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Midterm outcomes and durability of sinus segment preservation compared with root replacement for acute type A aortic dissection.
Bojko, Markian M; Assi, Roland; Bavaria, Joseph E; Suhail, Maham; Habertheuer, Andreas; Hu, Robert W; Harmon, Joey; Milewski, Rita K; Desai, Nimesh D; Szeto, Wilson Y; Vallabhajosyula, Prashanth.
Afiliación
  • Bojko MM; College of Medicine, Drexel University, Philadelphia, Pa.
  • Assi R; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Bavaria JE; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Suhail M; Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY.
  • Habertheuer A; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Hu RW; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Harmon J; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Milewski RK; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Desai ND; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Szeto WY; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Vallabhajosyula P; Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn. Electronic address: prashanth.vallabhajosyula@yale.edu.
J Thorac Cardiovasc Surg ; 163(3): 900-910.e2, 2022 Mar.
Article en En | MEDLINE | ID: mdl-32620395
OBJECTIVE: The durability of root repair for acute type A aortic dissection is not well studied in the context of aortic insufficiency and stability of the sinuses of Valsalva. We compared clinical and functional outcomes in patients undergoing root repair and replacement for acute type A aortic dissection. METHODS: Of 716 patients undergoing surgery for acute type A aortic dissection, 585 (81.7%) underwent root repair and 131 (18.3%) underwent root replacement. Survival, cumulative incidence of reoperation, aortic insufficiency, and sinuses of Valsalva dilation were compared between the 2 groups. RESULTS: Survival at 1, 5, and 10 years was 84.1% versus 77.3%, 70.8% versus 69.2%, 57.6% versus 58.0% in the root repair and replacement groups, respectively (P = .69). Cumulative incidence of reoperation at 1, 5, and 10 years was 0.0% versus 0.8%, 1.4% versus 3.8%, and 3.4% versus 8.6% in the root repair and root replacement groups, respectively (P = .011). Multivariable Cox regression identified sinuses of Valsalva diameter 45 mm or more as a risk factor for proximal aortic reoperation (hazard ratio, 9.06; 95% confidence interval, 1.26-65.24). In a repeated-measures, linear, mixed-effects model, root replacement was associated with smaller follow-up of sinuses of Valsalva dimensions (ß = -0.66, P < .001). In an ordinal longitudinal mixed model, root replacement was associated with lower severity of postoperative aortic insufficiency (ß = -3.10, P < .001). CONCLUSIONS: Survival is similar, but the incidence of aortic insufficiency and root dilation may be greater after root repair compared with root replacement for acute type A aortic dissection.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aneurisma de la Aorta / Válvula Aórtica / Insuficiencia de la Válvula Aórtica / Seno Aórtico / Implantación de Prótesis Vascular / Procedimientos Quirúrgicos Cardíacos / Disección Aórtica Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aneurisma de la Aorta / Válvula Aórtica / Insuficiencia de la Válvula Aórtica / Seno Aórtico / Implantación de Prótesis Vascular / Procedimientos Quirúrgicos Cardíacos / Disección Aórtica Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos