Low rate of reoperations after acute type A aortic dissection repair from The Nordic Consortium Registry

The Journal of Thoracic and Cardiovascular Surgery

Ari Mennander¹  Simon Fuglsang²  Vibeke Hjortdal³  Tomas Gudbjartsson⁴  Emma C. Hansson⁵  Anders Jeppsson⁶  Emily Pan⁷  Anders Ahlsson⁸  Arnar Geirsson⁹  Kati Järvelä^1,10 

[1] Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden;Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Orebro, Sweden;Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;Department of Surgery, University of Turku, Turku, Finland;Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark;Heart Center, Tampere University Hospital, Tampere, Finland;Heart Center, Turku University Hospital, Turku, Finland;Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland;School of Health and Medicine, Orebro University, Orebro, Sweden;University of Tampere, Tampere, Finland

关键词: aortic dissection;    reoperation;    midterm;    outcome;   

DOI  :  10.1016/j.jtcvs.2018.03.144

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectivesTo describe the relationship between the extent of primary aortic repair and the incidence of reoperations after surgery for type A aortic dissection.MethodsA retrospective cohort of 1159 patients treated for type A aortic dissection at eight Nordic low- to medium-sized cardiothoracic centers from 2005 to 2014. Data were gathered from patient records and national registries. Patients were separately divided into 3 groups according to the distal anastomoses technique (ascending aorta [n = 791], hemiarch [n = 247], and total arch [n = 66]), and into 2 groups for proximal repair (aortic root replacement [n = 285] and supracoronary repair [n = 832]). Freedom from reoperation was estimated with cumulative incidence survival and Fine-Gray competing risk regression model was used to identify independent risk factors for reoperation.ResultsThe median follow-up was 2.7 years (range, 0-10 years). Altogether 51 out of 911 patients underwent reoperation. Freedom from distal reoperation at 5 years was 96.9%, with no significant difference between the groups (P = .22). Freedom from proximal reoperation at 5 years was 97.8%, with no difference between the groups (P = .84). Neither DeBakey classification nor the extent of proximal or distal repair predicted freedom from a later reoperation. The only independent risk factor associated with a later proximal reoperation was a history of connective tissue disease.ConclusionsType A aortic dissection repair in low- to medium-volume centers was associated with a low reoperation rate and satisfactory midterm survival. The extent of the primary repair had no significant influence on reoperation rate or midterm survival.

【 授权许可】

Unknown