Surgical management of the aortic root in acute type A aortic dissection: A comparative analysis

被引:1
|
作者
Lin, Xin-Fan [1 ,2 ,3 ]
Xie, Lin-feng [1 ,2 ,3 ]
Zhang, Zhao-feng [1 ,2 ,3 ]
Wu, Qing-song [1 ,2 ,3 ]
Qiu, Zhi- huang [1 ,2 ,3 ,4 ]
Chen, Liang-wan [1 ,2 ,3 ,4 ]
机构
[1] Fujian Med Univ, Union Hosp, Dept Cardiovasc Surg, Fuzhou, Fujian, Peoples R China
[2] Fujian Prov Univ, Fujian Med Univ, Key Lab Cardiothorac Surg, Fuzhou, Fujian, Peoples R China
[3] Fujian Prov Ctr Cardiovasc Med, Fuzhou, Fujian, Peoples R China
[4] Fujian Med Univ, Union Hosp, Xinquan Rd 29, Fuzhou 350001, Fujian, Peoples R China
关键词
Acute type A aortic dissection; Root repair; Inverse probability of treatment weighting; Surgical outcomes; Reintervention; VALVE; REPLACEMENT; RECONSTRUCTION; REDUCTION; SURGERY; REPAIR; GRAFT;
D O I
10.1016/j.ijcard.2024.132182
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: This study aimed to assess the early- and mid-term outcomes of aortic root repair and replacement, and to provide evidence to improve root management in acute type A aortic dissection (AAAD). Methods: This study enrolled 455 patients who underwent AAAD root repair (n = 307) or replacement (n = 148) between January 2016 and December 2017. Inverse probability of treatment weighting (IPTW) method was used to control for treatment selection bias. The primary outcomes were in -hospital mortality, mid-term survival, and proximal aortic reintervention. Results: The success rate of root repair was 99.7%. The in -hospital mortality in the conservative root repair (CRR) and aggressive root replacement (ARR) were 8.1% and 10.8%. The median follow-up time was 67.76 months (IQR, 67-72 months). After adjusting for baseline factors, there was no significant differences in mid-term survival (p = .750) or the proximal aortic reintervention rate (p = .550) between the two groups. According to Cox analysis, age, hypertension, severe aortic regurgitation, CPB time, and concomitant CABG were all factors associated with mid-term mortality. Regarding reintervention, multivariate analysis identified renal insufficiency, bicuspid aortic valve, root diameter >= 45 mm, and severe aortic regurgitation as risk factors, while CRR did not increase the risk of reintervention. The subgroup analysis revealed heterogeneity in the effects of surgical treatment across diverse populations based on a variety of risk factors. Conclusions: For patients with AAAD, both CRR and ARR are appropriate operations with promising early and mid-term outcomes. The effects of treatment show heterogeneity across diverse populations based on various risk factors.
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页数:10
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