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dc.contributor.authorAcharya, Metesh
dc.contributor.authorEl-Dean, Zein
dc.contributor.authorMariscalco, Giovanni
dc.date.accessioned2023-09-19T09:51:30Z
dc.date.available2023-09-19T09:51:30Z
dc.date.issued2023-10-01
dc.identifier.citationBiancari, F., Juvonen, T., Fiore, A., Perrotti, A., Hervé, A., Touma, J., Pettinari, M., Peterss, S., Buech, J., Dell'Aquila, A. M., Wisniewski, K., Rukosujew, A., Demal, T., Conradi, L., Pol, M., Kacer, P., Onorati, F., Rossetti, C., Vendramin, I., Piani, D., … Mariscalco, G. (2023). Current Outcome after Surgery for Type A Aortic Dissection. Annals of surgery, 278(4), e885–e892. https://doi.org/10.1097/SLA.0000000000005840en_US
dc.identifier.other10.1097/SLA.0000000000005840
dc.identifier.urihttp://hdl.handle.net/20.500.12904/17571
dc.description.abstractObjective: The aim of this study was to evaluate the outcomes of different surgical strategies for acute Stanford type A aortic dissection (TAAD). Summary background data: The optimal extent of aortic resection during surgery for acute TAAD is controversial. Methods: This is a multicenter, retrospective cohort study of patients who underwent surgery for acute TAAD at 18 European hospitals. Results: Out of 3902 consecutive patients, 689 (17.7%) died during the index hospitalization. Among 2855 patients who survived 3 months after surgery, 10-year observed survival was 65.3%, while country-adjusted, age-adjusted, and sex-adjusted expected survival was 81.3%, yielding a relative survival of 80.4%. Among 558 propensity score-matched pairs, total aortic arch replacement increased the risk of in-hospital (21.0% vs. 14.9%, P =0.008) and 10-year mortality (47.1% vs. 40.1%, P =0.001), without decreasing the incidence of distal aortic reoperation (10-year: 8.9% vs. 7.4%, P =0.690) compared with ascending aortic replacement. Among 933 propensity score-matched pairs, in-hospital mortality (18.5% vs. 18.0%, P =0.765), late mortality (at 10-year: 44.6% vs. 41.9%, P =0.824), and cumulative incidence of proximal aortic reoperation (at 10-year: 4.4% vs. 5.9%, P =0.190) after aortic root replacement was comparable to supracoronary aortic replacement. Conclusions: Replacement of the aortic root and aortic arch did not decrease the risk of aortic reoperation in patients with TAAD and should be performed only in the presence of local aortic injury or aneurysm. The relative survival of TAAD patients is poor and suggests that the causes underlying aortic dissection may also impact late mortality despite surgical repair of the dissected aorta. Trial registration: ClinicalTrials.gov NCT04831073.
dc.description.urihttps://journals.lww.com/annalsofsurgery/abstract/2023/10000/current_outcome_after_surgery_for_type_a_aortic.51.aspxen_US
dc.language.isoenen_US
dc.subjecttype A aortic dissectionen_US
dc.subjectTAADen_US
dc.titleCurrent outcome after surgery for type A aortic dissectionen_US
dc.typeArticleen_US
rioxxterms.funderDefault funderen_US
rioxxterms.identifier.projectDefault projecten_US
rioxxterms.versionNAen_US
rioxxterms.versionofrecordhttps://doi.org/10.1097/SLA.0000000000005840en_US
rioxxterms.typeJournal Article/Reviewen_US
refterms.panelUnspecifieden_US
html.description.abstractObjective: The aim of this study was to evaluate the outcomes of different surgical strategies for acute Stanford type A aortic dissection (TAAD). Summary background data: The optimal extent of aortic resection during surgery for acute TAAD is controversial. Methods: This is a multicenter, retrospective cohort study of patients who underwent surgery for acute TAAD at 18 European hospitals. Results: Out of 3902 consecutive patients, 689 (17.7%) died during the index hospitalization. Among 2855 patients who survived 3 months after surgery, 10-year observed survival was 65.3%, while country-adjusted, age-adjusted, and sex-adjusted expected survival was 81.3%, yielding a relative survival of 80.4%. Among 558 propensity score-matched pairs, total aortic arch replacement increased the risk of in-hospital (21.0% vs. 14.9%, P =0.008) and 10-year mortality (47.1% vs. 40.1%, P =0.001), without decreasing the incidence of distal aortic reoperation (10-year: 8.9% vs. 7.4%, P =0.690) compared with ascending aortic replacement. Among 933 propensity score-matched pairs, in-hospital mortality (18.5% vs. 18.0%, P =0.765), late mortality (at 10-year: 44.6% vs. 41.9%, P =0.824), and cumulative incidence of proximal aortic reoperation (at 10-year: 4.4% vs. 5.9%, P =0.190) after aortic root replacement was comparable to supracoronary aortic replacement. Conclusions: Replacement of the aortic root and aortic arch did not decrease the risk of aortic reoperation in patients with TAAD and should be performed only in the presence of local aortic injury or aneurysm. The relative survival of TAAD patients is poor and suggests that the causes underlying aortic dissection may also impact late mortality despite surgical repair of the dissected aorta. Trial registration: ClinicalTrials.gov NCT04831073.en_US
rioxxterms.funder.project94a427429a5bcfef7dd04c33360d80cden_US


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