Outcomes of Reoperative Aortic Root Replacement After Previous Acute Type A Dissection Repair

IF 2.6 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
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Abstract

Limited aortic root repair for acute type A dissection is associated with greater risk of proximal reoperations compared to full aortic root replacement. Surgical outcomes for patients undergoing reoperative root replacement after previous dissection repair are unknown. This study seeks to determine outcomes for these patients to further inform the debate surrounding optimal upfront management of the aortic root in acute dissection. Retrospective record review of all patients who underwent full aortic root replacement after a previous type A dissection repair operation at a tertiary academic referral center from 2004–2020 was performed. Among 57 cases of reoperative root replacement after type A repair, 35 cases included concomitant aortic arch replacements, and 21 cases involved coronary reconstruction (unilateral or bilateral modified Cabrol grafts). There were 3 acute postoperative strokes and 4 operative mortalities (composite 30-day and in-hospital deaths, 7.0%). Mid-term outcomes were equivalent for patients who required arch replacement compared to isolated proximal repairs (81.8% vs 80.6% estimated 5-year survival, median follow-up 5.53 years. Reoperative root replacement after index type A dissection repairs, including those with concomitant aortic arch replacement and/or coronary reconstruction is achievable with acceptable outcomes at an experienced aortic center.

Abstract Image

既往急性 A 型夹层修复术后再手术主动脉根置换术的疗效。
与完全主动脉根部置换术相比,急性 A 型夹层的有限主动脉根部修复术与近端再次手术的更大风险相关。先前接受夹层修复术后再次接受主动脉根部置换术的患者的手术效果尚不清楚。本研究旨在确定这些患者的疗效,从而为围绕急性夹层主动脉根部最佳前期处理的讨论提供进一步信息。研究人员对一家三级学术转诊中心 2004-2020 年间所有接受过 A 型夹层修复手术后接受主动脉根部完全置换术的患者进行了回顾性记录审查。在 57 例 A 型修复术后再次进行主动脉根部置换的病例中,35 例同时进行了主动脉弓置换,21 例进行了冠状动脉重建(单侧或双侧改良卡布罗尔移植物)。术后急性中风 3 例,术后死亡 4 例(30 天和院内综合死亡率为 7.0%)。与孤立的近端修复相比,需要进行牙弓置换的患者的中期疗效相当(5年生存率估计为81.8% vs 80.6%,中位随访时间为5.53年)。在有经验的主动脉中心,进行指数A型夹层修复术后,包括同时进行主动脉弓置换和/或冠状动脉重建的患者,都可以进行再手术根部置换,并获得可接受的结果。
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来源期刊
Seminars in Thoracic and Cardiovascular Surgery
Seminars in Thoracic and Cardiovascular Surgery Medicine-Pulmonary and Respiratory Medicine
CiteScore
5.80
自引率
0.00%
发文量
324
审稿时长
12 days
期刊介绍: Seminars in Thoracic and Cardiovascular Surgery is devoted to providing a forum for cardiothoracic surgeons to disseminate and discuss important new information and to gain insight into unresolved areas of question in the specialty. Each issue presents readers with a selection of original peer-reviewed articles accompanied by editorial commentary from specialists in the field. In addition, readers are offered valuable invited articles: State of Views editorials and Current Readings highlighting the latest contributions on central or controversial issues. Another prized feature is expert roundtable discussions in which experts debate critical questions for cardiothoracic treatment and care. Seminars is an invitation-only publication that receives original submissions transferred ONLY from its sister publication, The Journal of Thoracic and Cardiovascular Surgery. As we continue to expand the reach of the Journal, we will explore the possibility of accepting unsolicited manuscripts in the future.
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