Extended-arch repair for acute type-A aortic dissection: perioperative and mid-term results
| العنوان: | Extended-arch repair for acute type-A aortic dissection: perioperative and mid-term results |
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| المؤلفون: | Fady Mina, Akash Fichadiya, Elizabeth Tai, Holly N. Smith, Jehangir J. Appoo, Alexander J. Gregory, Vamshi K. Kotha, Eric J. Herget, Ming Guo |
| المصدر: | European Journal of Cardio-Thoracic Surgery. 56:714-721 |
| بيانات النشر: | Oxford University Press (OUP), 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Pulmonary and Respiratory Medicine, Aortic dissection, Aorta, medicine.medical_specialty, business.industry, Mid term results, General Medicine, Perioperative, 030204 cardiovascular system & hematology, medicine.disease, Thrombosis, Surgery, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Acute type, medicine.artery, Descending aorta, Ascending aorta, medicine, Cardiology and Cardiovascular Medicine, business |
| الوصف: | OBJECTIVES: Extended-arch techniques offer the potential to comprehensively treat acute type-A aortic dissection (ATAAD), but add surgical complexity compared to the standard hemiarch technique. This study describes both perioperative and mid-term outcomes following the introduction of an extended-arch technique for ATAAD. METHODS: Ours is a retrospective single-centre observational study of 95 consecutive patients with ATAAD from 2011 to 2016. The decision to perform extended-arch or hemiarch repair was individualized based on clinical and radiological features. Extended-arch repair was defined as replacement of the ascending aorta and arch with reimplantation of head vessels with or without distal endovascular extension. Clinical follow-up was 100% complete. Cross-sectional double-oblique measurements were performed for aortic remodelling analysis. RESULTS: Extended-arch (n = 28) and hemiarch (n = 67) repair resulted in a in-hospital mortality of 10% (n = 3) and 10%, (n = 7), and permanent neurological deficit rate of 7% and 12%, respectively. At a mean imaging follow-up duration of 2.7 ± 1.5 years, false lumen thrombosis was achieved in 57% and 9% of patients undergoing extended-arch and hemiarch repair, respectively. Rate of growth in the proximal descending aorta was 0.7 ± 2.3 mm/year in the extended-arch group vs 2.7 ± 3.9 mm/year in the hemiarch group. At a mean clinical follow-up time of 3.0 ± 1.6 years, open surgical aortic reoperation was 0% in the extended-arch group and 22% in the hemiarch group. CONCLUSIONS: Extended-arch repair of ATAAD can be introduced in the acute setting without increase in perioperative mortality or morbidity. At mid-term follow-up, extended-arch for ATAAD improves aortic remodelling and reduces the need for open surgical reoperation. |
| تدمد: | 1873-734X 1010-7940 |
| DOI: | 10.1093/ejcts/ezz071 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_________::36a4f9066bb79081afe04d44e1ca3eeb https://doi.org/10.1093/ejcts/ezz071 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi...........36a4f9066bb79081afe04d44e1ca3eeb |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 1873734X 10107940 |
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| DOI: | 10.1093/ejcts/ezz071 |