P139. Limited versus Extended Repair for Acute Type A Aortic Dissection: Long-Term Outcomes in A Single Center Over Two Decades
Beijing Anzhen Hospital Capital Medical University
Beijing, Beijing
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Suwei Chen graduated as MD from Capital Medical University, China. He was honored as an Excellent Graduate of Capital Medical University in 2021
In 2021, he accomplished specialist training in Cardiovascular Surgery at Beijing Anzhen Hospital, Capital Medical University, China. He became a member of the Chinese Medical Doctor Association in the same year.
From 2021 to 2023, he entered the Postdoctoral Station of Beijing Anzhen Hospital, working on the clinical and basic research of aortic diseases.
In 2023, he became an attending doctor of Cardiovascular Surgery at Beijing Anzhen Hospital.
He has published 13 peer-reviewed publications and participated in 2 National Natural Science Foundation of China. He is also a reviewer for Frontiers in Cardiovascular Medicine.
His research focuses on postoperative organ protection in aortic surgery, clinical management and pathogenesis of complex aortic diseases.
Description
To compare the early and late outcomes of hemiarch vs total arch repair (TAR) in acute type A dissection (ATAAD).
Methods
Of 2326 patients with ATAAD from 2003–2020, 115 had hemiarch repair (HAR group) and 2133 had TAR with frozen elephant trunk (FET). Early and late outcomes of HAR (n=204) and TAR (n=110) were compared in a cohort of 314 patients propensity score matched at a 1 : 2 ratio by age, gender, year of surgery, and malperfusion using 0.2 calipers without replacement.
Results
Two groups were comparable at baseline and operative data (all P>0.05), except that HAR group had shorter CPB, cross-clamp and cerebral perfusion times (173 vs 198; 90 vs 112; 19 vs 26 min, all P<0.001) and more extra-anatomic bypass (EAB) (4.5% vs 1%, P=0.054). Operative mortality (10% [11/110] vs 8.3% [17/204], P=0.621) and morbidity were comparable in 2 groups (Table 1), except a higher incidence of spinal cord injury (SCI) in TAR group (2.9% vs 0, P=0.095).
Follow-up was 99.6% (284/285) at mean 11.2±4.9 years (range, 0.1–22.0). Late death occurred in 19 and 42 patients of HAR and TAR groups at median 7.2 and 7.9 years (interquartile range [IQR] 3.0–12.1 and 4.0–10.0), respectively. Leading cause of late death was distal aortic rupture in HAR group (36.8% [7/19] vs 7.1% [3/42], P=0.006), and non-cardiac/aortic reason in TAR group (5.3% [1/19] vs 33.3% [14/42], P=0.019). Death from stroke was seen in TAR groups only (14.3% [6/42] vs 0% [0/42] P<0.001). Distal aortic reoperation was done in 15 and 10 patients of HAR and TAR groups at median 3.5 and 2.5 (IQR 2.1–6.6 and 0.7–9.1) years, which was more common in HAR (15.2% [15/99] vs 5.4% [10/186], P=0.005). In HAR group, 6 had thoracoabdominal aortic aneurysm repair and 5 had TAR+FET, vs 7 and 0 in TAR group.
At 20 years, survival were 68.1% and 65.6% (95% confidence interval [CI], 60.4–75.8% and 60.2–71.0%) and freedom from reoperation were 86.6% and 88.7% (95% CI, 82.6%–90.6% and 83.5–93.9%) in HAR and TAR groups (P=0.542 and P=0.131), respectively, while HAR group showed significantly higher incidence of late distal aortic dilation and rupture (33% vs 10%; 95% CI, 18–48% vs 4.2–19%) (P<0.001).
Conclusions
Although HAR and TAR showed comparable early and late survival rates and TAR had higher risk of SCI, TAR was associated with reduced risks of late distal aortic dilatation and rupture. These results argue favorably for the use of the TAR+FET technique in selected patients with ATAAD.
Authors
Wei-Guo Ma (1), Su-Wei Chen (2), Yu Chen (3), Wentao Dong (2), Xiaoyang Zhang (2), Zhiyu Qiao (4), Jun-Ming Zhu (5), Li-Zhong Sun (6)
Institutions
(1) Yale School of Medicine, New Haven, CT, (2) Beijing Anzhen Hospital Capital Medical University, Beijing, Beijing, (3) Beijing Anzhen Hospital, Beijing, Please Select, (4) Beijing Anzhen Hospital of Capital Medical University, Beijing, NA, (5) N/A, Beijing, Beijing, (6) N/A, Beijing, China