P142. Hemi-Arch versus Total Arch Replacement in DeBakey Type I Communicating Acute Aortic Dissection
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Osaka Medical College
Kyoto
Japan - Contact Me
Dr. Masahiro Daimon graduated from Kyoto Prefectural University of Medicine in 1996. After completing his training residency in cardiovascular surgery at Kyoto Prefectural University of Medicine, He moved to the Graduate School of Tokyo Women's Medical University in 1999, where He was involved in clinical and research in cardiovascular surgery. In 2004, He received his PhD in medicine for his research on brain protection. Currently, He is an associate professor in the Department of Cardiovascular Surgery at Osaka Medical and Pharmaceutical University, specializing in aortic surgery among adult cardiovascular surgeries.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Although recent reports indicate a trend towards a more extensive arch operation, the recommended extent of graft replacement in acute aortic dissection (AAD) is an ongoing controversy. Thus, this study compared early and late outcomes of hemi-arch versus total arch replacement for DeBakey type I communicating AAD.
Methods: From 2004 to 2022, 221 patients with AAD underwent emergent surgery at our institution. A total of 39 patients were excluded, including those with DeBakey type II AAD, non-communicating aortic dissection, chronic type B dissection, previous thoracic aortic surgery, and those who had undergone surgery more than 14 days after onset. The remaining 182 patients were included in this study. Eighty patients received hemi-arch and 102 received total arch replacement. We compared the early and late outcomes between the two procedures retrospectively.
Results: There were no significant differences in preoperative characteristics between the two procedures, except age. Patients over 80 years of age were more likely to have undergone hemi-arch replacement. No significant differences were observed in postoperative complications, and in-hospital mortality was statistically similar in both procedures (4/80 (5.0%) vs 3/102 (2.9%); p=.368). The mean follow-up period was 6.4 years (0-19.7 years). At 5 years, mortality was 15.0% after hemi-arch replacement and 8.5% after total arch replacement (p=.558). The cumulative incidence of aortic reoperation was 8.8% (11 reoperations in 7 patients) in the hemi-arch replacement and 9.8% (11 reoperations in 10 patients) in the total arch replacement (p=.443). Though both procedures required aortic reoperations, multiple reoperations were more likely in patients undergoing hemi-arch replacement (3cases vs 1case). In multivariate analysis, aortic reoperation was significantly common in patients under 60 years of age (OR, 2.85; 95% CI, 1.01-8.05) and in patients with residual entry in the distal aortic arch (OR, 3.40; 95% CI, 1.20-9.62).
Conclusion: While hemi-arch replacement is adequate to achieve the primary goal of saving the AAD patient, total arch replacement is also a feasible approach with similar results to hemi-arch replacement. Total arch replacement might be useful for patients with a younger age. The main limitation of this study was its retrospective approach to the analysis, thus selection bias of patients could not be eliminated.
Authors
Masahiro Daimon (1), Yuki Asada (1), Takurou Makiura (1), Tatsuya Suzuki (1), Hiroaki Uchida (1), Junko Okamoto (1), Sachiko Kanki (1), Hideki Ozawa (1), Takahiro Katsumata (1)
Institutions
(1) Osaka Medical and Pharmaceutical University, Osaka, Japan
Methods: From 2004 to 2022, 221 patients with AAD underwent emergent surgery at our institution. A total of 39 patients were excluded, including those with DeBakey type II AAD, non-communicating aortic dissection, chronic type B dissection, previous thoracic aortic surgery, and those who had undergone surgery more than 14 days after onset. The remaining 182 patients were included in this study. Eighty patients received hemi-arch and 102 received total arch replacement. We compared the early and late outcomes between the two procedures retrospectively.
Results: There were no significant differences in preoperative characteristics between the two procedures, except age. Patients over 80 years of age were more likely to have undergone hemi-arch replacement. No significant differences were observed in postoperative complications, and in-hospital mortality was statistically similar in both procedures (4/80 (5.0%) vs 3/102 (2.9%); p=.368). The mean follow-up period was 6.4 years (0-19.7 years). At 5 years, mortality was 15.0% after hemi-arch replacement and 8.5% after total arch replacement (p=.558). The cumulative incidence of aortic reoperation was 8.8% (11 reoperations in 7 patients) in the hemi-arch replacement and 9.8% (11 reoperations in 10 patients) in the total arch replacement (p=.443). Though both procedures required aortic reoperations, multiple reoperations were more likely in patients undergoing hemi-arch replacement (3cases vs 1case). In multivariate analysis, aortic reoperation was significantly common in patients under 60 years of age (OR, 2.85; 95% CI, 1.01-8.05) and in patients with residual entry in the distal aortic arch (OR, 3.40; 95% CI, 1.20-9.62).
Conclusion: While hemi-arch replacement is adequate to achieve the primary goal of saving the AAD patient, total arch replacement is also a feasible approach with similar results to hemi-arch replacement. Total arch replacement might be useful for patients with a younger age. The main limitation of this study was its retrospective approach to the analysis, thus selection bias of patients could not be eliminated.
Authors
Masahiro Daimon (1), Yuki Asada (1), Takurou Makiura (1), Tatsuya Suzuki (1), Hiroaki Uchida (1), Junko Okamoto (1), Sachiko Kanki (1), Hideki Ozawa (1), Takahiro Katsumata (1)
Institutions
(1) Osaka Medical and Pharmaceutical University, Osaka, Japan
Presentation Duration
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