Extensive aortic surgery in acute aortic dissection type A on outcome – insights from 25 years single center experience
Abstract Background This single center study compares the different surgical techniques used in the treatment of acute aortic dissection type A (AADA) analyzing the influence of the extent of the surgical approach on outcome. Methods From 1988 to 2012, 407 patients were operated for AADA. The cohort...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-11-01
|
| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13019-019-1007-7 |
| _version_ | 1818347460781670400 |
|---|---|
| author | Bashar Dib Philipp Christian Seppelt Rawa Arif Alexander Weymann Gábor Veres Bastian Schmack Carsten J. Beller Arjang Ruhparwar Matthias Karck Klaus Kallenbach |
| author_facet | Bashar Dib Philipp Christian Seppelt Rawa Arif Alexander Weymann Gábor Veres Bastian Schmack Carsten J. Beller Arjang Ruhparwar Matthias Karck Klaus Kallenbach |
| author_sort | Bashar Dib |
| collection | DOAJ |
| description | Abstract Background This single center study compares the different surgical techniques used in the treatment of acute aortic dissection type A (AADA) analyzing the influence of the extent of the surgical approach on outcome. Methods From 1988 to 2012, 407 patients were operated for AADA. The cohort was divided into subgroups according to the surgical approach. These groups were compared with the supracommissural replacement group (SCR; n = 141). Groups included aortic valve sparing techniques (AVS; n = 29), Composite replacement (COMP; n = 119), COMP with total arch replacement (COMP+TAR; n = 27) and SCR with TAR (n = 75). Results Compared to SCR alone, operation (p = 0.005), bypass-, cross-clamp and circulatory arrest times were longer in SCR + TAR (all p < 0.001). Moreover, operation, bypass and cross clamp times were longer in COMP+TAR (p = 0.003, p = 0.002 and p < 0.001 respectively). COMP alone and AVS required longer cross-clamp time, too (p < 0,001 and p = 0.002, respectively). Overall 30-day mortality was 21% with the observed lowest rate after AVS (14%, SCR 18%, COMP 25%) but differences in 30-day mortality were not statistically significant. The estimated 10-year survival was 42%, especially AVS demonstrated a good 10-year survival (69%). David technique was superior to Yacoub technique concerning incidence of redo interventions (p = 0.036). Risk factors for early mortality included age, circulatory arrest, general malperfusion, bypass and operation time. Circulatory arrest per se was revealed as risk factor for long-term survival. Conclusions Within our single center retrospective study concomitant aortic root repair or aortic arch replacement for AADA demonstrated acceptable early and long-term survival. Circulatory arrest, long bypass and operation times per se might be important risk factors for early mortality. AVS techniques can be performed safely and have good outcomes in acute aortic dissection repair. |
| first_indexed | 2024-12-13T17:34:31Z |
| format | Article |
| id | doaj.art-ffb467596716427a8dc2e9b6db611c29 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-12-13T17:34:31Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-ffb467596716427a8dc2e9b6db611c292022-12-21T23:36:58ZengBMCJournal of Cardiothoracic Surgery1749-80902019-11-0114111010.1186/s13019-019-1007-7Extensive aortic surgery in acute aortic dissection type A on outcome – insights from 25 years single center experienceBashar Dib0Philipp Christian Seppelt1Rawa Arif2Alexander Weymann3Gábor Veres4Bastian Schmack5Carsten J. Beller6Arjang Ruhparwar7Matthias Karck8Klaus Kallenbach9Department of Cardiac Surgery, University Hospital HeidelbergDepartment of Medicine, Cardiology, Goethe University HospitalDepartment of Cardiac Surgery, University Hospital HeidelbergDepartment of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University OldenburgDepartment of Cardiac Surgery, University Hospital HeidelbergDepartment of Cardiac Surgery, University Hospital HeidelbergDepartment of Cardiac Surgery, University Hospital HeidelbergDepartment of Cardiac Surgery, University Hospital HeidelbergDepartment of Cardiac Surgery, University Hospital HeidelbergDepartment of Cardiac Surgery, INCCI HaerzZenterAbstract Background This single center study compares the different surgical techniques used in the treatment of acute aortic dissection type A (AADA) analyzing the influence of the extent of the surgical approach on