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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...

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Autores principales: 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
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
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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.
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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
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