used to assess whether blood products were risk factors for prolonged mechanical ventilation (PMV) in all three endpoints (PMV ≥24 h, ≥48 h, and ≥72 h).ResultsThe mean age of 384 patients was 47.6 ± 10.689 years, and 301 (78.39%) patients were men. Median MVT was 29.5 (4-574) h (h), and 213 (55.47%), 136 (35.42%), and 96 (25.00%) patients had PMV ≥24 h, ≥48 h, and ≥72 h, respectively. A total of 36 (9.38%) patients did not have any blood product transfusion, the number of patients with transfusion of pRBCs, FFP, and PC were 334 (86.98%), 286 (74.48%), and 189 (49.22%), respectively. According to the multivariate logistic regression of three PMV time-endpoints, age was a risk factor [PMV ≥ 24 h odds ratio (OR PMV≥24) = 1.045, p = 0.005; OR PMV≥48 = 1.060, p = 0.002; OR PMV≥72 = 1.051, p = 0.011]. pRBC transfusion (OR PMV≥24 = 1.156, p = 0.001; OR PMV≥48 = 1.156, p < 0.001; OR PMV≥72 = 1.135, p ≤ 0.001) and PC transfusion (OR PMV≥24 = 1.366, p = 0.029; OR PMV≥48 = 1.226, p = 0.030; OR PMV≥72 = 1.229, p = 0.011) were independent risk factors for PMV. FFP had no noticeable effect on PMV [OR PMV≥48 = 0.999, 95% confidence interval (CI) 0.998-1.000, p = 0.039; OR PMV≥72 = 0.999, 95% CI: 0.998-1.000, p = 0.025].ConclusionsIn patients with ATAAD after TAR, the incidence of PMV was very high. Blood products transfusion was closely related to postoperative mechanical ventilation time. pRBC and PC transfusions and age increased the incidence of PMV at all three endpoints.

Dataset Information

Limited vs. Extended Resection of Stanford Type A Acute Aortic Dissections.

Publications

Limited vs. Extended Resection of Stanford Type A Acute Aortic Dissections.

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