Key result
Open distal anastomosis under deep hypothermic circulatory arrest resulted in similar operative mortality (17% vs 21%, P=0.63) compared to distal aortic clamping in acute type A aortic dissection.
Why the study?
Does open distal anastomosis under deep hypothermic circulatory arrest improve clinical outcomes compared to distal aortic clamping on hypothermic cardiopulmonary bypass in patients with acute type A aortic dissection?
Cohort (n=124)
Does open distal anastomosis under deep hypothermic circulatory arrest improve clinical outcomes compared to distal aortic clamping on hypothermic cardiopulmonary bypass in patients with acute type A aortic dissection?
Absolute Event Rate: 17% vs 21%
p-value: p=0.63
Open distal anastomosis under deep hypothermic circulatory arrest and distal aortic clamping on hypothermic cardiopulmonary bypass yield comparable operative mortality and 5-year survival in acute type A aortic dissection.
Observed similar mortality with either technique; hypothesis-generating and should not yet change practice without randomized data.
The purpose of this study was to evaluate clinical outcomes of two different surgical techniques for the repair of acute type A dissection: open distal anastomosis under deep hypothermic circulatory arrest (DHCA) compared with distal aortic clamping on hypothermic cardiopulmonary bypass (ACPB). Between January 2000 and July 2008, 82 patients underwent DHCA and 42 had ACPB. Major morbidity, operative mortality and five-year actuarial survival were compared between groups. There were no significant differences in the preoperative characteristics. Operative mortality (17% in DHCA vs. 21% in ACPB, P=0.63), reoperation for bleeding (20% in DHCA vs. 34% in ACPB, P=0.16) and stroke rates (16 DHCA vs. 24% in ACPB, P=0.33) were comparable between the two groups. Actuarial five-year survival rates were 74% for DHCA vs. 73% for ACPB, P=0.99. No significant differences in operative mortality, major morbidity and actuarial five-year survival were observed between DHCA and ACPB. There are some practical technical advantages if the distal anastomosis is performed in an open manner. More studies are required to determine the fate of the false lumen between the two techniques.
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Stamou et al. (2010) conducted a cohort in Acute type A aortic dissection (n=124). Open distal anastomosis under deep hypothermic circulatory arrest (DHCA) vs. Distal aortic clamping on hypothermic cardiopulmonary bypass (ACPB) was evaluated on Operative mortality (p=0.63). Open distal anastomosis under deep hypothermic circulatory arrest resulted in similar operative mortality (17% vs 21%, P=0.63) compared to distal aortic clamping in acute type A aortic dissection.
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