Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger-Reference-Cited by-同舟云学术

Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

Published:2024-05-08 Issue:3 Volume:8 Page:
ISSN:2474-9842
Container-title:BJS Open
language:en
Short-container-title:

Author:

Biancari Fausto¹²^ORCID,Lega Javier Rodriguez³,Mariscalco Giovanni⁴,Peterss Sven⁵^ORCID,Buech Joscha⁵⁶^ORCID,Fiore Antonio⁷,Perrotti Andrea⁸,Rukosujew Andreas⁹,Pinto Angel G³,Demal Till¹⁰,Wisniewski Konrad⁹^ORCID,Pol Marek¹¹,Gatti Giuseppe¹²^ORCID,Vendramin Igor¹³,Rinaldi Mauro¹⁴,Pruna-Guillen Robert¹⁵,Di Perna Dario¹⁶,El-Dean Zein⁴,Sherzad Hiwa⁴,Nappi Francesco¹⁷,Field Mark¹⁸,Pettinari Matteo¹⁹,Jormalainen Mikko²,Dell’Aquila Angelo M⁹²⁰,Onorati Francesco²¹^ORCID,Quintana Eduard¹⁵,Juvonen Tatu²²²,Mäkikallio Timo¹

Affiliation:

1. Department of Medicine, South-Karelia Central Hospital, University of Helsinki , Lappeenranta , Finland

2. Heart and Lung Center, Helsinki University Hospital, University of Helsinki , Helsinki , Finland

3. Cardiovascular Surgery Department, University Hospital Gregorio Marañón , Madrid , Spain

4. Department of Cardiac Surgery, Glenfield Hospital , Leicester , UK

5. Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University , Munich , Germany

6. German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance , Munich , Germany

7. Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris , Creteil , France

8. Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte , Besancon , France

9. Department of Cardiothoracic Surgery, University Hospital Muenster , Muenster , Germany

10. Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg , Hamburg , Germany

11. Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady , Prague , Czech Republic

12. Division of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina , Trieste , Italy

13. Cardiothoracic Department, University Hospital , Udine , Italy

14. Cardiac Surgery, Molinette Hospital, University of Turin , Turin , Italy

15. Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona , Barcelona , Spain

16. Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois , Epagny Metz-Tessy , France

17. Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis , Paris , France

18. Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital , Liverpool , UK

19. Department of Cardiac Surgery, Ziekenhuis Oost Limburg , Genk , Belgium

20. Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg , Halle , Germany

21. Division of Cardiac Surgery, University of Verona Medical School , Verona , Italy

22. Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu , Oulu , Finland

Abstract

Abstract Background Extended aortic repair is considered a key issue for the long-term durability of surgery for DeBakey type 1 aortic dissection. The risk of aortic degeneration may be higher in young patients due to their long life expectancy. The early outcome and durability of aortic surgery in these patients were investigated in the present study. Methods The subjects of the present analysis were patients under 60 years old who underwent surgical repair for acute DeBakey type 1 aortic dissection at 18 cardiac surgery centres across Europe between 2005 and 2021. Patients underwent ascending aortic repair or total aortic arch repair using the conventional technique or the frozen elephant trunk technique. The primary outcome was 5-year cumulative incidence of reoperation on the distal aorta. Results Overall, 915 patients underwent surgical ascending aortic repair and 284 patients underwent surgical total aortic arch repair. The frozen elephant trunk procedure was performed in 128 patients. Among 245 propensity score–matched pairs, total aortic arch repair did not decrease the rate of distal aortic reoperation compared to ascending aortic repair (5-year cumulative incidence, 6.7% versus 6.7%, subdistributional hazard ratio 1.127, 95% c.i. 0.523 to 2.427). Total aortic arch repair increased the incidence of postoperative stroke/global brain ischaemia (25.7% versus 18.4%, P = 0.050) and dialysis (19.6% versus 12.7%, P = 0.003). Five-year mortality was comparable after ascending aortic repair and total aortic arch repair (22.8% versus 27.3%, P = 0.172). Conclusions In patients under 60 years old with DeBakey type 1 aortic dissection, total aortic arch replacement compared with ascending aortic repair did not reduce the incidence of distal aortic operations at 5 years. When feasible, ascending aortic repair for DeBakey type 1 aortic dissection is associated with satisfactory early and mid-term outcomes. Trial registration ClinicalTrials.gov Identifier: NCT04831073.

Funder

Finnish Foundation for Cardiovascular Research

Sigrid Juselius Foundation

Publisher

Oxford University Press (OUP)

Link

https://academic.oup.com/bjsopen/article-pdf/8/3/zrae047/58347251/zrae047.pdf

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