1. Hemiarch Replacement in Acute Type A Aortic Dissection in Patients with Arch Branch Vessel Dissection is a Risk Factor for Later Re-Intervention of the Distal Aorta
Emory University School of Medicine
Atlanta, GA
United States - Contact Me
Dr. Leshnower hails from Texas and received his Bachelor’s degree in music from the University of Texas at Austin. He received his medical degree from University of Texas Southwestern Medical School in Dallas, TX. Following medical school, Dr. Leshnower completed a residency in general surgery at the Hospital of the University of Pennsylvania in Philadelphia, Pa. During his time at Penn, Dr. Leshnower completed a two year post-doctoral fellowship in the Harrison Department of Surgical Research studying myocardial ischemia/reperfusion injury as a member of the Gorman Cardiovascular Research Group. Following completion of his general surgery training, Dr. Leshnower completed a cardiothoracic surgery residency under Dr. Robert Guyton at Emory University School of Medicine. Dr. Leshnower pursued advanced training in thoracic aortic surgery under Dr. Joseph Bavaria at the University of Pennsylvania and endovascular surgery at the Arizona Heart Institute. Dr. Leshnower joined faculty of the Division of Cardiothoracic Surgery at Emory in 2011 as a cardio-aortic surgeon. He is currently the Director of Thoracic Aortic Surgery for Emory Healthcare and performs all adult cardiac surgery and specializes in open and endovascular therapies for diseases of the thoracic aorta.
Kishiwada Tokusyukai hospital
Izumisano Shi, Osaka
Japan - Contact Me
My name is Makoto Matsuura, and I am a Japanese certified cardiovascular surgeon.
I'm interested in the treatment of Acute aortic dissection.
Description
The study was performed to identify the long-term outcome after hemiarch replacement for patients with acute type A aortic dissection and arch branch dissection.
Method:
From January 2008 to December 2021, 466 patients underwent open acute type A aortic dissection surgery. After excluding those who underwent total arch replacement(n=56), 411 patients met the criteria. Patients were divided into those with arch branch vessel dissection(n=204) and those without arch vessel dissection(n=207).
Result:
The median age of the entire cohort was 72 years, and other preoperative comorbidities were similar between the two groups. Both groups received aortic root replacement similarly (10% vs. 9%, P=0.60), and other intraoperative outcomes are similar. However, Deep hypothermic circulatory arrest time is a little longer in those without arch branch vessel dissection (41min vs. 45min, P=0.007). Postoperative outcomes were similar between the two groups, including operative mortality (9% vs. 7% P=0.478) and stroke (8% vs. 12% P=0.11). An anastomosis-related new entry was seen more in the arch branch dissection group (53% vs. 12% P<0.001). The arch branch vessel dissection group had a significantly greater cumulative incidence of reoperation for distal aorta (5-year 30% vs. 12% P<0.001) with a hazard ratio of 9.75(95% confidence interval, 6.92-14.6 P<0.001). The 10-year survival was similar between the arch-branch vessel dissection and no arch-branch vessel dissection groups (50% vs. 55% P=0.39).
An anastomosis-related new entry was associated with re-operation for the distal aorta (hazard ratio 3.17, P<0.001).
Conclusions:
Hemiarch replacement for patients with acute aortic dissection with arch branch vessel dissection was associated with the anastomosis-related new entry and later re-intervention of the distal aorta