DOI QR코드

DOI QR Code

Surgical Outcomes of Type A Aortic Dissection at a Small-Volume Medical Center: Analysis according to the Extent of Surgery

  • Lee, Chul Ho (Department of Thoracic and Cardiovascular Surgery, School of Medicine, Catholic University of Daegu) ;
  • Cho, Jun Woo (Department of Thoracic and Cardiovascular Surgery, School of Medicine, Catholic University of Daegu) ;
  • Jang, Jae Seok (Department of Thoracic and Cardiovascular Surgery, School of Medicine, Catholic University of Daegu) ;
  • Yoon, Tae Hong (Department of Thoracic and Cardiovascular Surgery, School of Medicine, Catholic University of Daegu)
  • 투고 : 2019.04.29
  • 심사 : 2019.08.27
  • 발행 : 2020.04.05

초록

Background: Despite progress in treatment, Stanford type A aortic dissection is still a life-threatening disease. In this study, we analyzed surgical outcomes in patients with Stanford type A aortic dissection according to the extent of surgery at Daegu Catholic University Medical Center. Methods: We retrospectively analyzed 98 patients with Stanford type A aortic dissection who underwent surgery at our institution between January 2008 and June 2018. Of these patients, 82 underwent limited replacement (hemi-arch or ascending aortic replacement), while 16 patients underwent total arch replacement (TAR). We analyzed in-hospital mortality, postoperative complications, the overall 5-year survival rate, and the 5-year aortic event-free survival rate. Results: The median follow-up time was 48 months (range, 1-128 months), with a completion rate of 85.7% (n=84). The overall in-hospital mortality rate was 8.2%: 6.1% in the limited replacement group and 18.8% in the TAR group (p=0.120). The overall 5-year survival rate was 78.8% in the limited replacement group and 81.3% in the TAR group (p=0.78). The overall 5-year aortic event-free survival rate was 85.3% in the limited replacement group and 88.9% in the TAR group (p=0.46). Conclusion: The extent of surgery was not related to the rates of in-hospital mortality, complications, aortic events, or survival. Although this study was conducted at a small-volume center, the in-hospital mortality and 5-year survival rates were satisfactory.

