Late Outcome after Surgery for Type-A Aortic Dissection
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Characteristics
2.2. Outcomes
2.3. Statistical Analysis
3. Results
3.1. Study Cohort
3.2. Late All-Cause Mortality
3.3. Aortic Reoperations
3.4. Outcome of Patients with DeBakey Type I Aortic Dissection
3.5. Maximal Diameter of the Aorta and Risk of Aortic Reoperation
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Covariates | Overall Dataset 309 Patients | All-Cause Mortality | Repeat Procedures on the Distal Aorta | ||
---|---|---|---|---|---|
Univariate Analysis p-Value | Multivariate Analysis HR, 95%CI | Univariate Analysis p-Value | Multivariate Analysis SHR, 95%CI | ||
Age, mean/median (years) | 61.7 (13.2)/63.3 (17.7) | <0.0001 | 1.056, 1.033–1.079 | 0.822 | |
Female | 102 (33.0) | 0.951 | 0.380 | ||
Anemia a | 129 (41.7) | 0.045 | 0.298 | ||
eGFR, mean/median (mL/min/1.73 m2) | 79.3 (27.3)/77.6 (33.0) | 0.027 | 0.277 | ||
Peripheral vascular disease | 13 (4.2) | 0.001 | <0.0001 | 1.14 × 10−8, 4.08 × 10−9–3.16 × 10−8 | |
Diabetes | 25 (8.1) | 0.031 | 1.996, 1.048–3.801 | 0.999 | |
Stroke | 17 (5.5) | 0.848 | 0.775 | ||
Pulmonary disease | 22 (7.1) | 0.372 | 0.169 | ||
Coronary artery disease | 29 (9.4) | 0.025 | 0.913 | ||
Acute myocardial infarction | 32 (10.4) | 0.307 | 0.295 | ||
LVEF ≤50% | 57 (19.3) | 0.081 | 0.034 | ||
Previous cardiac surgery | 13 (4.2) | 0.518 | 0.982 | ||
Acute neurological event | 73 (23.7) | 0.054 | 0.757 | ||
Cardiogenic shock | 68 (22.0) | 0.002 | 0.387 | ||
Resuscitation in operating room | 7 (2.3) | <0.0001 | 6.886, 2.451–19.348 | - | |
Cardiac tamponade | 87 (28.3) | 0.015 | 0.634 | ||
Aortic rupture | 49 (15.9) | 0.062 | 0.744 | ||
Bicuspid aortic valve | 26 (8.4) | 0.134 | 0.523 | ||
Connective tissue disorder | 7 (2.2) | 0.993 | - | ||
Preop. malperfusion at CT b | 138 (46.3) | 0.310 | 0.029 | ||
Cerebral vessel dissection | 108 (35.0) | 0.150 | 1.980, 1.249–3.140 | 0.248 | |
DeBakey Type II dissection | 33 (10.7) | 0.463 | <0.0001 | 2.02 × 10−8, 8.52 × 10−9–4.76 × 10−8 | |
Max. aortic diameter (mm) c | |||||
Aortic root, mean/median | 44.9 (8.3)/44.0 (11.0) | 0.830 | 0.837 | ||
Ascending aorta, mean/median | 51.4 (9.8)/50.0 (10.0) | 0.448 | 0.985 | ||
Aortic arch, mean/median | 38.0 (6.1)/37.0 (9.0) | 0.392 | 0.538 | ||
Descending thoracic aorta, mean/median | 33.3 (6.0)/33.0 (6.0) | 0.004 | <0.0001 | 1.118, 1.064–1.175 | |
EuroSCORE II, mean/median (%) | 13.9 (13.3)/9.0 (11.9) | <0.0001 | 0.295 |
Covariates | Overall Dataset 309 Patients | All-Cause Mortality | Repeat Procedure on the Distal Aorta | ||
---|---|---|---|---|---|
Univariate Analysis p-Value | Multivariate Analysis HR, 95%CI | Univariate Analysis p-Value | Multivariate Analysis SHR, 95%CI | ||
Arterial cannulation a | <0.0001 | <0.0001 | |||
Direct aortic | 80 (25.9) | ||||
