Key result
DeBakey type II acute aortic dissection was associated with significantly lower intra- and postoperative 60-day mortality compared to type I (RR 0.03), due to a lower incidence of malperfusion.
Why the study?
The study evaluated the effect of aortic dissection extent by DeBakey classification and preoperative peripheral and myocardial malperfusion on early and mid-term outcomes after emergent surgical repair.
Does DeBakey type II acute aortic dissection and absence of preoperative malperfusion improve early and mid-term survival outcomes after surgical repair compared to type I and presence of malperfusion?
Observational (n=135)
No
Does DeBakey type II acute aortic dissection and absence of preoperative malperfusion improve early and mid-term survival outcomes after surgical repair compared to type I and presence of malperfusion?
Relative Risk: 0.03 (95% CI 0.003–0.265)
Absolute Event Rate: 3.1% vs 38.8%
p-value: p=0.001
DeBakey type II acute aortic dissection is associated with significantly lower early and late mortality after surgical repair compared to type I, largely due to a lower incidence of preoperative peripheral and cardiac malperfusion.
May inform prognosis by DeBakey type; leaves open whether classification should guide surgical thresholds without prospective validation.
Introduction: Emergent surgical repair of DeBakey type I and II acute aortic dissection represents the standard of care to prevent lethal complications. Aim: Evaluation of the effect of extension of aortic dissection (AAD) according to DeBakey classification, type I and II AAD, and the relationship with preoperative peripheral and myocardial malperfusion on early outcome and the mid-term follow-up period. Material and methods: A total of 135 patients who underwent AAD surgery between January 2015 and October 2019 were analysed. Results: In total 103 patients were affected by DeBakey type I AAD and 32 by DeBakey type II; 56 patients preoperatively showed peripheral, cardiac malperfusion, or both. Intra-operative mortality was 11%. Postoperative peripheral, cardiac malperfusion, and intraoperative and postoperative mortality were lower for type II AAD. The protective factor for intra-and postoperative 60-day mortality was type II AAD (RR = 0.03, p = 0.001); independent predictors were hypertension, and preoperative cardiac and renalvisceral malperfusion. At 5 years the overall survival was 74 6.9%. Independent predictors of reduced survival were major extension of type I AAD (RR = 5.37, p < 0.05) and preoperative cardiac malperfusion (RR = 5.78, p < 0.05). Five-year freedom from cardiac death, redo surgical operation, and new vascular procedures on the thoracic and abdominal aorta was 92 5.7%, 99 1.2%, and 81 7.2%, respectively. Extension of DeBakey type I AAD into the thoracic-abdominal aorta segment was also a predictor of the need for new vascular procedures (RR = 1.66, p = 0.05). Conclusions: A more favourable anatomy of DeBakey type II AAD is associated with better early and late outcomes after aortic repair. This is due to a lower incidence of peripheral and cardiac malperfusion.
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Nardi et al. (2021) conducted an observational in Acute aortic dissection (n=135). DeBakey type II acute aortic dissection vs. DeBakey type I acute aortic dissection was evaluated on Intra- and postoperative 60-day mortality (RR 0.03, 95% CI 0.003-0.265, p=0.001). DeBakey type II acute aortic dissection was associated with significantly lower intra- and postoperative 60-day mortality compared to type I (RR 0.03), due to a lower incidence of malperfusion.
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