P144. Hemiarch versus Extended Arch Replacement for DeBakey Type I Acute Aortic Dissections
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Corewell Health
Grand Rapids, MI
United States - Contact Me
Stephen Thorp, MD is a fellow in cardiothoracic surgery at Corewell Health/Michigan State University in Grand Rapids, Michigan. He obtained his medical education at Loma Linda University School of Medicine and general surgery training at Corewell Health. Prior to fellowship he worked for the Indian Health Service in Alaska as a general surgeon. The disparity in access to cardiothoracic surgery was a main driving factor in deciding to pursue further fellowship training. In addition to his passion for cardiothoracic surgery, Stephen has interests in global inequalities in healthcare access and humanitarianism. Outside of work, he enjoys outdoor sports, classical music and spending time with his family.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective:
Optimal repair technique for DeBakey type I acute aortic dissection (AAD) is controversial. The purpose of this study is to compare the clinical outcomes and distal aortic remodeling in patients who had hemiarch repair versus those with an extended arch replacement in patients with DeBakey I AAD. All patients were managed post-operatively in a multidisciplinary aortic disease clinic with post-operative imaging surveillance at 1-, 6-, and 12-months, and yearly thereafter.
Methods:
All patients undergoing repair of DeBakey type I AAD between January 1, 2000, and January 1, 2021, were retrospectively analyzed. Patients were separated into hemiarch repair and extended arch replacement groups which included zones 1, 2, or 3 arch replacements with or without elephant trunks. Distal aortic remodeling was evaluated by assessing growth of the residual aorta as well as false lumen thrombosis on follow-up ECG-gated computed tomography angiography imaging. Linear mixed models were used to compare both aortic measurements and follow up year with subject and year follow up included as random effects.
Results:
One hundred and seventy-four patients had a hemiarch repair alone and twenty-one had an extended arch replacement. No significant differences in demographics were observed between groups. Mean age was 60 years, 27.2% (n=53) were female, 61.5% (n=120) were current or former smokers, and 46.7% (n=91) presented with neurologic, visceral, and/or peripheral malperfusion. Patients undergoing extended arch replacement had longer cross-clamp, cardiopulmonary bypass, and circulatory arrest times. Postoperatively there was no significant difference in rate of stroke, paralysis, renal failure, or death within 30 days. Overall, 30-day mortality was 11.9% (n=23). Mortality at 1 and 5 years was 16.7% (n=29), and 24.1% (n=42), in the hemiarch group, respectively, versus 14.3% (n=3) and 14.3% (n=3) in the extended arch replacement group (p=0.23). Rate of aortic reintervention at 1, 5, and 10 years was 1.1% (n=2), 3.4% (n=6), and 4.0% (n=7) in the hemiarch group; in the arch replacement group it was 9.5%, (n=2), and 14.3% (n=3) at 1 and 5 years (p=0.29). Follow up imaging was available for 91% (n=176) of patients Complete false lumen thrombosis of the descending aorta occurred in 7.2% (n=11) of hemiarch patients and 11.1% (n=2) of extended arch replacement patients (p=0.631). In the linear mixed models, no interaction between group and year of follow-up was significant. There was no significant difference in the measurements for each year of follow up for extended arch repair compared to hemiarch.
Conclusions:
In the setting of DeBakey type I AAD aggressive arch replacement can be safely accomplished despite increased technical complexity compared to hemiarch repair only. A lower-than-expected reintervention rate was observed in both groups, possibly due to post-operative surveillance and management in a specialty aortic disease clinic. Linear mixed models demonstrated progressive distal aortic growth but no difference in rate between groups.
Authors
Stephen Thorp (1), Caleb Weissman (2), Tomasz Timek (1), Stephane Leung (1)
Institutions
(1) Corewell Health, Grand Rapids, MI, (2) Michigan State University College of Human Medicine, Lansing, MI
Optimal repair technique for DeBakey type I acute aortic dissection (AAD) is controversial. The purpose of this study is to compare the clinical outcomes and distal aortic remodeling in patients who had hemiarch repair versus those with an extended arch replacement in patients with DeBakey I AAD. All patients were managed post-operatively in a multidisciplinary aortic disease clinic with post-operative imaging surveillance at 1-, 6-, and 12-months, and yearly thereafter.
Methods:
All patients undergoing repair of DeBakey type I AAD between January 1, 2000, and January 1, 2021, were retrospectively analyzed. Patients were separated into hemiarch repair and extended arch replacement groups which included zones 1, 2, or 3 arch replacements with or without elephant trunks. Distal aortic remodeling was evaluated by assessing growth of the residual aorta as well as false lumen thrombosis on follow-up ECG-gated computed tomography angiography imaging. Linear mixed models were used to compare both aortic measurements and follow up year with subject and year follow up included as random effects.
Results:
One hundred and seventy-four patients had a hemiarch repair alone and twenty-one had an extended arch replacement. No significant differences in demographics were observed between groups. Mean age was 60 years, 27.2% (n=53) were female, 61.5% (n=120) were current or former smokers, and 46.7% (n=91) presented with neurologic, visceral, and/or peripheral malperfusion. Patients undergoing extended arch replacement had longer cross-clamp, cardiopulmonary bypass, and circulatory arrest times. Postoperatively there was no significant difference in rate of stroke, paralysis, renal failure, or death within 30 days. Overall, 30-day mortality was 11.9% (n=23). Mortality at 1 and 5 years was 16.7% (n=29), and 24.1% (n=42), in the hemiarch group, respectively, versus 14.3% (n=3) and 14.3% (n=3) in the extended arch replacement group (p=0.23). Rate of aortic reintervention at 1, 5, and 10 years was 1.1% (n=2), 3.4% (n=6), and 4.0% (n=7) in the hemiarch group; in the arch replacement group it was 9.5%, (n=2), and 14.3% (n=3) at 1 and 5 years (p=0.29). Follow up imaging was available for 91% (n=176) of patients Complete false lumen thrombosis of the descending aorta occurred in 7.2% (n=11) of hemiarch patients and 11.1% (n=2) of extended arch replacement patients (p=0.631). In the linear mixed models, no interaction between group and year of follow-up was significant. There was no significant difference in the measurements for each year of follow up for extended arch repair compared to hemiarch.
Conclusions:
In the setting of DeBakey type I AAD aggressive arch replacement can be safely accomplished despite increased technical complexity compared to hemiarch repair only. A lower-than-expected reintervention rate was observed in both groups, possibly due to post-operative surveillance and management in a specialty aortic disease clinic. Linear mixed models demonstrated progressive distal aortic growth but no difference in rate between groups.
Authors
Stephen Thorp (1), Caleb Weissman (2), Tomasz Timek (1), Stephane Leung (1)
Institutions
(1) Corewell Health, Grand Rapids, MI, (2) Michigan State University College of Human Medicine, Lansing, MI
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.