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Outcome After Surgery for Acute Type A Aortic Dissection With or Without Primary Tear Resection

Outcome After Surgery for Acute Type A Aortic Dissection With or Without Primary Tear Resection


Title: Outcome After Surgery for Acute Type A Aortic Dissection With or Without Primary Tear Resection
Author: Uimonen, Mikko
Olsson, Christian
Jeppsson, Anders
Geirsson, Arnar   orcid.org/0000-0002-8943-9962
Chemtob, Raphaelle
Khalil, Ahmad
Hjortdal, Vibeke
Hansson, Emma C.
Nozohoor, Shahab
Zindovic, Igor
... 5 more authors Show all authors
Date: 2022-08-01
Language: English
Scope: 10
Department: Faculty of Medicine
Cardio-Vascular Center
Series: Annals of Thoracic Surgery; 114(2)
ISSN: 0003-4975
DOI: https://doi.org/10.1016/j.athoracsur.2021.09.067
Subject: Acute Disease; Aortic Dissection/surgery; Aorta/surgery; Aortic Aneurysm, Thoracic/surgery; Blood Vessel Prosthesis Implantation; Follow-Up Studies; Humans; Lacerations/surgery; Retrospective Studies; Treatment Outcome; Cardiology and Cardiovascular Medicine; Pulmonary and Respiratory Medicine; Surgery
URI: https://hdl.handle.net/20.500.11815/3834

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Citation:

Uimonen , M , Olsson , C , Jeppsson , A , Geirsson , A , Chemtob , R , Khalil , A , Hjortdal , V , Hansson , E C , Nozohoor , S , Zindovic , I , Gunn , J , Wickbom , A , Ahlsson , A , Gudbjartsson , T & Mennander , A 2022 , ' Outcome After Surgery for Acute Type A Aortic Dissection With or Without Primary Tear Resection ' , Annals of Thoracic Surgery , vol. 114 , no. 2 , pp. 492-501 . https://doi.org/10.1016/j.athoracsur.2021.09.067

Abstract:

Background: The outcome in patients after surgery for acute type A aortic dissection without replacement of the part of the aorta containing the primary tear is undefined. Methods: Data of 1122 patients who underwent surgery for acute type A aortic dissection in 8 Nordic centers from January 2005 to December 2014 were retrospectively analyzed. The patients with primary tear location unfound, unknown, not confirmed, or not recorded (n = 243, 21.7%) were excluded from the analysis. The patients were divided into 2 groups according to whether the aortic reconstruction encompassed the portion of the primary tear (tear resected [TR] group, n = 730) or not (tear not resected [TNR] group, n = 149). The restricted mean survival time ratios adjusted for patient characteristics and surgical details between the groups were calculated for all-cause mortality and aortic reoperation–free survival. The median follow-up time was 2.57 (interquartile range, 0.53-5.30) years. Results: For the majority of the patients in the TR group, the primary tear was located in the ascending aorta (83.6%). The reconstruction encompassed both the aortic root and the aortic arch in 7.4% in the TR group as compared with 0.7% in the TNR patients (P < .001). There were no significant differences in all-cause mortality (adjusted restricted mean survival time ratio, 1.01; 95% confidence interval, 0.92-1.12; P = .799) or reoperation-free survival (adjusted restricted mean survival time ratio, 0.98; 95% confidence interval, 0.95-1.02; P = .436) between the TR and TNR groups. Conclusions: Primary tear resection alone does not determine the midterm outcome after surgery for acute type A aortic dissection.

Description:

Funding Information: This study was funded by the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital and the Finnish Cultural Foundation from Pirkanmaa Regional Fund (Dr Mennander), The Mats Kleberg Foundation , Stockholm, Sweden (Dr Olsson), and the University of Iceland Research Fund and the Lanspitali Research Fund (Dr. Gudbjartsson). Publisher Copyright: © 2022 The Society of Thoracic Surgeons

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