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Limited Distal Repair Results in Low Rates of Distal Events Following Surgery for Acute Type A Aortic Dissection

Chemtob, Raphaelle A. ; Ede, Jacob LU orcid ; Herou, Erik LU orcid ; Larsson, Mårten LU ; Nozohoor, Shahab LU ; Sjögren, Johan LU ; Wierup, Per LU and Zindovic, Igor LU (2023) In Seminars in Thoracic and Cardiovascular Surgery 35(1). p.7-15
Abstract

To investigate mortality and reoperation rates following limited distal repair after acute type A aortic dissection (ATAAD) at a single medium volume institution. We analyzed all patients that underwent limited distal repair (ascending aortic or hemiarch replacement) following ATAAD between January 1998 and April 2020 at our institution. During the study period, 489 patients underwent ATAAD surgery, of which 457 (94%) underwent limited distal repair with a 30-day mortality of 12.9%. Among 30-day survivors, late follow-up was 97.7% complete with a mean follow-up of 6.0 ± 5.5 years. In all, 50 patients (11%) required a reoperation during the study period at a mean of 3.4 ± 3.4 years after initial repair, with a 30-day mortality of 12%. An... (More)

To investigate mortality and reoperation rates following limited distal repair after acute type A aortic dissection (ATAAD) at a single medium volume institution. We analyzed all patients that underwent limited distal repair (ascending aortic or hemiarch replacement) following ATAAD between January 1998 and April 2020 at our institution. During the study period, 489 patients underwent ATAAD surgery, of which 457 (94%) underwent limited distal repair with a 30-day mortality of 12.9%. Among 30-day survivors, late follow-up was 97.7% complete with a mean follow-up of 6.0 ± 5.5 years. In all, 50 patients (11%) required a reoperation during the study period at a mean of 3.4 ± 3.4 years after initial repair, with a 30-day mortality of 12%. An aortic reoperation was required in 4.1 (2.0–6.1)%, 10.3 (7.1–13.6)%, 15.1 (10.9–19.4)%, and 18.0 (13.0–22.9)% of patients at 1, 5, 10, and 15 years. A distal reoperation was required in 3.0 (1.2–4.7)%, 8.0 (5.1–10.9)%, 10.3 (6.8–13.8)%, and 12.4 (8.2–16.5)% of patients and 4.4 (2.3–6.4)%, 10.4 (7.1–13.7)%, 13.9 (9.8–18.0)%, and 16.9 (12.0–21.9)% of patents had a distal event at 1, 5, 10, and 15 years, respectively. Limited distal repair with an ascending aortic or hemiarch replacement was associated with acceptable survival and rates of reoperations and distal events. Limited distal repair is a safe and feasible standard approach to ATAAD surgery at a medium-volume center.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Aorta, Dissection, Reoperation
in
Seminars in Thoracic and Cardiovascular Surgery
volume
35
issue
1
pages
7 - 15
publisher
W.B. Saunders
external identifiers
  • pmid:34774770
  • scopus:85120656193
ISSN
1043-0679
DOI
10.1053/j.semtcvs.2021.11.004
language
English
LU publication?
yes
id
60f48c09-5e57-463e-8b25-bb5c6e80a04b
date added to LUP
2022-01-18 12:16:22
date last changed
2024-06-16 00:03:01
@article{60f48c09-5e57-463e-8b25-bb5c6e80a04b,
  abstract     = {{<p>To investigate mortality and reoperation rates following limited distal repair after acute type A aortic dissection (ATAAD) at a single medium volume institution. We analyzed all patients that underwent limited distal repair (ascending aortic or hemiarch replacement) following ATAAD between January 1998 and April 2020 at our institution. During the study period, 489 patients underwent ATAAD surgery, of which 457 (94%) underwent limited distal repair with a 30-day mortality of 12.9%. Among 30-day survivors, late follow-up was 97.7% complete with a mean follow-up of 6.0 ± 5.5 years. In all, 50 patients (11%) required a reoperation during the study period at a mean of 3.4 ± 3.4 years after initial repair, with a 30-day mortality of 12%. An aortic reoperation was required in 4.1 (2.0–6.1)%, 10.3 (7.1–13.6)%, 15.1 (10.9–19.4)%, and 18.0 (13.0–22.9)% of patients at 1, 5, 10, and 15 years. A distal reoperation was required in 3.0 (1.2–4.7)%, 8.0 (5.1–10.9)%, 10.3 (6.8–13.8)%, and 12.4 (8.2–16.5)% of patients and 4.4 (2.3–6.4)%, 10.4 (7.1–13.7)%, 13.9 (9.8–18.0)%, and 16.9 (12.0–21.9)% of patents had a distal event at 1, 5, 10, and 15 years, respectively. Limited distal repair with an ascending aortic or hemiarch replacement was associated with acceptable survival and rates of reoperations and distal events. Limited distal repair is a safe and feasible standard approach to ATAAD surgery at a medium-volume center.</p>}},
  author       = {{Chemtob, Raphaelle A. and Ede, Jacob and Herou, Erik and Larsson, Mårten and Nozohoor, Shahab and Sjögren, Johan and Wierup, Per and Zindovic, Igor}},
  issn         = {{1043-0679}},
  keywords     = {{Aorta; Dissection; Reoperation}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{7--15}},
  publisher    = {{W.B. Saunders}},
  series       = {{Seminars in Thoracic and Cardiovascular Surgery}},
  title        = {{Limited Distal Repair Results in Low Rates of Distal Events Following Surgery for Acute Type A Aortic Dissection}},
  url          = {{http://dx.doi.org/10.1053/j.semtcvs.2021.11.004}},
  doi          = {{10.1053/j.semtcvs.2021.11.004}},
  volume       = {{35}},
  year         = {{2023}},
}