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Surgical Strategy for the Repair of Acute Type A Aortic Dissection: A Multicenter Study

Type A acute aortic dissection is associated with significant morbidity and mortality, with prompt referral imaging and management to tertiary referral centers needed urgently. Surgery is usually needed emergently, but the choice of surgery often varies depending on the patient and the presentation....

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Autores principales: Nappi, Francesco, Avtaar Singh, Sanjeet Singh, Gambardella, Ivancarmine, Alzamil, Almothana, Salsano, Antonio, Santini, Francesco, Biancari, Fausto, Schoell, Thibaut, Bonnet, Nicolas, Folliguet, Thierry, Fiore, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10299256/
https://www.ncbi.nlm.nih.gov/pubmed/37367418
http://dx.doi.org/10.3390/jcdd10060253
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author Nappi, Francesco
Avtaar Singh, Sanjeet Singh
Gambardella, Ivancarmine
Alzamil, Almothana
Salsano, Antonio
Santini, Francesco
Biancari, Fausto
Schoell, Thibaut
Bonnet, Nicolas
Folliguet, Thierry
Fiore, Antonio
author_facet Nappi, Francesco
Avtaar Singh, Sanjeet Singh
Gambardella, Ivancarmine
Alzamil, Almothana
Salsano, Antonio
Santini, Francesco
Biancari, Fausto
Schoell, Thibaut
Bonnet, Nicolas
Folliguet, Thierry
Fiore, Antonio
author_sort Nappi, Francesco
collection PubMed
description Type A acute aortic dissection is associated with significant morbidity and mortality, with prompt referral imaging and management to tertiary referral centers needed urgently. Surgery is usually needed emergently, but the choice of surgery often varies depending on the patient and the presentation. Staff and center expertise also play a major role in determining the surgical strategy employed. The aim of this study was to compare the early- and medium-term outcomes of patients undergoing a conservative approach extended only to the ascending aorta and the hemiarch to those of patients subjected to extensive surgery (total arch reconstruction and root replacement) across three European referral centers. A retrospective study was conducted across three sites between January 2008 and December 2021. In total, 601 patients were included within the study, of which 30% were female, and the median age was 64.4 years. The most common operation was ascending aorta replacement (n = 246, 40.9%). The aortic repair was extended proximally (i.e., root n = 105; 17.5%) and distally (i.e., arch n = 250; 41.6%). A more extensive approach, extending from the root to the arch, was employed in 24 patients (4.0%). Operative mortality occurred in 146 patients (24.3%), and the most common morbidity was stroke (75, 12.6%). An increased length of ICU admission was noted in the extensive surgery group, which comprised younger and more frequently male patients. No significant differences were noted in surgical mortality between patients managed with extensive surgery and those managed conservatively. However, age, arterial lactate levels, “intubated/sedated” status on arrival, and “emergency or salvage” status at presentation were independent predictors of mortality both within the index hospitalization and during the follow-up. The overall survival was similar between the groups.
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spelling pubmed-102992562023-06-28 Surgical Strategy for the Repair of Acute Type A Aortic Dissection: A Multicenter Study Nappi, Francesco Avtaar Singh, Sanjeet Singh Gambardella, Ivancarmine Alzamil, Almothana Salsano, Antonio Santini, Francesco Biancari, Fausto Schoell, Thibaut Bonnet, Nicolas Folliguet, Thierry Fiore, Antonio J Cardiovasc Dev Dis Article Type A acute aortic dissection is associated with significant morbidity and mortality, with prompt referral imaging and management to tertiary referral centers needed urgently. Surgery is usually needed emergently, but the choice of surgery often varies depending on the patient and the presentation. Staff and center expertise also play a major role in determining the surgical strategy employed. The aim of this study was to compare the early- and medium-term outcomes of patients undergoing a conservative approach extended only to the ascending aorta and the hemiarch to those of patients subjected to extensive surgery (total arch reconstruction and root replacement) across three European referral centers. A retrospective study was conducted across three sites between January 2008 and December 2021. In total, 601 patients were included within the study, of which 30% were female, and the median age was 64.4 years. The most common operation was ascending aorta replacement (n = 246, 40.9%). The aortic repair was extended proximally (i.e., root n = 105; 17.5%) and distally (i.e., arch n = 250; 41.6%). A more extensive approach, extending from the root to the arch, was employed in 24 patients (4.0%). Operative mortality occurred in 146 patients (24.3%), and the most common morbidity was stroke (75, 12.6%). An increased length of ICU admission was noted in the extensive surgery group, which comprised younger and more frequently male patients. No significant differences were noted in surgical mortality between patients managed with extensive surgery and those managed conservatively. However, age, arterial lactate levels, “intubated/sedated” status on arrival, and “emergency or salvage” status at presentation were independent predictors of mortality both within the index hospitalization and during the follow-up. The overall survival was similar between the groups. MDPI 2023-06-09 /pmc/articles/PMC10299256/ /pubmed/37367418 http://dx.doi.org/10.3390/jcdd10060253 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
Nappi, Francesco
Avtaar Singh, Sanjeet Singh
Gambardella, Ivancarmine
Alzamil, Almothana
Salsano, Antonio
Santini, Francesco
Biancari, Fausto
Schoell, Thibaut
Bonnet, Nicolas
Folliguet, Thierry
Fiore, Antonio
Surgical Strategy for the Repair of Acute Type A Aortic Dissection: A Multicenter Study
title Surgical Strategy for the Repair of Acute Type A Aortic Dissection: A Multicenter Study
title_full Surgical Strategy for the Repair of Acute Type A Aortic Dissection: A Multicenter Study
title_fullStr Surgical Strategy for the Repair of Acute Type A Aortic Dissection: A Multicenter Study
title_full_unstemmed Surgical Strategy for the Repair of Acute Type A Aortic Dissection: A Multicenter Study
title_short Surgical Strategy for the Repair of Acute Type A Aortic Dissection: A Multicenter Study
title_sort surgical strategy for the repair of acute type a aortic dissection: a multicenter study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10299256/
https://www.ncbi.nlm.nih.gov/pubmed/37367418
http://dx.doi.org/10.3390/jcdd10060253
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