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

Pan, Emily; Gudbjartsson, Tomas; Ahlsson, Anders; Fuglsang, Simon; Geirsson, Arnar; Hansson, Emma C.; Hjortdal, Vibeke; Jeppsson, Anders; Järvelä, Kati and Mennander, Ari, et al. (2018) In Journal of Thoracic and Cardiovascular Surgery 156(3). p.939-948
Abstract

Objectives: To describe the relationship between the extent of primary aortic repair and the incidence of reoperations after surgery for type A aortic dissection. Methods: A 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... (More)

Objectives: To describe the relationship between the extent of primary aortic repair and the incidence of reoperations after surgery for type A aortic dissection. Methods: A 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. Results: The 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. Conclusions: Type 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.

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publication status
published
subject
keywords
aortic dissection, midterm, outcome, reoperation
in
Journal of Thoracic and Cardiovascular Surgery
volume
156
issue
3
pages
939 - 948
publisher
Mosby
external identifiers
  • scopus:85046699116
ISSN
0022-5223
DOI
10.1016/j.jtcvs.2018.03.144
language
English
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yes
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7fa2966d-4e62-4435-bf58-64b4c15b1384
date added to LUP
2018-05-25 14:54:23
date last changed
2019-01-14 17:35:45
@article{7fa2966d-4e62-4435-bf58-64b4c15b1384,
  abstract     = {<p>Objectives: To describe the relationship between the extent of primary aortic repair and the incidence of reoperations after surgery for type A aortic dissection. Methods: A 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. Results: The 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. Conclusions: Type 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.</p>},
  author       = {Pan, Emily and Gudbjartsson, Tomas and Ahlsson, Anders and Fuglsang, Simon and Geirsson, Arnar and Hansson, Emma C. and Hjortdal, Vibeke and Jeppsson, Anders and Järvelä, Kati and Mennander, Ari and Nozohoor, Shahab and Olsson, Christian and Wickbom, Anders and Zindovic, Igor and Gunn, Jarmo},
  issn         = {0022-5223},
  keyword      = {aortic dissection,midterm,outcome,reoperation},
  language     = {eng},
  month        = {01},
  number       = {3},
  pages        = {939--948},
  publisher    = {Mosby},
  series       = {Journal of Thoracic and Cardiovascular Surgery},
  title        = {Low rate of reoperations after acute type A aortic dissection repair from The Nordic Consortium Registry},
  url          = {http://dx.doi.org/10.1016/j.jtcvs.2018.03.144},
  volume       = {156},
  year         = {2018},
}