Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger
Biancari, Fausto; Lega, Javier Rodriguez; Mariscalco, Giovanni; Peterss, Sven; Buech, Joscha; Fiore, Antonio; Perrotti, Andrea; Rukosujew, Andreas; Pinto, Angel G; Demal, Till; Wisniewski, Konrad; Pol, Marek; Gatti, Giuseppe; Vendramin, Igor; Rinaldi, Mauro; Pruna-Guillen, Robert; Di Perna, Dario; El-Dean, Zein; Sherzad, Hiwa; Nappi, Francesco; Field, Mark; Pettinari, Matteo; Jormalainen, Mikko; Dell'Aquila, Angelo M; Onorati, Francesco; Quintana, Eduard; Juvonen, Tatu; Mäkikallio, Timo (2024-05-20)
Oxford University Press
20.05.2024
Fausto Biancari, Javier Rodriguez Lega, Giovanni Mariscalco, Sven Peterss, Joscha Buech, Antonio Fiore, Andrea Perrotti, Andreas Rukosujew, Angel G Pinto, Till Demal, Konrad Wisniewski, Marek Pol, Giuseppe Gatti, Igor Vendramin, Mauro Rinaldi, Robert Pruna-Guillen, Dario Di Perna, Zein El-Dean, Hiwa Sherzad, Francesco Nappi, Mark Field, Matteo Pettinari, Mikko Jormalainen, Angelo M Dell’Aquila, Francesco Onorati, Eduard Quintana, Tatu Juvonen, Timo Mäkikallio, Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger, BJS Open, Volume 8, Issue 3, June 2024, zrae047, https://doi.org/10.1093/bjsopen/zrae047
https://creativecommons.org/licenses/by/4.0/
© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
https://creativecommons.org/licenses/by/4.0/
© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
https://creativecommons.org/licenses/by/4.0/
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:oulu-202405213763
https://urn.fi/URN:NBN:fi:oulu-202405213763
Tiivistelmä
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.
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.
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