|
1
|
Moon MR, Kachroo P. Distal Extent of Resection in Type A Dissection: Keeping It Simple. Tex Heart Inst J 2024; 51:e238371. [PMID: 38509048 DOI: 10.14503/thij-23-8371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| |
Collapse
|
|
2
|
Jankovic N, Matkovic M, Bilbija I, Milicevic V, Zlatkovic M, Aleksic N, Cvetic V, Milin-Lazovic J, Putnik S. The Clinical Impact of the Extension of Acute Type A Aortic Surgery on Long-Term Outcomes: Should We Tend to Be Conservative? MEDICINA (KAUNAS, LITHUANIA) 2023; 60:35. [PMID: 38256296 PMCID: PMC10821435 DOI: 10.3390/medicina60010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Despite advances in surgical techniques, industry adjuncts, and cerebral perfusion techniques, the in-hospital mortality rate of type A acute dissection (TAAD) remains at 15-30%. This study aimed to investigate the influence of different extents of aortic resection on survival and quality of life (QoL) after long-term follow-up. Materials and Methods: A retrospective observational trial was performed, including 165 patients operated upon for TAAD. Patients were divided into two groups according to the extent of their aortic repair: the first group comprised patients who had ascending aorta replacement and the second included patients who had hemiarch or total arch replacement. The groups were compared with regard to their baseline characteristics, operative characteristics, survival, complications, and QoL during nine years of follow-up. Results: The mean follow-up time was 75.6 months (1-108 months). The mean survival in the ascending aorta repair group was 89.651 (81.242-98.061) months and was 54.801 (40.053-69.548) months in the hemiarch and arch group; the difference between the groups was significant (log-rank p < 0.001). The rate of new postoperative neurological deficits was statistically higher in the hemiarch and arch group (17.5% vs. 8.4%, p = 0.045), the most common being stroke, and was also more frequent in the hemiarch and arch group than in the ascending aorta group (with statistical significance (15.7% vs. 6.5%)). The mean SF-12 physical score from the QoL questionnaire was higher in the ascending aorta replacement group than in the hemiarch and arch group (50.1 ± 7.3 vs. 44.0 ± 11.9, p = 0.017). Additionally, the mean SF-12 mental score was higher in the ascending aorta replacement group (52.3 ± 7.3 vs. 47.1 ± 12.8, p = 0.032). Conclusions: A more aggressive approach involving aortic arch repair means a lower survival rate and lesser quality of life after long-term follow-up in comparison with the replacement of the ascending aorta. If clinically applicable, a more defensive strategy may be considered.
Collapse
Affiliation(s)
- Natasa Jankovic
- Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.M.); (I.B.); (V.M.); (M.Z.); (N.A.); (S.P.)
| | - Milos Matkovic
- Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.M.); (I.B.); (V.M.); (M.Z.); (N.A.); (S.P.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.C.); (J.M.-L.)
| | - Ilija Bilbija
- Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.M.); (I.B.); (V.M.); (M.Z.); (N.A.); (S.P.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.C.); (J.M.-L.)
| | - Vladimir Milicevic
- Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.M.); (I.B.); (V.M.); (M.Z.); (N.A.); (S.P.)
| | - Mina Zlatkovic
- Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.M.); (I.B.); (V.M.); (M.Z.); (N.A.); (S.P.)
| | - Nemanja Aleksic
- Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.M.); (I.B.); (V.M.); (M.Z.); (N.A.); (S.P.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.C.); (J.M.-L.)
| | - Vladimir Cvetic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.C.); (J.M.-L.)
- Department for Cardiovascular Radiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Jelena Milin-Lazovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.C.); (J.M.-L.)
- Department of Biostatistics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Svetozar Putnik
- Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.M.); (I.B.); (V.M.); (M.Z.); (N.A.); (S.P.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (V.C.); (J.M.-L.)
| |
Collapse
|