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Outcome After Surgery for Acute Type A Aortic Dissection With or Without Primary Tear Resection

Uimonen, Mikko ; Olsson, Christian ; Jeppsson, Anders ; Geirsson, Arnar ; Chemtob, Raphaelle ; Khalil, Ahmad ; Hjortdal, Vibeke ; Hansson, Emma C. ; Nozohoor, Shahab LU and Zindovic, Igor LU , et al. (2022) In Annals of Thoracic Surgery 114(2). p.492-501
Abstract

Background: The outcome in patients after surgery for acute type A aortic dissection without replacement of the part of the aorta containing the primary tear is undefined. Methods: Data of 1122 patients who underwent surgery for acute type A aortic dissection in 8 Nordic centers from January 2005 to December 2014 were retrospectively analyzed. The patients with primary tear location unfound, unknown, not confirmed, or not recorded (n = 243, 21.7%) were excluded from the analysis. The patients were divided into 2 groups according to whether the aortic reconstruction encompassed the portion of the primary tear (tear resected [TR] group, n = 730) or not (tear not resected [TNR] group, n = 149). The restricted mean survival time ratios... (More)

Background: The outcome in patients after surgery for acute type A aortic dissection without replacement of the part of the aorta containing the primary tear is undefined. Methods: Data of 1122 patients who underwent surgery for acute type A aortic dissection in 8 Nordic centers from January 2005 to December 2014 were retrospectively analyzed. The patients with primary tear location unfound, unknown, not confirmed, or not recorded (n = 243, 21.7%) were excluded from the analysis. The patients were divided into 2 groups according to whether the aortic reconstruction encompassed the portion of the primary tear (tear resected [TR] group, n = 730) or not (tear not resected [TNR] group, n = 149). The restricted mean survival time ratios adjusted for patient characteristics and surgical details between the groups were calculated for all-cause mortality and aortic reoperation–free survival. The median follow-up time was 2.57 (interquartile range, 0.53-5.30) years. Results: For the majority of the patients in the TR group, the primary tear was located in the ascending aorta (83.6%). The reconstruction encompassed both the aortic root and the aortic arch in 7.4% in the TR group as compared with 0.7% in the TNR patients (P < .001). There were no significant differences in all-cause mortality (adjusted restricted mean survival time ratio, 1.01; 95% confidence interval, 0.92-1.12; P = .799) or reoperation-free survival (adjusted restricted mean survival time ratio, 0.98; 95% confidence interval, 0.95-1.02; P = .436) between the TR and TNR groups. Conclusions: Primary tear resection alone does not determine the midterm outcome after surgery for acute type A aortic dissection.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Thoracic Surgery
volume
114
issue
2
pages
492 - 501
publisher
Elsevier
external identifiers
  • scopus:85123620613
  • pmid:34774491
ISSN
0003-4975
DOI
10.1016/j.athoracsur.2021.09.067
language
English
LU publication?
yes
id
9ee7856d-56ea-42ee-a2ba-df68d9a24840
date added to LUP
2022-04-08 12:09:02
date last changed
2024-06-09 02:59:30
@article{9ee7856d-56ea-42ee-a2ba-df68d9a24840,
  abstract     = {{<p>Background: The outcome in patients after surgery for acute type A aortic dissection without replacement of the part of the aorta containing the primary tear is undefined. Methods: Data of 1122 patients who underwent surgery for acute type A aortic dissection in 8 Nordic centers from January 2005 to December 2014 were retrospectively analyzed. The patients with primary tear location unfound, unknown, not confirmed, or not recorded (n = 243, 21.7%) were excluded from the analysis. The patients were divided into 2 groups according to whether the aortic reconstruction encompassed the portion of the primary tear (tear resected [TR] group, n = 730) or not (tear not resected [TNR] group, n = 149). The restricted mean survival time ratios adjusted for patient characteristics and surgical details between the groups were calculated for all-cause mortality and aortic reoperation–free survival. The median follow-up time was 2.57 (interquartile range, 0.53-5.30) years. Results: For the majority of the patients in the TR group, the primary tear was located in the ascending aorta (83.6%). The reconstruction encompassed both the aortic root and the aortic arch in 7.4% in the TR group as compared with 0.7% in the TNR patients (P &lt; .001). There were no significant differences in all-cause mortality (adjusted restricted mean survival time ratio, 1.01; 95% confidence interval, 0.92-1.12; P = .799) or reoperation-free survival (adjusted restricted mean survival time ratio, 0.98; 95% confidence interval, 0.95-1.02; P = .436) between the TR and TNR groups. Conclusions: Primary tear resection alone does not determine the midterm outcome after surgery for acute type A aortic dissection.</p>}},
  author       = {{Uimonen, Mikko and Olsson, Christian and Jeppsson, Anders and Geirsson, Arnar and Chemtob, Raphaelle and Khalil, Ahmad and Hjortdal, Vibeke and Hansson, Emma C. and Nozohoor, Shahab and Zindovic, Igor and Gunn, Jarmo and Wickbom, Anders and Ahlsson, Anders and Gudbjartsson, Tomas and Mennander, Ari}},
  issn         = {{0003-4975}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{492--501}},
  publisher    = {{Elsevier}},
  series       = {{Annals of Thoracic Surgery}},
  title        = {{Outcome After Surgery for Acute Type A Aortic Dissection With or Without Primary Tear Resection}},
  url          = {{http://dx.doi.org/10.1016/j.athoracsur.2021.09.067}},
  doi          = {{10.1016/j.athoracsur.2021.09.067}},
  volume       = {{114}},
  year         = {{2022}},
}