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.
引用
收藏
页数:10
相关论文
共 50 条
  • [31] Inner Coating for the Aortic Root in Acute Type A Dissection
    Rosati, Carlo M.
    Fukuhara, Shinichi
    ANNALS OF THORACIC SURGERY, 2021, 112 (01): : 82 - 82
  • [32] Conservative treatment of the aortic root in acute type a dissection
    Niederhäuser, U
    Künzli, A
    Seifert, B
    Schmidli, J
    Lachat, M
    Zünd, G
    Vogt, P
    Turina, M
    EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 1999, 15 (05) : 557 - 563
  • [33] The Aortic Root in Acute Type A Dissection: Repair or Replace?
    Arabkhani, Bardia
    Verhoef, Jos
    Tomsic, Anton
    van Brakel, Thomas J.
    Hjortnaes, Jesper
    Klautz, Robert J. M.
    ANNALS OF THORACIC SURGERY, 2023, 115 (06): : 1396 - 1402
  • [34] Aortic root surgery in acute type A aortic dissection: indication might be the problem
    Heo, Woon
    Song, Suk-Won
    JOURNAL OF THORACIC DISEASE, 2018, 10 : S3252 - S3253
  • [35] Selective Aortic Arch and Root Replacement in Repair of Acute Type A Aortic Dissection
    Fleischman, Fernando
    Elsayed, Ramsey S.
    Cohen, Robbin G.
    Tatum, James M.
    Kumar, S. Ram
    Kazerouni, Kayvan
    Mack, Wendy J.
    Barr, Mark L.
    Cunningham, Mark J.
    Hackmann, Amy E.
    Baker, Craig J.
    Starnes, Vaughn A.
    Bowdish, Michael E.
    ANNALS OF THORACIC SURGERY, 2018, 105 (02): : 505 - 512
  • [36] Fate of Preserved Aortic Root Following Acute Type A Aortic Dissection Repair
    Ellauzi, Hesham
    Zafar, Mohammad A.
    Wu, Jinlin
    Papanikolaou, Dimitra
    Buntin, Joelle
    Ziganshin, Bulat A.
    Elefteriades, John A.
    SEMINARS IN THORACIC AND CARDIOVASCULAR SURGERY, 2022, 34 (02) : 419 - 427
  • [37] Durability of aortic valve preservation with root reconstruction for acute type A aortic dissection †
    Yamanaka, Kazuo
    Hori, Yuki
    Ikarashi, Jin
    Kusuhara, Takayoshi
    Nakatsuka, Daisuke
    Hirose, Keiichi
    Nishina, Takeshi
    Fujita, Masatoshi
    EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2012, 41 (04) : E32 - E36
  • [38] AORTIC ROOT REPAIR USING PERICARDIAL AUTOGRAFT FOR ACUTE TYPE A AORTIC DISSECTION
    Guo, Hong-Wei
    Chang, Yi
    Qian, Xiang-Yang
    JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2021, 161 (02): : E154 - E154
  • [39] Aortic root remodelling with external ring annuloplasty in acute type A aortic dissection
    Kato, Yasuyuki
    Sasaki, Kenichi
    Yamauchi, Hidetaka
    Kanno, Yasuyuki
    Jinno, Taiyo
    Yamada, Muneaki
    Kiyama, Hiroshi
    Koyanagi, Toshiya
    INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY, 2020, 30 (01) : 85 - 90
  • [40] A New Aortic Root Reinforcement Technique for Acute Type A Aortic Dissection Surgery
    Zhu, Cuilin
    Piao, Hulin
    Wang, Yong
    Wang, Tiance
    Li, Dan
    Xu, Rihao
    Zhu, Zhicheng
    Li, Bo
    Zhang, Yixin
    Liu, Kexiang
    INTERNATIONAL HEART JOURNAL, 2019, 60 (05) : 1131 - 1136