Relationship Between the Extent of Aortic Replacement and Stent Graft for Acute DeBakey Type I Aortic Dissection and Outcomes: Results from a Medical Center in Taiwan

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2019 Jan 5

PMID 30608954

Citations 5

Authors

Chiao-Po Hsu

Chun-Yang Huang

Fei-Yi Wu

Affiliations

Soon will be listed here.

Abstract

Background: Total arch replacement (TAR) and/or stent graft implantation has been proposed as the primary surgical treatment for acute DeBakey type I aortic dissection. However, the suggestion was based on excellent outcomes of high-volume or aortic centers. How about the real results in most places around the world? The purpose of this study was intended to compared in-hospital mortality, major complications, and aortic remodeling between TAR and/or stent graft implantation in a medical center of northern Taiwan.

Methods: Between January 2008 and August 2017, 156 patients with acute type I aortic dissection underwent surgery at our institution, including proximal aortic replacement only (Group I, n = 72), concomitant TAR (Group II, n = 23), concomitant TAR extended with stent grafting (Group III, n = 45), and proximal aortic replacement with descending aortic stent grafting (Group IV, n = 16).

Results: No significant differences were found in underlying disease and preoperative presentations, including operative risk among four groups. Overall in-hospital mortality was 22.4% (13 patients in Group I, 9 in Group II, 12 in Group III, and 1 in Group IV). New-onset stroke occurred in 15 patients postoperatively (3 patients [5.2%] in Group I, 3 [21.4%] in Group II, and 9 [26.5%] in Group III after excluding 36 patients with documented preoperative cerebrovascular accident or cerebral malperfusion). Root reconstruction and TAR were significantly associated with in-hospital mortality. TAR was significantly associated with surgery-related stroke. Compared to those in Group I, true lumen expansion and false lumen shrinkage during 1-year aortic remodeling were significantly higher in Groups III and IV. Both TAR and descending aorta stent grafting were significantly associated with decreased risk of patent false lumen.

Conclusions: Proximal aortic replacement remains the preferred surgical strategy for acute type I aortic dissection, with lower mortality and neurological complications. Proximal descending aorta stent grafting may benefit aortic remodeling, even without TAR.

Citing Articles

Outcomes after concomitant arch replacement at the time of aortic root surgery.

Krishnan A, Dalal A, Pedroza A, Nakamura K, Yokoyama N, Tognozzi E JTCVS Open. 2023; 13:1-8.

PMID: 37063158 PMC: 10091289. DOI: 10.1016/j.xjon.2022.12.014.

Frozen elephant trunk in acute type A aortic dissections: frontiers and challenges.

Idhrees M, Velayudhan B Indian J Thorac Cardiovasc Surg. 2022; 38(Suppl 1):79-82.

PMID: 35463715 PMC: 8980971. DOI: 10.1007/s12055-021-01315-w.

Long-term outcomes after ascending aortic replacement and aortic root replacement for type A aortic dissection.

Jormalainen M, Kesavuori R, Raivio P, Vento A, Mustonen C, Honkanen H Interact Cardiovasc Thorac Surg. 2022; 34(3):453-461.

PMID: 35188959 PMC: 8860427. DOI: 10.1093/icvts/ivab324.

Aortic Dissection: A Review of the Pathophysiology, Management and Prospective Advances.

Sayed A, Munir M, Bahbah E Curr Cardiol Rev. 2020; 17(4):e230421186875.

PMID: 33059568 PMC: 8762162. DOI: 10.2174/1573403X16666201014142930.

Late Outcome after Surgery for Type-A Aortic Dissection.

Jormalainen M, Raivio P, Biancari F, Mustonen C, Honkanen H, Venermo M J Clin Med. 2020; 9(9).

PMID: 32847062 PMC: 7563246. DOI: 10.3390/jcm9092731.

References

Uchida N, Shibamura H, Katayama A, Shimada N, Sutoh M . Total arch replacement with an open stent graft for acute type A aortic dissection: fate of the false lumen. Eur J Cardiothorac Surg. 2008; 35(1):83-8. DOI: 10.1016/j.ejcts.2008.09.034. View

Eggebrecht H, Nienaber C, Neuhauser M, Baumgart D, Kische S, Schmermund A . Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J. 2005; 27(4):489-98. DOI: 10.1093/eurheartj/ehi493. View

Spielvogel D, Strauch J, Minanov O, Lansman S, Griepp R . Aortic arch replacement using a trifurcated graft and selective cerebral antegrade perfusion. Ann Thorac Surg. 2002; 74(5):S1810-4; discussion S1825-32. DOI: 10.1016/s0003-4975(02)04156-5. View

