Document Detail


Fate of the residual distal and proximal aorta after acute type a dissection repair using a contemporary surgical reconstruction algorithm.
MedLine Citation:
PMID:  18036916     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In this study, we evaluated the long-term results of our contemporary, standardized surgical management algorithm for repair of acute type A aortic dissections. Prior reports have analyzed heterogeneous techniques and populations. METHODS: From 1993 to 2004, 221 consecutive patients underwent repair of acute type A aortic dissection at our aortic center. Hemiarch repair was performed in 97.7% (216 of 221), and total arch in 2.3% (5 of 221). Of these, 72.9% (161 of 221) underwent aortic valve resuspension, and 27.1% (60 of 221) had aortic root replacement. RESULTS: In-hospital mortality for a primary operation was 12.7% (28 of 221). Actuarial survival was 79.2% at 1 year, 62.8% at 5 years, and 46.3% at 10 years. Significant risk factors for decreased survival included prior stroke, cerebral malperfusion, and length of cardiopulmonary bypass. Freedom from proximal reoperation after aortic valve resuspension was 94.6% at 5 years and 76.8% at 10 years, with cardiac malperfusion as the main risk factor. Freedom from distal reoperation was 87.6% at 5 years and 76.4% at 10 years, with Marfan syndrome, age, and extent of dissection as significant risk factors for reoperation. In-hospital mortality was 18.2% (2 of 11) after proximal reoperation and 31.2% (5 of 16) after distal reoperation. CONCLUSIONS: We report improved long-term durability of our proximal root repair, with cardiac malperfusion as a significant risk factor. Marfan disease, younger age, and DeBakey type I dissection are risk factors for distal reoperation. To further improve long-term outcome, means to prevent progression of distal aortic disease need to be developed.
Authors:
Arnar Geirsson; Joseph E Bavaria; Daniel Swarr; Martin G Keane; Y Joseph Woo; Wilson Y Szeto; Alberto Pochettino
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  84     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-11-26     Completed Date:  2007-12-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1955-64; discussion 1955-64     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiothoracic Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Aged, 80 and over
Algorithms
Aneurysm, Dissecting / mortality,  surgery*
Aorta / surgery*
Aortic Aneurysm / mortality,  surgery*
Aortic Valve / surgery
Echocardiography, Transesophageal
Female
Hospital Mortality
Humans
Male
Middle Aged
Multivariate Analysis
Reoperation

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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