Long-Term Outcomes of Antegrade Thoracic Stent Grafting During Repair of Acute DeBakey I Dissection

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2024-09-07 DOI:10.1016/j.athoracsur.2024.07.045

Selim Mosbahi MD , Mikolaj Berezowski MD , Joseph E. Bavaria MD , John J. Kelly MD , Nicholas Goel MD , Fei Jiang BSc , Murat Yildiz MD , Yu Zhao MSc , Wilson Y. Szeto MD , Nimesh D. Desai MD, PhD

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引用次数: 0

Abstract

Background

We aim to evaluate the impact of antegrade stenting of the distal arch and proximal descending aorta combined with non-total arch procedures in acute type A aortic dissection.

Methods

From 2005 to 2022, 733 nonsyndromic patients presented with acute DeBakey type I aortic dissection and underwent non-total arch procedure. Ninety-five patients underwent antegrade stenting and 638 did not. Propensity-score analysis was performed, and 95 optimal pairs were created. Survival was estimated using the Kaplan-Meier method and cumulative incidence of reintervention with death as a competing event was calculated and compared using Gray’s method.

Results

Survival estimates at 10 years after propensity score matching were similar between both groups, 58.9% (95% CI, 46.5%-74.5%) vs 58.4% (95% CI, 48.3%-70.6%) (P = .6) in the non-stented vs stented group. Cumulative incidence of reintervention with competing risk of death at 10 years after propensity matching was 27% (95% CI, 17%-37%) vs 22% (95% CI, 14%-32%) (P = .44), respectively.

Conclusions

Antegrade thoracic endovascular aortic repair may be beneficial for remodeling and facilitating future endovascular reinterventions and reduces the occurrence of reintervention for malperfusion.

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在修复急性 DeBakey I 型胸膜剥离时进行前向胸腔支架移植的长期疗效。

背景：我们旨在评估远端弓和近端降主动脉前向支架植入术与非全弓手术相结合对急性A型主动脉夹层的影响：2005年至2022年，733名非综合征患者因急性DeBakey I型主动脉夹层接受了非全弓手术。95名患者接受了前向支架植入术，638名患者未接受前向支架植入术。进行了倾向分数分析，并创建了 95 个最佳配对。使用 Kaplan-Meier 法估算生存率，使用格雷法计算并比较以死亡为竞争事件的再介入累积发生率：倾向得分匹配后，两组患者的 10 年生存率相似，非支架组为 58.9%（95%CI：46.5-74.5），支架组为 58.4%（95%CI：48.3-70.6）（P=0.6）。倾向匹配后，10年后有死亡竞争风险的再介入累积发生率为27%（95%CI：17-37）对22%（95%CI：14-32）（P=0.44）：前向 TEVAR 可能有利于重塑和促进未来的血管内再介入，并减少因灌注不良而再介入的发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.