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Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection

Geirsson, Arnar; Shioda, Kayoko; Olsson, Christian; Ahlsson, Anders; Gunn, Jarmo; Hansson, Emma C.; Hjortdal, Vibeke; Jeppsson, Anders; Mennander, Ari and Wickbom, Anders, et al. (2018) In Journal of Thoracic and Cardiovascular Surgery
Abstract

Objectives: Open-distal anastomosis is the preferred technique over clamp-on technique for surgical repair of acute type A aortic dissection (ATAAD). The aim of this study was to define how outcomes of ATAAD were affected by the use of either technique. Methods: Nordic Consortium for Acute Type A Aortic Dissection includes 8 academic cardiothoracic hospitals in 4 Nordic countries. The cohort consisted of 1134 patients, 153 clamp-on and 981 open-distal, from 2005 to 2014. Results: Patients who underwent operation with the clamp-on were younger, more frequently had coronary artery disease, bicuspid aortic valve, hypotension/shock or syncope, and a greater PennClass than open-distal patients. Postoperative cerebral vascular accident... (More)

Objectives: Open-distal anastomosis is the preferred technique over clamp-on technique for surgical repair of acute type A aortic dissection (ATAAD). The aim of this study was to define how outcomes of ATAAD were affected by the use of either technique. Methods: Nordic Consortium for Acute Type A Aortic Dissection includes 8 academic cardiothoracic hospitals in 4 Nordic countries. The cohort consisted of 1134 patients, 153 clamp-on and 981 open-distal, from 2005 to 2014. Results: Patients who underwent operation with the clamp-on were younger, more frequently had coronary artery disease, bicuspid aortic valve, hypotension/shock or syncope, and a greater PennClass than open-distal patients. Postoperative cerebral vascular accident occurred less frequently in clamp-on (14/153, 10%) compared with the open-distal group (190/981, 20%). Clamp-on had greater 30-day mortality (39/153, 25%) than the open-distal group (158/981, 16%), and 5-year survival was also worse in clamp-on (61.8% ± 4.4%) compared with the open-distal group (73.0% ± 1.6%). The open-distal technique was used more frequently in greater-volume hospitals but was not independently associated with 30-day mortality. Preoperative condition was an independent risk factor whereas hospital volume and later year of operation were beneficial in regard to short-term outcome. Open-distal was independently associated with improved mid-term survival. Conclusions: Patients who underwent operation with the clamp-on were sicker on presentation and had worse short- and mid-term survival compared with the open-distal group. Patients in the open-distal group had greater rates of cerebrovascular complications. The results support the routine use of open-distal anastomosis as the primary operative strategy for ATAAD, although clamp-on can be performed successfully in select cases.

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epub
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keywords
aortic dissection, hypothermic arrest, outcomes, surgical techniques, survival
in
Journal of Thoracic and Cardiovascular Surgery
publisher
Mosby
external identifiers
  • scopus:85055899843
ISSN
0022-5223
DOI
10.1016/j.jtcvs.2018.09.020
language
English
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no
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1c63150f-1928-4a77-b408-935fe0930bd2
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2018-12-14 15:57:34
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2019-03-12 04:19:03
@article{1c63150f-1928-4a77-b408-935fe0930bd2,
  abstract     = {<p>Objectives: Open-distal anastomosis is the preferred technique over clamp-on technique for surgical repair of acute type A aortic dissection (ATAAD). The aim of this study was to define how outcomes of ATAAD were affected by the use of either technique. Methods: Nordic Consortium for Acute Type A Aortic Dissection includes 8 academic cardiothoracic hospitals in 4 Nordic countries. The cohort consisted of 1134 patients, 153 clamp-on and 981 open-distal, from 2005 to 2014. Results: Patients who underwent operation with the clamp-on were younger, more frequently had coronary artery disease, bicuspid aortic valve, hypotension/shock or syncope, and a greater PennClass than open-distal patients. Postoperative cerebral vascular accident occurred less frequently in clamp-on (14/153, 10%) compared with the open-distal group (190/981, 20%). Clamp-on had greater 30-day mortality (39/153, 25%) than the open-distal group (158/981, 16%), and 5-year survival was also worse in clamp-on (61.8% ± 4.4%) compared with the open-distal group (73.0% ± 1.6%). The open-distal technique was used more frequently in greater-volume hospitals but was not independently associated with 30-day mortality. Preoperative condition was an independent risk factor whereas hospital volume and later year of operation were beneficial in regard to short-term outcome. Open-distal was independently associated with improved mid-term survival. Conclusions: Patients who underwent operation with the clamp-on were sicker on presentation and had worse short- and mid-term survival compared with the open-distal group. Patients in the open-distal group had greater rates of cerebrovascular complications. The results support the routine use of open-distal anastomosis as the primary operative strategy for ATAAD, although clamp-on can be performed successfully in select cases.</p>},
  author       = {Geirsson, Arnar and Shioda, Kayoko and Olsson, Christian and Ahlsson, Anders and Gunn, Jarmo and Hansson, Emma C. and Hjortdal, Vibeke and Jeppsson, Anders and Mennander, Ari and Wickbom, Anders and Zindovic, Igor and Gudbjartsson, Tomas},
  issn         = {0022-5223},
  keyword      = {aortic dissection,hypothermic arrest,outcomes,surgical techniques,survival},
  language     = {eng},
  publisher    = {Mosby},
  series       = {Journal of Thoracic and Cardiovascular Surgery},
  title        = {Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection},
  url          = {http://dx.doi.org/10.1016/j.jtcvs.2018.09.020},
  year         = {2018},
}