Treatment approach to type A aortic dissection with malperfusion, immediate open aortic
repair vs upfront endovascular treatment, remains controversial. From January 2017
to July 2021, 301 consecutive type A repairs were evaluated at our institution. Starting
in 2019, all type A aortic dissections were performed in a fixed-fluoroscopy, hybrid
operating room. Propensity score matching was used to control baseline patient characteristics
between traditional and hybrid operating room approaches. There were 144 patients
in the traditional group and 157 in the hybrid group. In the hybrid group, 41% (64/157)
underwent intraoperative angiograms, and of those, 58% (37/64) received at least 1
endovascular intervention. Following propensity matching, 125 patients remained in
each the traditional and hybrid groups. Thirty-day survival was significantly improved
in the hybrid cohort at 96.7% (122/125) as compared to the traditional cohort at 87.2%
(109/125) (P = 0.002). There were no significant differences in perioperative paralysis (1.6% vs 1.6%,
P > 0.9), new hemodialysis (12% vs 9.6%, P = 0.5), fasciotomy (2.4% vs 5.6%, P = 0.20, and exploratory laparotomy (1.6% vs 4.8%, P = 0.3). The hybrid operating room approach to type A aortic dissection, provides the ability
to immediately assess distal malperfusion and perform endovascular interventions at
the time of open aortic repair, and is associated with significantly higher 30-day
and 2-year survival when compared to a stepwise repair approach in a traditional operating
room.
Graphical Abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: December 22, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: The authors acknowledge research funding from the National Institutes of Health F32HL160058 (ARD).
Disclosures: Authors have no commercial support to disclose.
IRB/Informed Consent: All elements of this study were prospectively approved with waiver of individual patient consent by the Institutional Review Board (IRB) at Stanford University (IRB: #56359 Approved 11/18/2021).
Read at the 48th Annual Meeting of the Western Thoracic Surgical Association, June 22 - 25, 2022, Koloa, Hawaii.
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