Eric E Roselli1, Gabriel Loor2, Jiayan He3, Aldo E Rafael2, Jeevanantham Rajeswaran3, Penny L Houghtaling3, Lars G Svensson2, Eugene H Blackstone4, Bruce W Lytle2. 1. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: roselle@ccf.org. 2. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 3. Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio. 4. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
Abstract
OBJECTIVE: Survivors of ascending aortic dissection repair frequently require downstream aortic interventions. Because of a paucity of data, we assessed early and long-term outcomes, and risk factors, of these distal procedures. METHODS: From January 1993 to January 2011, 305 patients underwent 429 distal aortic interventions after acute type A (95% DeBakey type I) dissection repair performed 3.8 years earlier (median); 11% of interventions used an endovascular approach. Maximum aortic size was 5.9 ± 1.3 cm. Median follow-up was 3.6 years. RESULTS: Hospital mortality was 6.1%. Risk factors included graft infection, concomitant coronary artery bypass grafting, combined open arch and descending procedures, and lower distal anastomotic site. Within 10 years, the probability of patients undergoing a reintervention was 38%, with a cumulative incidence of 55 per 100 patients; however, 40 (9.3%) were stage-II elephant trunks. Patients with larger aortic diameters distal to the initial repair, and a stage-I elephant trunk, were more likely to undergo distal interventions. Survival was 65% at 10 years. Higher body mass index, a longer time between reinterventions, graft infection, combined open arch and descending procedures, and lower distal anastomosis sites were risk factors. The extent of aorta replaced was not associated with increased morbidity or mortality, unless it involved a combined open arch and descending aorta procedure. CONCLUSIONS: Distal interventions after ascending aortic dissection repair are feasible, but they are associated with early morbidity and subsequent reinterventions. Rigorous follow-up with early reintervention is important for improving short- and long-term outcomes. An extended hybrid endovascular repair for initial dissection warrants study.
OBJECTIVE: Survivors of ascending aortic dissection repair frequently require downstream aortic interventions. Because of a paucity of data, we assessed early and long-term outcomes, and risk factors, of these distal procedures. METHODS: From January 1993 to January 2011, 305 patients underwent 429 distal aortic interventions after acute type A (95% DeBakey type I) dissection repair performed 3.8 years earlier (median); 11% of interventions used an endovascular approach. Maximum aortic size was 5.9 ± 1.3 cm. Median follow-up was 3.6 years. RESULTS: Hospital mortality was 6.1%. Risk factors included graft infection, concomitant coronary artery bypass grafting, combined open arch and descending procedures, and lower distal anastomotic site. Within 10 years, the probability of patients undergoing a reintervention was 38%, with a cumulative incidence of 55 per 100 patients; however, 40 (9.3%) were stage-II elephant trunks. Patients with larger aortic diameters distal to the initial repair, and a stage-I elephant trunk, were more likely to undergo distal interventions. Survival was 65% at 10 years. Higher body mass index, a longer time between reinterventions, graft infection, combined open arch and descending procedures, and lower distal anastomosis sites were risk factors. The extent of aorta replaced was not associated with increased morbidity or mortality, unless it involved a combined open arch and descending aorta procedure. CONCLUSIONS: Distal interventions after ascending aortic dissection repair are feasible, but they are associated with early morbidity and subsequent reinterventions. Rigorous follow-up with early reintervention is important for improving short- and long-term outcomes. An extended hybrid endovascular repair for initial dissection warrants study.
Authors: Jay J Idrees; Eric E Roselli; Charles M Wojnarski; Ke Feng; Muhammad Aftab; Douglas R Johnston; Edward G Soltesz; Joseph F Sabik; Lars G Svensson Journal: J Thorac Cardiovasc Surg Date: 2015-07-30 Impact factor: 5.209
Authors: Nimesh D Desai; Ashley Hoedt; Grace Wang; Wilson Y Szeto; Prasthanth Vallabhajosyula; Mary Reinke; Joseph E Bavaria Journal: Ann Cardiothorac Surg Date: 2018-05
Authors: Hanghang Wang; Matthew Wagner; Ehsan Benrashid; Jeffrey Keenan; Alice Wang; David Ranney; Babatunde Yerokun; Jeffrey G Gaca; Richard L McCann; G Chad Hughes Journal: J Am Heart Assoc Date: 2017-10-03 Impact factor: 5.501