Ming Tse K, Chiu P, Lee H, Ho P . Investigation of hemodynamics in the development of dissecting aneurysm within patient-specific dissecting aneurismal aortas using computational fluid dynamics (CFD) simulations. J Biomech. 2011; 44(5):827-36. DOI: 10.1016/j.jbiomech.2010.12.014. View

Moon M, Sundt 3rd T, Pasque M, BARNER H, Huddleston C, Damiano Jr R . Does the extent of proximal or distal resection influence outcome for type A dissections?. Ann Thorac Surg. 2001; 71(4):1244-9; discussion 1249-50. DOI: 10.1016/s0003-4975(00)02610-2. View

Kimura N, Tanaka M, Kawahito K, Yamaguchi A, Ino T, Adachi H . Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2008; 136(5):1160-6, 1166.e1-3. DOI: 10.1016/j.jtcvs.2008.05.052. View

Guthaner D, Miller D, Silverman J, Stinson E, Wexler L . Fate of the false lumen following surgical repair of aortic dissections: an angiographic study. Radiology. 1979; 133(1):1-8. DOI: 10.1148/133.1.1. View

Galvin S, Perera N, Matalanis G . Surgical management of acute type A aortic dissection: branch-first arch replacement with total aortic repair. Ann Cardiothorac Surg. 2016; 5(3):236-44. PMC: 4893537. DOI: 10.21037/acs.2016.05.11. View

Yun K, Glower D, Miller D, Fann J, Mitchell R, White W . Aortic dissection resulting from tear of transverse arch: is concomitant arch repair warranted?. J Thorac Cardiovasc Surg. 1991; 102(3):355-68; discussion 368-70. View

10.

Preventza O, Al-Najjar R, LeMaire S, Weldon S, Coselli J . Total arch replacement with frozen elephant trunk technique. Ann Cardiothorac Surg. 2013; 2(5):649-52. PMC: 3791205. DOI: 10.3978/j.issn.2225-319X.2013.06.01. View

11.

Yan Y, Xu L, Zhang H, Xu Z, Ding X, Wang S . Proximal aortic repair versus extensive aortic repair in the treatment of acute type A aortic dissection: a meta-analysis. Eur J Cardiothorac Surg. 2015; 49(5):1392-401. DOI: 10.1093/ejcts/ezv351. View

12.

Parker J, Golledge J . Outcome of endovascular treatment of acute type B aortic dissection. Ann Thorac Surg. 2008; 86(5):1707-12. DOI: 10.1016/j.athoracsur.2008.06.074. View

13.

Augoustides J, Geirsson A, Szeto W, Walsh E, Cornelius B, Pochettino A . Observational study of mortality risk stratification by ischemic presentation in patients with acute type A aortic dissection: the Penn classification. Nat Clin Pract Cardiovasc Med. 2008; 6(2):140-6. DOI: 10.1038/ncpcardio1417. View

14.

Panos A, Kalangos A, Christofilopoulos P, Khatchatourian G . Combined surgical and endovascular treatment of aortic type A dissection. Ann Thorac Surg. 2005; 80(3):1087-90. DOI: 10.1016/j.athoracsur.2004.09.056. View

15.

Mizuno T, Toyama M, Tabuchi N, Wu H, Sunamori M . Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection. Eur J Cardiothorac Surg. 2002; 22(4):504-9. DOI: 10.1016/s1010-7940(02)00429-3. View

16.

Smith H, Boodhwani M, Ouzounian M, Saczkowski R, Gregory A, Herget E . Classification and outcomes of extended arch repair for acute Type A aortic dissection: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2017; 24(3):450-459. DOI: 10.1093/icvts/ivw355. View

17.

Halstead J, Meier M, Etz C, Spielvogel D, Bodian C, Wurm M . The fate of the distal aorta after repair of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2007; 133(1):127-35. DOI: 10.1016/j.jtcvs.2006.07.043. View

18.

Poon S, Theologou T, Harrington D, Kuduvalli M, Oo A, Field M . Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2016; 5(3):156-73. PMC: 4893527. DOI: 10.21037/acs.2016.05.06. View

19.

Geirsson A, Szeto W, Pochettino A, McGarvey M, Keane M, Woo Y . Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg. 2007; 32(2):255-62. DOI: 10.1016/j.ejcts.2007.04.012. View

20.

Bonser R, Ranasinghe A, Loubani M, Evans J, Thalji N, Bachet J . Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. J Am Coll Cardiol. 2011; 58(24):2455-74. DOI: 10.1016/j.jacc.2011.06.067. View