P201. Long-Term Prognosis of Preserved Aortic Root after Open Repair for Acute Type A Aortic Dissection
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Severance hospital
Seoul, Seoul
South Korea - Contact Me
Associate Professor
Division of Cardiovascular Surgery
Department of Thoracic & Cardiovascular Surgery
Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: The aim of this study was to investigate the long-term prognosis of the preserved, native aortic root after supra-coronary replacement in open repair for acute type A aortic dissection (ATAAD) and risk factors for root dilatation and aortic root re-operation.
Methods: Between 2001 and 2020, 238 consecutive patients (mean age, 62.6 ± 13.9 years) with ATAAD underwent supra-coronary replacement. The maximum diameter of aortic root was measured with computed tomography (CT) before-, immediate after surgery and every 1~2 years after surgery. The mean follow-up duration was 9.0 ± 5.9 years and the mean CT follow-up duration was 7.3 ± 5.02 years. End-points were aortic root re-operation, all-cause mortality and aortic root dilatation.
Results: There were 9 (3.8%) patients with Marfan syndrome and 1 (0.4%) with bicuspid aortic valve. The pre-operative mean aortic root diameter was 39.0 ± 5.4mm; 139 patients (58.4%) with <40mm, 66 patients (27.7%) with ≥40mm and <45mm, and 33 patients (13.9%) with ≥45mm. In-hospital mortality was 10.9%. The mean aortic root diameter increased from 48.6mm to 63.5mm in pre-operative aortic root ≥45mm patients, but it did not significantly increase (37.7mm to 38.9mm) in <45mm patients. Pre-operative aortic root ≥45mm patients showed significantly lower rates of 10-year aortic root re-operation free survival (73.5% vs. 99.4%, p<0.01) and overall survival (49.8% vs. 75.8%, p<0.01) than <45mm patients. The receiver operating characteristic curve showed aortic root re-operation was significantly corelated with pre-operative aortic root diameter (area under curve, 0.911; p<0.01) and optimal cut-off value was 45mm. Multivariate analysis showed that pre-operative aortic root ≥45mm was independent risk factor for aortic root re-operation (hazard ratio, 55.43 [6.79-452.80]; p<0.01) and all-cause death (hazard ratio, 3.41 [1.81-6.44]; p<0.01).
Conclusions: Pre-operative aortic root ≥45mm showed significantly higher risk of aortic root re-operation and late mortality because of the progressive aortic root dilatation.
Authors
Jung-Hwan Kim (1), Seung Hyun Lee (2), Sak Lee (3), Young-Nam Youn (2), Kyung-Jong Yoo (2), Hyun Chel Joo (4)
Institutions
(1) Severance hospital, Seoul, Seoul, (2) Severance Cardiovascular Hospital, Seoul, AK, (3) Severance Hospital, Seoul, none, (4) Severance hospital, Seoul, seoul
Methods: Between 2001 and 2020, 238 consecutive patients (mean age, 62.6 ± 13.9 years) with ATAAD underwent supra-coronary replacement. The maximum diameter of aortic root was measured with computed tomography (CT) before-, immediate after surgery and every 1~2 years after surgery. The mean follow-up duration was 9.0 ± 5.9 years and the mean CT follow-up duration was 7.3 ± 5.02 years. End-points were aortic root re-operation, all-cause mortality and aortic root dilatation.
Results: There were 9 (3.8%) patients with Marfan syndrome and 1 (0.4%) with bicuspid aortic valve. The pre-operative mean aortic root diameter was 39.0 ± 5.4mm; 139 patients (58.4%) with <40mm, 66 patients (27.7%) with ≥40mm and <45mm, and 33 patients (13.9%) with ≥45mm. In-hospital mortality was 10.9%. The mean aortic root diameter increased from 48.6mm to 63.5mm in pre-operative aortic root ≥45mm patients, but it did not significantly increase (37.7mm to 38.9mm) in <45mm patients. Pre-operative aortic root ≥45mm patients showed significantly lower rates of 10-year aortic root re-operation free survival (73.5% vs. 99.4%, p<0.01) and overall survival (49.8% vs. 75.8%, p<0.01) than <45mm patients. The receiver operating characteristic curve showed aortic root re-operation was significantly corelated with pre-operative aortic root diameter (area under curve, 0.911; p<0.01) and optimal cut-off value was 45mm. Multivariate analysis showed that pre-operative aortic root ≥45mm was independent risk factor for aortic root re-operation (hazard ratio, 55.43 [6.79-452.80]; p<0.01) and all-cause death (hazard ratio, 3.41 [1.81-6.44]; p<0.01).
Conclusions: Pre-operative aortic root ≥45mm showed significantly higher risk of aortic root re-operation and late mortality because of the progressive aortic root dilatation.
Authors
Jung-Hwan Kim (1), Seung Hyun Lee (2), Sak Lee (3), Young-Nam Youn (2), Kyung-Jong Yoo (2), Hyun Chel Joo (4)
Institutions
(1) Severance hospital, Seoul, Seoul, (2) Severance Cardiovascular Hospital, Seoul, AK, (3) Severance Hospital, Seoul, none, (4) Severance hospital, Seoul, seoul
Presentation Duration
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