To investigate mortality and reoperation rates following limited distal repair after
acute type A aortic dissection (ATAAD) at a single medium volume institution. We analyzed
all patients that underwent limited distal repair (ascending aortic or hemiarch replacement)
following ATAAD between January 1998 and April 2020 at our institution. During the
study period, 489 patients underwent ATAAD surgery, of which 457 (94%) underwent limited
distal repair with a 30-day mortality of 12.9%. Among 30-day survivors, late follow-up
was 97.7% complete with a mean follow-up of 6.0 ± 5.5 years. In all, 50 patients (11%)
required a reoperation during the study period at a mean of 3.4 ± 3.4 years after
initial repair, with a 30-day mortality of 12%. An aortic reoperation was required
in 4.1 (2.0–6.1)%, 10.3 (7.1–13.6)%, 15.1 (10.9–19.4)%, and 18.0 (13.0–22.9)% of patients
at 1, 5, 10, and 15 years. A distal reoperation was required in 3.0 (1.2–4.7)%, 8.0
(5.1–10.9)%, 10.3 (6.8–13.8)%, and 12.4 (8.2–16.5)% of patients and 4.4 (2.3–6.4)%,
10.4 (7.1–13.7)%, 13.9 (9.8–18.0)%, and 16.9 (12.0–21.9)% of patents had a distal
event at 1, 5, 10, and 15 years, respectively. Limited distal repair with an ascending
aortic or hemiarch replacement was associated with acceptable survival and rates of
reoperations and distal events. Limited distal repair is a safe and feasible standard
approach to ATAAD surgery at a medium-volume center.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
ATAAD (acute type A aortic dissection), AV (aortic valve), CAD (coronary artery disease), CI (confidence interval), CPB (cardiopulmonary bypass), COPD (chronic obstructive pulmonary disease), FET (frozen elephant trunk), GERAADA (German Registry for Acute Aortic Dissection Type A), HCA (hypothermic circulatory arrest), ICU (intensive Care Unit), IRAD (International Registry for Acute Aortic Dissection), LOS (length of stay), NORCAAD (Nordic Consortium for Acute Type A Aortic Dissection), SD (standard deviation), TIA (transient ischemic attack)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Seminars in Thoracic and Cardiovascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A contemporary analysis of outcomes for operative repair of type A aortic dissection in the United States.Surgery. 2007; 142 (e1): 524-528
- 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine.Circulation. 2010; 121: 266-369
- Acute type A aortic dissection extending beyond ascending aorta: Limited or extensive distal repair.J Thorac Cardiovasc Surg. 2014; 148: 949-954
- Evolution of simplified frozen elephant trunk repair for acute DeBakey type I dissection: Midterm outcomes.Ann Thorac Surg. 2018; 105: 749-755
- Limited repair with tear-oriented approach for type A aortic dissection.J Cardiovasc Surg (Torino). 2020; 61: 278-284
- Late outcomes of strategic arch resection in acute type A aortic dissection.J Thorac Cardiovasc Surg. 2018; 157: 1313-1321
- Acute DeBakey type I dissection repair using frozen elephant trunk: The Cleveland Clinic technique.Semin Cardiothorac Vasc Anesth. 2017; 21: 200-205
- Reoperation after surgical correction of acute type A aortic dissection: Risk factor analysis.Ann Thorac Surg. 2012; 93: 450-455
- Extended versus limited arch replacement in acute type A aortic dissection.Eur J Cardiothorac Surg. 2017; 52: 1104-1110
- Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation: Experience with 107 patients.J Thorac Cardiovasc Surg. 2009; 138: 1358-1362
- Operative strategy for acute type A aortic dissection: Ascending aortic or hemiarch versus total arch replacement with frozen elephant trunk.Ann Thorac Surg. 2009; 87: 773-777
- Surgery for acute dissection of ascending aorta: Should the arch be included?.J Thorac Cardiovasc Surg. 1992; 104: 46-59
- Surgery for aortic dissection with intimal tear in the transverse aortic arch.Eur J Cardiothorac Surg. 1996; 10: 784-790
- Aortic dissection resulting from tear of transverse arch: Is concomitant arch repair warranted?.J Thorac Cardiovasc Surg. 1991; 102: 355-370
