TY - JOUR
T1 - Does the extent of proximal or distal resection influence outcome for type A dissections?
AU - Moon, Marc R.
AU - Sundt, Thoralf M.
AU - Pasque, Michael K.
AU - Barner, Hendrick B.
AU - Huddleston, Charles B.
AU - Damiano, Ralph J.
AU - Gay, William A.
PY - 2001/5/1
Y1 - 2001/5/1
N2 - Background. The extent of proximal and distal aortic resection that should be performed for acute type A aortic dissections remains controversial. Methods. From 1984 to 1999, 119 patients underwent repair of an acute type A dissection. Distal resection was to the ascending aorta in 78 (66%) and hemiarch in 41 (34%) patients. Proximally, the aortic valve was preserved in 69 (58%) patients, 40 (34%) underwent composite valve grafting, and 10 (8%) underwent separate graft and valve replacement. Results. Operative mortality was higher for separate graft and valve (50% ± 16%) than for valve preservation (16% ± 5%) or composite grafts (20% ± 7%) (p < 0.05). Hemiarch replacement did not increase operative risk compared to distal reconstruction to the ascending aorta (17% ± 6% versus 22% ± 5%, p > 0.71). At 10 years, freedom from reoperation was 81% ± 7% and long-term survival was 60% ± 8%, but neither was related to the proximal or distal surgical technique (p > 0.15). Risk factors for late reoperation included a nonresected primary tear and Marfan syndrome (p < 0.05). Conclusions. An aggressive surgical approach, including a full root or hemiarch replacement, is not associated with increased operative risk and should be considered when type A dissections extensively involve the valve, sinuses, or arch.
AB - Background. The extent of proximal and distal aortic resection that should be performed for acute type A aortic dissections remains controversial. Methods. From 1984 to 1999, 119 patients underwent repair of an acute type A dissection. Distal resection was to the ascending aorta in 78 (66%) and hemiarch in 41 (34%) patients. Proximally, the aortic valve was preserved in 69 (58%) patients, 40 (34%) underwent composite valve grafting, and 10 (8%) underwent separate graft and valve replacement. Results. Operative mortality was higher for separate graft and valve (50% ± 16%) than for valve preservation (16% ± 5%) or composite grafts (20% ± 7%) (p < 0.05). Hemiarch replacement did not increase operative risk compared to distal reconstruction to the ascending aorta (17% ± 6% versus 22% ± 5%, p > 0.71). At 10 years, freedom from reoperation was 81% ± 7% and long-term survival was 60% ± 8%, but neither was related to the proximal or distal surgical technique (p > 0.15). Risk factors for late reoperation included a nonresected primary tear and Marfan syndrome (p < 0.05). Conclusions. An aggressive surgical approach, including a full root or hemiarch replacement, is not associated with increased operative risk and should be considered when type A dissections extensively involve the valve, sinuses, or arch.
UR - http://www.scopus.com/inward/record.url?scp=0035059796&partnerID=8YFLogxK
U2 - 10.1016/S0003-4975(00)02610-2
DO - 10.1016/S0003-4975(00)02610-2
M3 - Article
C2 - 11308168
AN - SCOPUS:0035059796
VL - 71
SP - 1244
EP - 1249
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 4
ER -