Key result
Supracoronary ascending aortic replacement achieved comparable 10-year mortality to aortic root replacement for acute type A aortic dissection (35.2% vs 33.8%; HR 1.25; 95% CI 0.77-2.02; P=0.806).
Why the study?
It was unknown whether the selective use of supracoronary ascending aorta replacement achieves late outcomes comparable to aortic root replacement for acute Stanford type A aortic dissection.
Does supracoronary ascending aortic replacement achieve comparable late outcomes to aortic root replacement in patients with acute Stanford type A aortic dissection?
Cohort (n=309)
No
Does supracoronary ascending aortic replacement achieve comparable late outcomes to aortic root replacement in patients with acute Stanford type A aortic dissection?
Hazard Ratio: 1.25 (95% CI 0.77–2.02)
Absolute Event Rate: 35.2% vs 33.8%
p-value: p=0.806
Selective use of supracoronary ascending aortic replacement achieves comparable 10-year survival and reoperation rates to aortic root replacement in acute type A aortic dissection.
Supports selective supracoronary replacement under stringent criteria in TAAD; leaves open randomized confirmation of long-term durability.
OBJECTIVES: We investigated whether the selective use of supracoronary ascending aorta replacement achieves late outcomes comparable to those of aortic root replacement for acute Stanford type A aortic dissection (TAAD). METHODS: Patients who underwent surgery for acute type A aortic dissection from 2005 to 2018 at the Helsinki University Hospital, Finland, were included in this analysis. Late mortality was evaluated with the Kaplan-Meier method and proximal aortic reoperation, i.e. operation on the aortic root or aortic valve, with the competing risk method. RESULTS: Out of 309 patients, 216 underwent supracoronary ascending aortic replacement and 93 had aortic root replacement. At 10 years, mortality was 33.8% after aortic root replacement and 35.2% after ascending aortic replacement (P = 0.806, adjusted hazard ratio 1.25, 95% confidence interval, 0.77-2.02), and the cumulative incidence of proximal aortic reoperation was 6.0% in the aortic root replacement group and 6.2% in the ascending aortic replacement group (P = 0.65; adjusted subdistributional hazard ratio 0.53, 95% confidence interval 0.15-1.89). Among 71 propensity score matched pairs, 10-year survival was 34.4% after aortic root replacement and 36.2% after ascending aortic replacement surgery (P = 0.70). Cumulative incidence of proximal aortic reoperation was 7.0% after aortic root replacement and 13.0% after ascending aortic replacement surgery (P = 0.22). Among 102 patients with complete imaging data [mean follow-up, 4.7 (3.2) years], the estimated growth rate of the aortic root diameter was 0.22 mm/year, that of its area 7.19 mm2/year and that of its perimeter 0.43 mm/year. CONCLUSIONS: When stringent selection criteria were used to determine the extent of proximal aortic reconstruction, aortic root replacement and ascending aortic replacement for type A aortic dissection achieved comparable clinical outcomes.
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Jormalainen et al. (2021) conducted a cohort in Acute Stanford type A aortic dissection (TAAD) (n=309). Supracoronary ascending aorta replacement vs. Aortic root replacement was evaluated on 10-year mortality (HR 1.25, 95% CI 0.77-2.02, p=0.806). Supracoronary ascending aortic replacement achieved comparable 10-year mortality to aortic root replacement for acute type A aortic dissection (35.2% vs 33.8%; HR 1.25; 95% CI 0.77-2.02; P=0.806).
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