Cargando…
Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years
Background After a type A aortic dissection repair, a patent false lumen in the descending aorta is the most common situation encountered, and is a well-known risk factor for aortic growth, reinterventions and mortality. The aim of this study was to analyze the long-term results of residual aortic d...
Autores principales: | , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10054589/ https://www.ncbi.nlm.nih.gov/pubmed/36983363 http://dx.doi.org/10.3390/jcm12062363 |
_version_ | 1785015707492155392 |
---|---|
author | Porto, Alizée Omnes, Virgile Bartoli, Michel A. Azogui, Ron Resseguier, Noémie De Masi, Mariangela Bal, Laurence Imbert, Laura Jaussaud, Nicolas Morera, Pierre Jacquier, Alexis Barral, Pierre-Antoine Gariboldi, Vlad Gaudry, Marine |
author_facet | Porto, Alizée Omnes, Virgile Bartoli, Michel A. Azogui, Ron Resseguier, Noémie De Masi, Mariangela Bal, Laurence Imbert, Laura Jaussaud, Nicolas Morera, Pierre Jacquier, Alexis Barral, Pierre-Antoine Gariboldi, Vlad Gaudry, Marine |
author_sort | Porto, Alizée |
collection | PubMed |
description | Background After a type A aortic dissection repair, a patent false lumen in the descending aorta is the most common situation encountered, and is a well-known risk factor for aortic growth, reinterventions and mortality. The aim of this study was to analyze the long-term results of residual aortic dissection (RAD) at a high-volume aortic center with prospective follow-up. Methods In this prospective single-center study, all patients operated for type A aortic dissection between January 2017 and December 2022 were included. Patients without postoperative computed tomography scans or during follow-up at our center, and patients without RAD were excluded. The primary endpoint was all-cause mortality during follow-up for patients with RAD. The secondary endpoints were perioperative mortality, rate of distal aneurysmal evolution, location of distal aneurysmal evolution, rate of distal reinterventions, outcomes of distal reinterventions, and aortic-related death during follow-up. Results In total, 200 survivors of RAD comprised the study group. After a mean follow-up of 27.2 months (1–66), eight patients (4.0%) died and 107 (53.5%) had an aneurysmal progression. The rate of distal reintervention was 19.5% (39/200), for malperfusion syndrome in seven cases (3.5%) and aneurysmal evolution in 32 cases (16.0%). Most reinterventions occurred during the first 2 years (82.1%). Twenty-seven patients were treated for an aneurysmal evolution of RAD including aortic arch with hybrid repair in 21 cases and branched aortic arch endoprosthesis in six cases. In the hybrid repair group, there was no death, and the rate of morbidity was 28.6% (6/21) (one minor stroke, one pulmonary complication, one recurrent paralysis with complete recovery and three major bleeding events). In the branched endograft group, there was no death, no stroke, and no paraplegia. There was one case (16.7%) of carotid dissection. Complete aortic remodeling or complete FL thrombosis on the thoracic aorta was found in 18 cases (85.7%) and in five cases (83.3%) in the hybrid and branched endograft groups, respectively. Conclusions: Despite a critical course in most cases of RAD, with a high rate of aneurysmal evolution and reintervention, the long-term mortality rate remains low with a close follow-up and a multidisciplinary management in an expert center. |
format | Online Article Text |
id | pubmed-10054589 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-100545892023-03-30 Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years Porto, Alizée Omnes, Virgile Bartoli, Michel A. Azogui, Ron Resseguier, Noémie De Masi, Mariangela Bal, Laurence Imbert, Laura Jaussaud, Nicolas Morera, Pierre Jacquier, Alexis Barral, Pierre-Antoine Gariboldi, Vlad Gaudry, Marine J Clin Med Article Background After a type A aortic dissection repair, a patent false lumen in the descending aorta is the most common situation encountered, and is a well-known risk factor for aortic growth, reinterventions and mortality. The aim of this study was to analyze the long-term results of residual aortic dissection (RAD) at a high-volume aortic center with prospective follow-up. Methods In this prospective single-center study, all patients operated for type A aortic dissection between January 2017 and December 2022 were included. Patients without postoperative computed tomography scans or during follow-up at our center, and patients without RAD were excluded. The primary endpoint was all-cause mortality during follow-up for patients with RAD. The secondary endpoints were perioperative mortality, rate of distal aneurysmal evolution, location of distal aneurysmal evolution, rate of distal reinterventions, outcomes of distal reinterventions, and aortic-related death during follow-up. Results In total, 200 survivors of RAD comprised the study group. After a mean follow-up of 27.2 months (1–66), eight patients (4.0%) died and 107 (53.5%) had an aneurysmal progression. The rate of distal reintervention was 19.5% (39/200), for malperfusion syndrome in seven cases (3.5%) and aneurysmal evolution in 32 cases (16.0%). Most reinterventions occurred during the first 2 years (82.1%). Twenty-seven patients were treated for an aneurysmal evolution of RAD including aortic arch with hybrid repair in 21 cases and branched aortic arch endoprosthesis in six cases. In the hybrid repair group, there was no death, and the rate of morbidity was 28.6% (6/21) (one minor stroke, one pulmonary complication, one recurrent paralysis with complete recovery and three major bleeding events). In the branched endograft group, there was no death, no stroke, and no paraplegia. There was one case (16.7%) of carotid dissection. Complete aortic remodeling or complete FL thrombosis on the thoracic aorta was found in 18 cases (85.7%) and in five cases (83.3%) in the hybrid and branched endograft groups, respectively. Conclusions: Despite a critical course in most cases of RAD, with a high rate of aneurysmal evolution and reintervention, the long-term mortality rate remains low with a close follow-up and a multidisciplinary management in an expert center. MDPI 2023-03-18 /pmc/articles/PMC10054589/ /pubmed/36983363 http://dx.doi.org/10.3390/jcm12062363 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Porto, Alizée Omnes, Virgile Bartoli, Michel A. Azogui, Ron Resseguier, Noémie De Masi, Mariangela Bal, Laurence Imbert, Laura Jaussaud, Nicolas Morera, Pierre Jacquier, Alexis Barral, Pierre-Antoine Gariboldi, Vlad Gaudry, Marine Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years |
title | Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years |
title_full | Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years |
title_fullStr | Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years |
title_full_unstemmed | Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years |
title_short | Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years |
title_sort | reintervention of residual aortic dissection after type a aortic repair: results of a prospective follow-up at 5 years |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10054589/ https://www.ncbi.nlm.nih.gov/pubmed/36983363 http://dx.doi.org/10.3390/jcm12062363 |
work_keys_str_mv | AT portoalizee reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years AT omnesvirgile reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years AT bartolimichela reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years AT azoguiron reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years AT resseguiernoemie reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years AT demasimariangela reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years AT ballaurence reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years AT imbertlaura reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years AT jaussaudnicolas reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years AT morerapierre reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years AT jacquieralexis reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years AT barralpierreantoine reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years AT gariboldivlad reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years AT gaudrymarine reinterventionofresidualaorticdissectionaftertypeaaorticrepairresultsofaprospectivefollowupat5years |