Long-term outcomes after ascending aortic replacement and aortic root replacement for type A aortic dissection. (22nd November 2021)

• Record Type: Journal Article
• Authors: Jormalainen, Mikko; Kesävuori, Risto; Raivio, Peter; Vento, Antti; Mustonen, Caius; Honkanen, Hannu-Pekka; Rosato, Stefano; Simpanen, Jarmo; Teittinen, Kari; Biancari, Fausto; Juvonen, Tatu
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 34:Number 3(2022)
• Page Start: 453
• Page End: 461
• Publication Date: 2021-11-22
• Subjects: Type A aortic dissection -- Aortic dissection -- Ascending aortic replacement -- Supracoronary -- Aortic root replacement -- Bentall procedure; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivab324
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: : OBJECTIVES: We investigated whether the selective use of supracoronary ascending aorta replacement achieves late outcomes comparable to those of aortic root replacement for acute Stanford type A aortic dissection (TAAD). METHODS: Patients who underwent surgery for acute type A aortic dissection from 2005 to 2018 at the Helsinki University Hospital, Finland, were included in this analysis. Late mortality was evaluated with the Kaplan–Meier method and proximal aortic reoperation, i.e. operation on the aortic root or aortic valve, with the competing risk method. RESULTS: Out of 309 patients, 216 underwent supracoronary ascending aortic replacement and 93 had aortic root replacement. At 10 years, mortality was 33.8% after aortic root replacement and 35.2% after ascending aortic replacement ( P = 0.806, adjusted hazard ratio 1.25, 95% confidence interval, 0.77–2.02), and the cumulative incidence of proximal aortic reoperation was 6.0% in the aortic root replacement group and 6.2% in the ascending aortic replacement group ( P = 0.65; adjusted subdistributional hazard ratio 0.53, 95% confidence interval 0.15–1.89). Among 71 propensity score matched pairs, 10-year survival was 34.4% after aortic root replacement and 36.2% after ascending aortic replacement surgery ( P = 0.70). Cumulative incidence of proximal aortic reoperation was 7.0% after aortic root replacement and 13.0% after ascending aortic replacement surgery ( P = 0.22). Among 102 patients with complete imaging data [mean follow-up, 4.7 (3.2) years], the estimated growth rate of the aortic root diameter was 0.22 mm/year, that of its area 7.19 mm 2 /year and that of its perimeter 0.43 mm/year. CONCLUSIONS: When stringent selection criteria were used to determine the extent of proximal aortic reconstruction, aortic root replacement and ascending aortic replacement for type A aortic dissection achieved comparable clinical outcomes. Abstract : Surgery for acute Stanford type A aortic dissection (TAAD) is associated with substantial mortality and morbidity [1, 2].