Simple vs Complex Aortic Arch Repair in Acute Type A Aortic Dissection.

IF 3.8 2区医学 Q1 SURGERY

Journal of the American College of Surgeons Pub Date : 2025-04-01 Epub Date: 2025-03-17 DOI:10.1097/XCS.0000000000001300

Jordyn Pendarvis, Omar M Sharaf, Ahmet Bilgili, Zhihua Jiang, Jaden A Jeng, Daniel S Demos, John R Spratt, Phillip Hess, Thomas M Beaver, Gilbert R Upchurch, Tomas D Martin, Eric I Jeng

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引用次数: 0

Abstract

Background: The purpose of this study was to evaluate the clinical outcomes of patients undergoing a simpler (hemiarch) vs complex (zone 2 arch) aortic repair for acute type A aortic dissection (TAAD).

Study design: Adults (18 years or older) who underwent hemiarch or zone 2 arch repair for acute, hyperacute, or acute on chronic TAAD at a single institution between January 2018 and April 2024 were reviewed. Disabling stroke was defined as a modified Rankin scale of 4 or greater. Statistical analysis included univariate comparisons, Kaplan-Meier analysis, and multivariable modeling.

Results: Two hundred eighty-three patients with acute TAAD underwent hemiarch (44.5%, n = 126) and/or zone 2 arch (55.5%, n = 157) repair. Hemiarch patients were older (63.3 ± 14.1 vs 56.3 ± 12.2 years, p < 0.001), but had lower rates of preoperative cerebrovascular disease (11.1% [n = 14] vs 21.7% [n = 34], p = 0.03), chronic kidney disease (16.7% [n = 21] vs 33.1% [n = 52], p = 0.003), and previous sternotomy (13.5% [n = 17] vs 35.0% [n = 55], p < 0.001). Cardiopulmonary bypass and cross-clamp times were shorter in hemiarch patients (214 ± 78.5 vs 261 ± 62.3 minutes, p < 0.001; 135 ± 54.4 vs 182 ± 60.0 minutes, p < 0.001, respectively). Postoperatively, there was no difference in the rate of disabling stroke (4.5% [n = 13], p = 0.12), tracheostomy (14.8% [n = 43], p = 0.15), pneumonia (17.2% [n = 50], p = 0.24), or renal failure requiring permanent dialysis (6.2% [n = 18], p = 0.47). In multivariable analysis, older age (hazard ratio 1.05, 95% CI 1.02 to 1.08) was a risk factor for longitudinal mortality, while complex aortic arch repair did not confer an increased risk (hazard ratio 0.68, 95% CI 0.35 to 1.31).

Conclusions: Complex aortic arch reconstruction provides a framework for downstream endovascular procedures for the remaining aorta and can be performed in acute TAAD without increased risk of morbidity or mortality compared with a simpler repair.

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来源期刊

Journal of the American College of Surgeons 医学-外科

CiteScore

6.90

自引率

5.80%

发文量

1515

审稿时长

3-6 weeks

期刊介绍： The Journal of the American College of Surgeons (JACS) is a monthly journal publishing peer-reviewed original contributions on all aspects of surgery. These contributions include, but are not limited to, original clinical studies, review articles, and experimental investigations with clear clinical relevance. In general, case reports are not considered for publication. As the official scientific journal of the American College of Surgeons, JACS has the goal of providing its readership the highest quality rapid retrieval of information relevant to surgeons.