Key result
Limited aortic replacement significantly reduced hospital mortality compared to total arch replacement (4.9% vs 19.4%, p=0.042) in elderly patients with type A acute aortic dissection.
Why the study?
It was unclear whether limited aortic repair is more justified than extended-arch repair in patients aged 65 or older with type A acute aortic dissection.
Does limited aortic replacement improve outcomes compared to total arch replacement in patients aged 65 or older with type A acute aortic dissection?
Cohort (n=103)
No
Does limited aortic replacement improve outcomes compared to total arch replacement in patients aged 65 or older with type A acute aortic dissection?
Absolute Event Rate: 4.9% vs 19.4%
p-value: p=0.042
Limited aortic resection is an acceptable surgical strategy for elderly patients with type A acute aortic dissection, offering lower perioperative times and similar 5-year survival despite a higher rate of adverse aortic events.
Limited repair was associated with lower early mortality but more late aortic events in elderly type A dissection; leaves open optimal extent pending randomized data.
BACKGROUND: This study compared limited aortic repair (ascending, and /or hemi-arch replacement) versus extended-arch repair (ascending, arch and proximal descending aortic replacement) used for patients aged 65 or older, who had type A acute aortic dissection (AAD), analyzing the influence of the extent of aortic repair on outcomes. METHODS: From January, 2001 to December, 2015, 103 patients aged 65 or older underwent operation due to type A AAD in Nanjing First Hospital. The cohort was divided into two subgroups according to the surgical approaches, including limited aortic replacement (LAR, n = 41) and total arch replacement + stent elephant trunk implantation (TAR+SET, n = 62). RESULTS: There was no significant difference in gender, age, hypertension, diabetes, smoking, PCI history, atrial fibrillation, pericardial effusion, aortic valve insufficiency (≥ moderate), shock situation before operation, and Euro-score II between the two groups except limb malperfusion and tear location. The cross-clamp time, CPB time, intubation time, ICU stay time and hospital time were all significantly less in the LAR group than in the TAR+SET group. A total of 89 patients were discharged home successfully after operation, with a difference of hospital mortality (P = 0.04). The overall survival rates at 5-year follow-up were 82.5 ± 6.0% in LAR group and 75.2 ± 5.6% in TAR+SET group, but with no difference (p = 0.151). The freedom from adverse aortic events at 5-year was 84.3 ± 6.5% in LAR group versus 97.9 ± 2.1% in TAR+SET group, with a statistical difference (p = 0.03). CONCLUSION: These findings support limited aortic resection is acceptable for elderly patients with type A AAD if surgical principles allow.
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Qin et al. (2020) conducted a cohort in Type A acute aortic dissection (n=103). Limited aortic replacement (LAR) vs. Total arch replacement + stent elephant trunk implantation (TAR+SET) was evaluated on Hospital mortality (p=0.042). Limited aortic replacement significantly reduced hospital mortality compared to total arch replacement (4.9% vs 19.4%, p=0.042) in elderly patients with type A acute aortic dissection.
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