- Early and late outcomes of repaired acute DeBakey type I aortic dissection after graft replacement.J Thorac Cardiovasc Surg. 2016; 151: 341-348
- Is total arch replacement associated with worse outcomes during repair of acute type A aortic dissection?.Ann Thorac Surg. 2015; 100: 2159-2166
- Influence of operative strategy for the aortic arch in DeBakey type I aortic dissection: Analysis of the German Registry for Acute Aortic Dissection Type A.J Thorac Cardiovasc Surg. 2012; 144: 617-623
- Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection.Eur J Cardiothorac Surg. 2011; 40: 881-887
- Proximal aortic repair versus extensive aortic repair in the treatment of acute type A aortic dissection: A meta-analysis.Eur J Cardiothorac Surg. 2016; 49: 1392-1401
- Total arch versus hemiarch replacement for type A acute aortic dissection: A single-center experience.Tex Hear Inst J. 2016; 43: 488-495
- Total arch replacement versus more conservative management in type A acute aortic dissection.Ann Thorac Surg. 2015; 100: 88-94
- Fate of the residual distal and proximal aorta after acute type A dissection repair using a contemporary surgical reconstruction algorithm.Ann Thorac Surg. 2007; 84: 1955-1964
- Late reoperations after repaired acute type A aortic dissection.J Thorac Cardiovasc Surg. 2012; 144: 300-307
- Management and long-term outcome of aortic dissection.Ann Surg. 1991; 214: 31-41
- Risk of late reoperations in patients with acute type A aortic dissection: Impact of a more radical surgical approach.Eur J Cardiothorac Surg. 1998; 13: 576-581
- Aortic dissection: Prevalence, cause, and results of late reoperations.J Thorac Cardiovasc Surg. 1994; 108: 199-206
- Contemporary surgical strategies for acute type A aortic dissection.Semin Thorac Cardiovasc Surg. 2020; 32: 617-629
- Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients.J Thorac Cardiovasc Surg. 2020; 160 (e4): 20-33
- Low rate of reoperations after acute type A aortic dissection repair from The Nordic Consortium Registry.J Thorac Cardiovasc Surg. 2018; 156: 939-948
- A modified frozen elephant trunk technique for acute Stanford type A aortic dissection.J Cardiothorac Surg. 2020; 15: 1-8
- Frozen elephant trunk for DeBakey type 1 dissection: The Cleveland Clinic technique.Ann Cardiothorac Surg. 2016; 5: 251-255
- Acute type A dissection repair by high-volume vs low-volume surgeons at a high-volume aortic center.Ann Thorac Surg. 2019; 108: 1330-1336
- Thoracic aortic aneurysms after acute type A aortic dissection: Necessity for follow-up.Ann Thor Surg. 1990; 49: 580-584
- The frozen elephant trunk technique for acute type A aortic dissection: Results from 15 years of experience.Eur J Cardiothorac Surg. 2014; 47: 355-360
Article info
Publication history
Published online: November 10, 2021
Footnotes
Institutional Review Board Approval: The study was approved by the Ethics Committee for Clinical Research, Lund, Sweden (ref. 2015/197, April 7, 2015).
This study was presented at the AATS Aortic Symposium, 2021.
Funding: This study was funded by grants from the Swedish Medical Training and Research Agreement.
Conflicts of Interest: The authors have no conflicts of interest to report.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: The Art and Science of SimplicitySeminars in Thoracic and Cardiovascular SurgeryVol. 35Issue 1
- PreviewChemtob et al. examined event rates after limited distal repair in patients undergoing repair for acute type A aortic dissection. In a 22-year timeframe at a tertiary referral center that serves 1.9 million people, only 487 people underwent surgery for acute type A aortic dissection (ATAAD). That equals out to 22 patients per year who underwent an operation at this institution for ATAAD. Of these patients, only 30 underwent an extensive distal repair (any arch vessel replacement) with a mortality rate of 23%.
- Full-Text
- Preview
- Commentary: Strike a Happy MediumSeminars in Thoracic and Cardiovascular SurgeryVol. 35Issue 1
