Comparison of the outcomes between total arch replacement and nontotal arch replacement in patients with acute type A aortic dissection
Issued Date
2023-01-01
Resource Type
ISSN
09709134
eISSN
09737723
Scopus ID
2-s2.0-85167928059
Journal Title
Indian Journal of Thoracic and Cardiovascular Surgery
Rights Holder(s)
SCOPUS
Bibliographic Citation
Indian Journal of Thoracic and Cardiovascular Surgery (2023)
Suggested Citation
Lerdpunnapongse P., Slisatkorn W., Wongkornrat W., Sanphasitvong V. Comparison of the outcomes between total arch replacement and nontotal arch replacement in patients with acute type A aortic dissection. Indian Journal of Thoracic and Cardiovascular Surgery (2023). doi:10.1007/s12055-023-01576-7 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/88953
Title
Comparison of the outcomes between total arch replacement and nontotal arch replacement in patients with acute type A aortic dissection
Author's Affiliation
Other Contributor(s)
Abstract
Objective: To compare the outcomes between total arch replacement (TAR) and nontotal arch replacement (non-TAR) in patients with acute type A aortic dissection (ATAAD). Methods: Between 2006 and 2018, 275 ATAAD patients were divided into 2 groups, the TAR group (n = 63) and the non-TAR group (n = 212), and multiple variables were analyzed. Results: The TAR patients were older than the non-TAR patients (61.5 ± 11.8 vs. 57.4 ± 14.5 years, p = 0.024). The TAR group had longer operative, cardiopulmonary bypass, aortic clamping, and circulatory arrest times than the non-TAR group (all p < 0.001). The overall hospital mortality rate was 8.7% with no statistically significant difference between the TAR and non-TAR groups (9.5% vs. 8.5%, p = 0.799). There was no significant difference in the incidence of acute kidney injury (AKI), intubation time, incidence of postoperative atrial fibrillation (AF), or reoperation for bleeding or reintervention rates between the TAR and non-TAR groups (68.3% vs. 65.7% (p = 0.912), 44.8% vs. 33.8% (p = 0.127), 30.2% vs. 22.6% (p = 0.222), 9.5% vs. 9.5% (p = 0.189), and 7.9% vs. 7.1% (p = 0.077), respectively). The TAR group had a higher rate of new permanent neurological deficit (PND) than the non-TAR group and longer median length of hospital stay (17.5% vs. 6.1% (p < 0.001) and 9 vs. 12 days (p = 0.049), respectively). TAR (relative risk (RR) 3.66, p = 0.005) and preoperative cardiopulmonary resuscitation (CPR) (RR 6.60, p = 0.019) were risk factors of PND. Survival rate was similar between the two groups. Conclusion: The mortality rates in ATAAD patients with TAR and non-TAR were similar. However, the incidence of new permanent postoperative neurological deficit was significantly higher, and the length of hospital stay was longer in patients with TAR. TAR in ATAAD should be avoided especially in patients who have experienced preoperative CPR to abate risk of PND.