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Indications and outcomes of second aortic procedures after acute type A dissection repair.
Morjan, Mohammed; Mestres, Carlos-A; Savic, Vedran; Gerçek, Mustafa; Van Hemelrijck, Mathias; Sromicki, Juri; Dzemali, Omer; Reser, Diana.
Afiliación
  • Morjan M; Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland.
  • Mestres CA; Department of Cardiovascular Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany.
  • Savic V; Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland.
  • Gerçek M; Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland.
  • Van Hemelrijck M; Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Heart Center Duisburg, Duisburg, Germany.
  • Sromicki J; Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland.
  • Dzemali O; Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland.
  • Reser D; Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland.
Interdiscip Cardiovasc Thorac Surg ; 38(5)2024 May 03.
Article en En | MEDLINE | ID: mdl-38688455
ABSTRACT

OBJECTIVES:

Aortic arch or aortic root replacement is not performed in all cases of acute type A aortic dissection (ATAD), and a second aortic procedure will become necessary over time for some patients. Indications and outcomes, of second aortic procedures have not been studied extensively.

METHODS:

Characteristics and in-hospital outcomes of all patients undergoing surgical repair for type A acute aortic dissection were analysed and patients needing second aortic procedure during follow-up were identified. The latter group was divided in 2 subgroups on-pump includes patients operated on using cardiopulmonary bypass and off-pump without cardiopulmonary bypass.

RESULTS:

A total of 638 patients underwent surgery for ATAD; 8% required a second aortic procedure. The most frequent indication for the second aortic procedure was dehiscence of suture lines (44%), followed by arch dilatation (24%). In-hospital mortality was 12%. Isolated ascending aorta replacement at the first surgery was associated with higher incidence of second aortic procedure (P = 0.006). Most patients in the on-pump group underwent a proximal reoperation (75%), with a mortality rate of 14.2%. In-hospital mortality of patients in the off-pump group was 7.7%. Long-term survival analysis showed no difference between groups (P = 0,526), Off-pump patients have greater likelihood of a second intervention during follow-up (P = 0.004).

CONCLUSIONS:

Extended aortic root surgery and customized aortic arch repair in ATAD could be reasonable to reduce the incidence and mortality of high-risk second aortic procedures.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Interdiscip Cardiovasc Thorac Surg Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Interdiscip Cardiovasc Thorac Surg Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Reino Unido