1
|
Sá MP, Tasoudis P, Jacquemyn X, Van den Eynde J, Rad AA, Weymann A, Ruhparwar A, Caranasos TG, Ikonomidis JS, Chu D, Serna-Gallegos D, Sultan I. Long-term outcomes of valve-sparing root versus composite valve graft replacement for acute type A aortic dissection: Meta-analysis of reconstructed time-to-event data. Int J Cardiol 2023; 382:12-19. [PMID: 37004942 DOI: 10.1016/j.ijcard.2023.03.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/28/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVES To evaluate the long-term outcomes of valve-sparing aortic root replacement (VSARR) versus composite aortic valve graft replacement (CAVGR) in the treatment of acute type A aortic dissections (ATAAD). METHODS We performed a pooled meta-analysis of Kaplan-Meier-derived time-to-event data from studies with longer follow-up beyond the immediate postoperative period. RESULTS Seven studies met our eligibility criteria, comprising a total of 858 patients (367 patients in the VSARR groups and 491 patients in the CAVGR group). We found no statistically significant differences in the overall survival between the groups over time (HR 0.83, 95%CI 0.63-1.10, P = 0.192), but we observed a higher risk of reoperation in the VSARR group when compared with the CAVGR group (HR 9.99, 95% CI 2.23-44.73, P = 0.003). The meta-regression revealed statistically significant positive coefficients for age (P < 0.001) in the analysis of survival, which means that this covariate has a modulating effect on this outcome. The higher the mean age, the higher the HR for overall mortality was found to be with VSARR as compared with CAVGR. Other covariates such as female sex, hypertension, diabetes, connective tissue disorders, bicuspid aortic valve, hemiarch and/or total arch replacement, concomitant coronary bypass surgery did not seem to have any effect on the outcomes. CONCLUSION VSARR did not confer a better (or worse) survival over time in patients with ATAAD, but it was associated with higher risk of reoperations in the long run.
Collapse
Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
| | - Panagiotis Tasoudis
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC, United States of America
| | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Arian Arjomandi Rad
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Thomas G Caranasos
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC, United States of America
| | - John S Ikonomidis
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC, United States of America
| | - Danny Chu
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Derek Serna-Gallegos
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| |
Collapse
|
2
|
Alhussaini M, Jeng EI, Martin TD, Fillion A, Beaver TM, Arnaoutakis GJ. Florida sleeve is a safe and effective technique for valve salvage in acute stanford type A aortic dissection. J Card Surg 2021; 37:39-46. [PMID: 34652039 DOI: 10.1111/jocs.16078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Valve-sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute type-A aortic dissection (ATAAD). The Florida sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the FS repair in patients with dilated roots in the setting of an ATAAD. METHODS We retrospectively reviewed 24 consecutive patients (2002-2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow-up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. RESULTS Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal-perfusion or shock. The FS was combined with hemi-arch replacement in 15 (62.5%) patients and a zone-2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow-up period was 46 months (range, 0.3-146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. CONCLUSION FS is simplified and reproducible valve-sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type-A aortic dissection with excellent early and long-term results.
Collapse
Affiliation(s)
| | - Eric I Jeng
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Tomas D Martin
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Amber Fillion
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Thomas M Beaver
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - George J Arnaoutakis
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
3
|
Rosenblum JM, Leshnower BG, Moon RC, Lasanajak Y, Binongo J, McPherson L, Chen EP. Durability and safety of David V valve-sparing root replacement in acute type A aortic dissection. J Thorac Cardiovasc Surg 2018; 157:14-23.e1. [PMID: 30557940 DOI: 10.1016/j.jtcvs.2018.10.059] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/20/2018] [Accepted: 10/01/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Valve-sparing root replacement (VSRR) is an attractive option in type A aortic dissection (TAAD) repair for a young patient with normal cusp anatomy, but conventional root replacement using a composite valved-conduit (ROOT) remains the gold standard in this emergent clinical setting. We examine the long-term safety and durability of the David V VSRR compared with ROOT in TAAD repair. METHODS From March 2004 to April 2017, 136 patients underwent repair of acute TAAD using either ROOT (n = 77; 56.6%) or VSRR (n = 59; 43.4%). Annual echocardiograms were performed for follow-up in VSRR patients. Univariable regression, Kaplan-Meier, and competing risk analyses were performed. RESULTS Preoperative characteristics were similar between groups, except that VSRR patients were younger (mean age 43.5 ± 11.4 years VSRR vs 50.4 ± 3.0 years ROOT; P = .001). Both groups had similar rates of preoperative malperfusion or shock (29.3% VSRR vs 37.0% ROOT; P = .35) and ≥3+ aortic insufficiency (63% VSRR vs 76.8% ROOT). Thirty-day mortality in the VSRR group was 2/59 (3.4%) and 11/77 in the ROOT group (14.3%; P < .001). All-cause survival at 9 years was 92% (VSRR) and 59% (ROOT; P = .002). The incidence of aortic reintervention was similar between groups (20%-23% at 5 years; P = .81). At 9 years of follow-up, 5/52 (9.6%) VSRR patients had ≥2+ aortic insufficiency, and 1 patient required valve reintervention. CONCLUSIONS In highly-selected patients, the David V VSRR provides a safe repair of acute TAAD with concomitant root pathology and valve insufficiency. In our center, the incidence of valve-related reintervention at long-term follow-up is low after emergent repair.
Collapse
Affiliation(s)
- Joshua M Rosenblum
- Division of Cardiac Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga.
| | - Bradley G Leshnower
- Division of Cardiac Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Rena C Moon
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Yi Lasanajak
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Jose Binongo
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - LaRonica McPherson
- Division of Cardiac Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Edward P Chen
- Division of Cardiac Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| |
Collapse
|
4
|
Yang B, Patel HJ, Sorek C, Hornsby WE, Wu X, Ward S, Thomas M, Driscoll A, Waidley VA, Norton EL, Likosky DS, Deeb GM. Sixteen-Year Experience of David and Bentall Procedures in Acute Type A Aortic Dissection. Ann Thorac Surg 2018; 105:779-784. [DOI: 10.1016/j.athoracsur.2017.09.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/07/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
|