Common femoral artery | 131 (42.4) | ||||
Axillary/subclavian artery | 96 (31.1) | ||||
Left ventricle apex | 2 (0.6) | ||||
Aortic root repair/replacement | 94 (30.4) | 0.618 | 0.832 | ||
Type of aortic root repair | 0.652 | <0.0001 | |||
Interposition graft procedure | 210 (68.0) | ||||
Interposition graft + AVR | 5 (1.6) | ||||
Bentall-DeBono procedure | 84 (27.2) | ||||
David procedure | 9 (2.9) | ||||
Yacoub procedure | 1 (0.3) | ||||
Concomitant major cardiac procedure | 43 (13.9) | 0.127 | 0.751 | ||
Open distal anastomosis | 289 (93.5) | 0.295 | 0.644 | ||
Distal aortic anastomosis | 0.144 | <0.0001 | |||
Ascending aorta | 277 (89.6) | - | |||
Between innominate a. and left CCA | 4 (1.3) | 1.06 × 10−8, 1.88 × 10−9–5.94 × 10−8 | |||
Between left CCA and left subclavian a. | 6 (1.9) | 6.029, 1.883–19.306 | |||
Descending thoracic aorta | 22 (7.1) | 0.674, 0.128–3.522 | |||
Hemiarch repair | 264 (85.4) | 0.098 | 0.373 | ||
Partial or total arch repair | 32 (10.4) | 0.025 | 2.770, 1.562–4.913 | 0.738 | |
Partial arch repair | 10 (3.2) | ||||
Total arch repair | 22 (7.1) | ||||
Frozen elephant trunk procedure | 4 (1.3) | 0.028 | - | ||
Aortic cross clamp time, mean/median (min) | 103 (39)/92 (47) | 0.143 | 0.553 | ||
Cardiopulmonary bypass time mean/median (min) | 198 (62)/191 (76) | 0.313 | 0.680 | ||
Hypothermic circulatory arrest | 273 (88.3) | 0.920 | 0.694 | ||
Hypothermic circulatory arrest time mean/median (min) | 27 (11)/26 (35) | 0.260 | 0.172 | ||
Antegrade cerebral perfusion | 57 (18.5) | 0.009 | 0.445 | ||
Antegrade cerebral perfusion time mean/median (min) | 39 (25)/32 (35) | 0.898 | 0.336 | ||
Lowest core temperature, mean/median (°C) | 19 (2)/18 (1) | 0.821 | 0.850 |
Outcomes | Multivariate Analysis HR, 95%CI |
---|---|
Age | 1.066, 1.040–1.092 |
Resuscitation in operating room | 3.912, 1.176–13.021 |
Partial or total arch repair | 2.493, 1.291–4.811 |
Cerebral vessel dissection | 1.653, 1.025–2.666 |
Postop. stroke/global brain ischemia | 1.989, 1.197–3.305 |
Postop. acute kidney injury | 2.156, 1.297–3.582 |
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Jormalainen, M.; Raivio, P.; Biancari, F.; Mustonen, C.; Honkanen, H.-P.; Venermo, M.; Vento, A.; Juvonen, T. Late Outcome after Surgery for Type-A Aortic Dissection. J. Clin. Med. 2020, 9, 2731. https://doi.org/10.3390/jcm9092731
Jormalainen M, Raivio P, Biancari F, Mustonen C, Honkanen H-P, Venermo M, Vento A, Juvonen T. Late Outcome after Surgery for Type-A Aortic Dissection. Journal of Clinical Medicine. 2020; 9(9):2731. https://doi.org/10.3390/jcm9092731
Chicago/Turabian StyleJormalainen, Mikko, Peter Raivio, Fausto Biancari, Caius Mustonen, Hannu-Pekka Honkanen, Maarit Venermo, Antti Vento, and Tatu Juvonen. 2020. "Late Outcome after Surgery for Type-A Aortic Dissection" Journal of Clinical Medicine 9, no. 9: 2731. https://doi.org/10.3390/jcm9092731