outcome. Methods From 1988 to 2012, 407 patients were operated for AADA. The cohort was divided into subgroups according to the surgical approach. These groups were compared with the supracommissural replacement group (SCR; n = 141). Groups included aortic valve sparing techniques (AVS; n = 29), Composite replacement (COMP; n = 119), COMP with total arch replacement (COMP+TAR; n = 27) and SCR with TAR (n = 75). Results Compared to SCR alone, operation (p = 0.005), bypass-, cross-clamp and circulatory arrest times were longer in SCR + TAR (all p < 0.001). Moreover, operation, bypass and cross clamp times were longer in COMP+TAR (p = 0.003, p = 0.002 and p < 0.001 respectively). COMP alone and AVS required longer cross-clamp time, too (p < 0,001 and p = 0.002, respectively). Overall 30-day mortality was 21% with the observed lowest rate after AVS (14%, SCR 18%, COMP 25%) but differences in 30-day mortality were not statistically significant. The estimated 10-year survival was 42%, especially AVS demonstrated a good 10-year survival (69%). David technique was superior to Yacoub technique concerning incidence of redo interventions (p = 0.036). Risk factors for early mortality included age, circulatory arrest, general malperfusion, bypass and operation time. Circulatory arrest per se was revealed as risk factor for long-term survival. Conclusions Within our single center retrospective study concomitant aortic root repair or aortic arch replacement for AADA demonstrated acceptable early and long-term survival. Circulatory arrest, long bypass and operation times per se might be important risk factors for early mortality. AVS techniques can be performed safely and have good outcomes in acute aortic dissection repair.http://link.springer.com/article/10.1186/s13019-019-1007-7Aortic dissectionAortic valve sparingDavid techniqueAortic arch replacement |
| spellingShingle | Bashar Dib Philipp Christian Seppelt Rawa Arif Alexander Weymann Gábor Veres Bastian Schmack Carsten J. Beller Arjang Ruhparwar Matthias Karck Klaus Kallenbach Extensive aortic surgery in acute aortic dissection type A on outcome – insights from 25 years single center experience Journal of Cardiothoracic Surgery Aortic dissection Aortic valve sparing David technique Aortic arch replacement |
| title | Extensive aortic surgery in acute aortic dissection type A on outcome – insights from 25 years single center experience |
| title_full | Extensive aortic surgery in acute aortic dissection type A on outcome – insights from 25 years single center experience |
| title_fullStr | Extensive aortic surgery in acute aortic dissection type A on outcome – insights from 25 years single center experience |
| title_full_unstemmed | Extensive aortic surgery in acute aortic dissection type A on outcome – insights from 25 years single center experience |
| title_short | Extensive aortic surgery in acute aortic dissection type A on outcome – insights from 25 years single center experience |
| title_sort | extensive aortic surgery in acute aortic dissection type a on outcome insights from 25 years single center experience |
| topic | Aortic dissection Aortic valve sparing David technique Aortic arch replacement |
| url | http://link.springer.com/article/10.1186/s13019-019-1007-7 |
| work_keys_str_mv | AT bashardib extensiveaorticsurgeryinacuteaorticdissectiontypeaonoutcomeinsightsfrom25yearssinglecenterexperience AT philippchristianseppelt extensiveaorticsurgeryinacuteaorticdissectiontypeaonoutcomeinsightsfrom25yearssinglecenterexperience AT rawaarif extensiveaorticsurgeryinacuteaorticdissectiontypeaonoutcomeinsightsfrom25yearssinglecenterexperience AT alexanderweymann extensiveaorticsurgeryinacuteaorticdissectiontypeaonoutcomeinsightsfrom25yearssinglecenterexperience AT gaborveres extensiveaorticsurgeryinacuteaorticdissectiontypeaonoutcomeinsightsfrom25yearssinglecenterexperience AT bastianschmack extensiveaorticsurgeryinacuteaorticdissectiontypeaonoutcomeinsightsfrom25yearssinglecenterexperience AT carstenjbeller extensiveaorticsurgeryinacuteaorticdissectiontypeaonoutcomeinsightsfrom25yearssinglecenterexperience AT arjangruhparwar extensiveaorticsurgeryinacuteaorticdissectiontypeaonoutcomeinsightsfrom25yearssinglecenterexperience AT matthiaskarck extensiveaorticsurgeryinacuteaorticdissectiontypeaonoutcomeinsightsfrom25yearssinglecenterexperience AT klauskallenbach extensiveaorticsurgeryinacuteaorticdissectiontypeaonoutcomeinsightsfrom25yearssinglecenterexperience |