Late outcomes of strategic arch resection in acute type A aortic dissection

The Journal of Thoracic and Cardiovascular Surgery

Elizabeth L. Norton¹  Bo Yang²  Terry Shih³ 

[1] Creighton University School of Medicine, Omaha, Neb;Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich;Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich

关键词: aortic dissection;    aortic arch surgery;    total arch replacement;    long-term outcome;    acute type A aortic dissection;   

DOI  :  10.1016/j.jtcvs.2018.10.139

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveTo compare perioperative and long-term outcomes in patients undergoing hemiarch and aggressive arch replacement for acute type A aortic dissection (ATAAD).MethodsFrom 1996 to 2017, we compared outcomes of hemiarch (n = 322) versus aggressive arch replacements (zones 2 and 3 arch replacement with implantation of 2-4 arch branches, n = 150) in ATAAD. Indications for aggressive arch were arch aneurysm >4 cm or intimal tear in the aortic arch that was not resectable by hemiarch replacement, or dissection of arch branches with malperfusion.ResultsPatients in the aggressive arch group were significantly younger (mean age: 57 vs 61 years old) and had significantly longer hypothermic circulatory arrest, cardiopulmonary bypass, and aortic crossclamp times. There were no significant differences in perioperative outcomes between hemiarch and aggressive arch groups, including 30-day mortality (5.3% vs 7.3%, P = .38) and postoperative stroke rate (7% vs 7%, P = .96). Over 15 years, Kaplan–Meier survival was similar between hemiarch and aggressive arch groups (log-rank P = .55, 10-year survival 70% vs 72%). Given death as a competing factor, incidence rates of reoperation over 15 years (2.1% vs 2.0% per year, P = 1) and 10-year cumulative incidence of reoperation (14% vs 12%, P = .89) for arch and distal aorta pathology were similar between the 2 groups.ConclusionsBoth hemiarch and aggressive arch replacement are appropriate approaches for select patients with ATAAD. Aggressive arch replacement should be considered for an arch aneurysm >4 cm or an intimal tear at the arch unable to be resected by hemiarch replacement, or dissection of the arch branches with malperfusion.

【 授权许可】

Unknown