The following is the summary of “A tailored strategy for repair of acute type A aortic dissection” published in the December 2022 issue of Thoracic and cardiovascular surgery by Lau, et al.
Repairing an acute type A aortic dissection (ATAAD) involves various surgical approaches. Root-sparing and hemiarch methods were used in their analysis for patients at higher risk, while root and whole arch replacement were used for patients at reduced risk.
Their aortic database was queried to find all patients with ATAAD repair in a particular time frame. The univariate and multivariate analysis compared patient outcomes in groups 1 (conservative repair) and 2 (extensive repair).
Repairs using the ATAAD were performed on 343 patients between 1997 and 2019. Of the total number of repairs, 240 were considered conservative (root-sparing, hemiarch), and 103 were considered extensive (root replacement and/or total arch). Patients in Group 1 had a higher average age and a higher prevalence of co-morbidities like hypertension, MI history, and kidney disease. Group 2 had significantly higher rates of aortic insufficiency, intraoperative durations, and connective tissue disease (2.1% vs. 12.6%; P<.01). Individual postoperative complications had a similar incidence rate across methods. Significantly more people in the conservative group experienced a composite of major adverse events (operative mortality, myocardial infarction, stroke, dialysis, or tracheostomy; 15.1% vs. 5.9%; P=.03) than those in the more liberal group. 5.6% of patients died during or after surgery, and the groups had no significant differences. At 10 years, there was no difference in survival rates between the 2 operations.
The cumulative risk of reintervention over 10 years was higher in group 2 (5.6% vs. 21% at ten years; P<.01). Multivariate research revealed that ejection fraction and diabetes predicted severe adverse outcomes, while an exhaustive strategy did not. Late reoperation was associated with a more extensive initial surgical approach (odds ratio, 3.03 [95% confidence interval, 1.29-7.2]; P=.01). Operative success and long-term viability are increased when ATAAD is approached conservatively.
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