키워드

참고문헌

  1. Criado FJ. Aortic dissection: a 250-year perspective. Tex Heart Inst J 2011;38:694-700.
  2. De Bakey ME, Cooley DA, Creech O Jr. Surgical considerations of dissecting aneurysm of the aorta. Ann Surg 1955;142:586-612. https://doi.org/10.1097/00000658-195510000-00005
  3. Rice RD, Sandhu HK, Leake SS, et al. Is total arch replacement associated with worse outcomes during repair of acute type A aortic dissection? Ann Thorac Surg 2015;100:2159-66. https://doi.org/10.1016/j.athoracsur.2015.06.007
  4. Trivedi D, Navid F, Balzer JR, et al. Aggressive aortic arch and carotid replacement strategy for type A aortic dissection improves neurologic outcomes. Ann Thorac Surg 2016;101:896-905. https://doi.org/10.1016/j.athoracsur.2015.08.073
  5. Moon MR, Sundt TM 3rd, Pasque MK, et al. Does the extent of proximal or distal resection influence outcome for type A dissections? Ann Thorac Surg 2001;71:1244-50. https://doi.org/10.1016/S0003-4975(00)02610-2
  6. Merlo AE, Chauhan D, Pettit C, et al. Outcomes following emergent open repair for thoracic aortic dissection are improved at higher volume centers in direct admissions and transfers. J Cardiothorac Surg 2016;11:118. https://doi.org/10.1186/s13019-016-0529-5
  7. Arsalan M, Squiers JJ, Herbert MA, et al. Comparison of outcomes of operative therapy for acute type A aortic dissections provided at high-volume versus low-volume medical centers in North Texas. Am J Cardiol 2017;119:323-7. https://doi.org/10.1016/j.amjcard.2016.09.034
  8. Bashir M, Harky A, Fok M, et al. Acute type A aortic dissection in the United Kingdom: surgeon volume-outcome relation. J Thorac Cardiovasc Surg 2017;154:398-406. https://doi.org/10.1016/j.jtcvs.2017.02.015
  9. Kim JB, Chung CH, Moon DH, et al. Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection. Eur J Cardiothorac Surg 2011;40:881-7.
  10. Larsen M, Trimarchi S, Patel HJ, et al. Extended versus limited arch replacement in acute type A aortic dissection. Eur J Cardiothorac Surg 2017;52:1104-10. https://doi.org/10.1093/ejcts/ezx214
  11. Lio A, Nicolo F, Bovio E, et al. Total arch versus hemiarch replacement for type A acute aortic dissection: a single-center experience. Tex Heart Inst J 2016;43:488-95. https://doi.org/10.14503/THIJ-15-5379
  12. Chiu P, Trojan J, Tsou S, Goldstone AB, Woo YJ, Fischbein MP. Limited root repair in acute type A aortic dissection is safe but results in increased risk of reoperation. J Thorac Cardiovasc Surg 2018;155:1-7. https://doi.org/10.1016/j.jtcvs.2017.08.137
  13. Di Eusanio M, Trimarchi S, Peterson MD, et al. Root replacement surgery versus more conservative management during type A acute aortic dissection repair. Ann Thorac Surg 2014;98:2078-84. https://doi.org/10.1016/j.athoracsur.2014.06.070
  14. Di Marco L, Leone A, Murana G, et al. Acute type A aortic dissection: rationale and outcomes of extensive repair of the arch and distal aorta. Int J Cardiol 2018;267:145-9. https://doi.org/10.1016/j.ijcard.2018.05.111
  15. Cho K, Jeong J, Park J, Yun S, Woo J. Long-term changes in the distal aorta after aortic arch replacement in acute DeBakey type I aortic dissection. Korean J Thorac Cardiovasc Surg 2016;49:264-72. https://doi.org/10.5090/kjtcs.2016.49.4.264
  16. Tagusari O, Ogino H, Kobayashi J, et al. Should the transverse aortic arch be replaced simultaneously with aortic root replacement for annuloaortic ectasia in Marfan syndrome? J Thorac Cardiovasc Surg 2004;127:1373-80. https://doi.org/10.1016/j.jtcvs.2004.01.009
  17. Schoenhoff FS, Kadner A, Czerny M, et al. Should aortic arch replacement be performed during initial surgery for aortic root aneurysm in patients with Marfan syndrome? Eur J Cardiothorac Surg 2013;44:346-51. https://doi.org/10.1093/ejcts/ezs705
  18. Bachet J, Larrazet F, Goudot B, et al. When should the aortic arch be replaced in Marfan patients? Ann Thorac Surg 2007;83:S774-9, S785-90. https://doi.org/10.1016/j.athoracsur.2006.10.085
  19. Genoni M, Paul M, Jenni R, Graves K, Seifert B, Turina M. Chronic beta-blocker therapy improves outcome and reduces treatment costs in chronic type B aortic dissection. Eur J Cardiothorac Surg 2001;19:606-10. https://doi.org/10.1016/S1010-7940(01)00662-5
  20. Melby SJ, Zierer A, Damiano RJ Jr, Moon MR. Importance of blood pressure control after repair of acute type A aortic dissection: 25-year follow-up in 252 patients. J Clin Hypertens (Greenwich) 2013;15:63-8. https://doi.org/10.1111/jch.12024

피인용 문헌

  1. Can preoperative neutrophil-to-lymphocyte ratio predict in-hospital mortality in postoperative patients with Stanford type A aortic dissection? Evidence-based appraisal by meta-analysis and GRADE vol.33, pp.4, 2020, https://doi.org/10.4103/tcmj.tcmj_249_20