Key result
Operative procedures for type A aortic dissection had an 18.0% hospital mortality, with no significant survival differences between various aortic root strategies or extent of distal resection.
Why the study?
Do different surgical strategies for managing the aortic root and distal aorta affect mortality and long-term survival in patients with Stanford Type A aortic dissection?
Cohort (n=50)
Do different surgical strategies for managing the aortic root and distal aorta affect mortality and long-term survival in patients with Stanford Type A aortic dissection?
Preservation or repair of the aortic valve and distal extension of the resection do not significantly increase surgical risk or decrease late survival in patients with Type A aortic dissection.
Answers are grounded in this paper and cite their sources.
May support individualized root and distal strategies in type A dissection; leaves open need for contemporary randomized comparisons.
Background: To evaluate long-term effectiveness of strategies for managing the aortic root and distal aorta in type A dissections. Methods: From 1990 to 1999, 50 patients (32 men, 64.07%; 18 women, 36.0%; mean age 57.4 y ± 11.1) underwent operation for ascending aortic dissection. Surgical strategies included aortic root replacement with a composite graft (21/50; 42.0%), valve replacement with supracoronary ascending aortic graft (3/50, 6%), and valve preservation or repair (26/50; 52.0%). Results: Overall hospital mortality rate was 18.0%. Follow-up was completed for 47 patients (94.0%) and ranged from 1 month to 10.5 years (mean 28.8 months). Actuarial survival for patients discharged from the hospital was 84% at 1 year, 75% at 5 years, and 66% at 10 years. There was no significant difference between the various procedures regarding mortality, neurological complications, long term survival and proximal re-operations. The ascending aorta alone was replaced in 8/50 patients (16%), ascending and hemiarch in 30/50 patients (60%) and arch and proximal descending aorta in 12/50 patients (24%) Hospital mortality (11.5, 20.0 and 16.7% respectively; p > 0.05) and 5- and 10-year survival ( p > 0.05) were not statistically dependent on the extension of the resection distally. Residual distal dissection was not associated with a decrease in late survival. With regard to emergency surgery (36/50) there was no significant difference in hospital mortality ( p > 0.05) and 5 year survival ( p > 0.05) between those who had undergone coronary angiography (19/36; 52.8%) on the day of surgery with those who had not (17/36; 47.2%). Conclusions: Preservation or repair of the aortic valve can be recommended in the majority of patients with type A dissection. Distal extension of the resection does not increase surgical risk. Residual distal dissection does not decrease late survival. Preoperative coronary angiography may not affect survival in patients undergoing emergency surgery.
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Driever et al. (2003) conducted a cohort in Stanford Type A Aortic Dissections (n=50). Operative procedures for aortic root and distal aorta vs. Various surgical strategies was evaluated on Hospital mortality and long-term survival (p=>0.05). Operative procedures for type A aortic dissection had an 18.0% hospital mortality, with no significant survival differences between various aortic root strategies or extent of distal resection.
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