Objective: Advancements in cardiothoracic surgery prompted investigation into changes in operative management for acute type A aortic dissections over time. Methods: One thousand seven hundred thirty-two patients undergoing surgery for type A aortic dissection were identified from the International Registry of Acute Aortic Dissection Interventional Cohort Database. Patients were divided into time tertiles (T) (T1: 1996-2003, T2: 2004-2010, and T3: 2011-2016). Results: Frequency of valve sparing procures increased (T1: 3.9%, T2: 18.6%, and T3: 26.7%; trend P < .001). Biologic valves were increasingly utilized (T1: 35.6%, T2; 40.6%, and T3: 52.0%; trend P = .009), whereas mechanical valve use decreased (T1: 57.6%, T2: 58.0%, and T3: 45.4%; trend P = .027) for aortic valve replacement. Adjunctive cerebral perfusion use increased (T1: 67.1%, T2: 89.5%, and T3: 84.8%; trend P < .001), with increase in antegrade cerebral techniques (T1: 55.9%, T2: 58.8%, and T3: 66.1%; trend P = .005) and hypothermic circulatory arrest (T1: 80.1%, T2: 85.9%, and T3: 86.8%; trend P = .030). Arterial perfusion through axillary cannulation increased (T1: 18.0%, T2: 33.2%, and T3: 55.7%), whereas perfusion via a femoral approach diminished (T1: 76.0%, T2: 53.3%, and T3: 30.1%) (both P values < .001). Hemiarch replacement was utilized more frequently (T1: 27.0%, T2: 63.3%, and T3: 51.7%; trend P = .001) and partial arch was utilized less frequently (T1: 20.7%, T2: 12.0%, and T3: 8.4%; trend P < .001), whereas complete arch replacement was used similarly (P = .131). In-hospital mortality significantly decreased (T1: 17.5%, T2: 15.8%, and T3: 12.2%; trend P = .017). Conclusions: There have been significant changes in operative strategy over time in the management of type A aortic dissection, with more frequent use of valve-sparing procedures, bioprosthetic aortic valve substitutes, antegrade cerebral perfusion strategies, and hypothermic circulatory arrest. Most importantly, a significant decrease of in-hospital mortality was observed during the 20-year timespan.
Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program / N. Parikh, S. Trimarchi, T.G. Gleason, A.V. Kamman, M. di Eusanio, T. Myrmel, A. Korach, H. Maniar, T. Ota, A. Khoynezhad, D.G. Montgomery, N.D. Desai, K.A. Eagle, C.A. Nienaber, E.M. Isselbacher, J. Bavaria, T.M. Sundt, H.J. Patel. - In: JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. - ISSN 0022-5223. - 153:4(2017 Apr), pp. S74-S79-S79. ((Intervento presentato al convegno Amarican Association of Thoracic Surgery - Aortic Symposium 2017 tenutosi a New York nel 2017.
|Titolo:||Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program|
TRIMARCHI, SANTI (Secondo)
|Parole Chiave:||Aortic dissection; Operative strategy; Surgical management; Survival; Trends; Surgery; Pulmonary and Respiratory Medicine; Cardiology and Cardiovascular Medicine|
|Settore Scientifico Disciplinare:||Settore MED/22 - Chirurgia Vascolare|
Settore MED/23 - Chirurgia Cardiaca
|Data di pubblicazione:||apr-2017|
|Data ahead of print / Data di stampa:||gen-2017|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.jtcvs.2016.12.029|
|Appare nelle tipologie:||01 - Articolo su periodico|