Acute type A aortic dissection extending beyond ascending aorta: Limited or extensive distal repair

作者：Rylski Bartosz^*; Beyersdorf Friedhelm; Kari Fabian A; Schlosser Julia; Blanke Philipp; Siepe Matthias

来源：The Journal of Thoracic and Cardiovascular Surgery, 2014, 148(3): 949-954.

DOI：10.1016/j.jtcvs.2014.05.051

Objective: The aim of our study was to delineate the effect of aortic arch surgery extension on the outcomes in acute type A dissection extending beyond the ascending aorta.
Methods: From 2001 to 2013, of 197 patients with type A dissection, 153 (78%) with dissection extending beyond the ascending aorta (age, 61 years; first quartile, 50; third quartile, 69; 67% men) were identified. Aortic repair involved isolated ascending replacement (n = 102), hemiarch (n = 37), and total arch replacement (n = 14). The median follow-up period was 4.9 years (first quartile, 2.5; third quartile, 7.6; 733 patient-years).
Results: In-hospital mortality was 9.8%, 21.6%, and 28.6%(P = .122) for patients with no, hemiarch, and total arch replacement. Age > 80 years (odds ratio [OR], 9.37; P = .006), malperfusion syndrome (OR, 4.74; P = .004), and total arch replacement (OR, 6.47; P = .016) were independent predictors of perioperative mortality. Freedom from distal reintervention was 93% +/- 3%, 97% +/- 3%, and 100% at 1 year and 89% +/- 3%, 97% +/- 3%, and 100% at 5 years for the no, hemiarch, and total arch replacement groups, respectively (log-rank, P = .440). Marfan syndrome (OR, 12.40; P = .038) and dissection of all aortic segments (OR, 10.68; P = .007) predicted distal aortic reintervention. In-hospital mortality for elective reintervention was 0%.
Conclusions: Limiting the extent of surgery for type A aortic dissection to ascending aortic replacement was associated with low perioperative mortality. Thus, aortic arch repair can be deferred, because it can be performed electively with a lower mortality risk.

• 出版日期2014-9