期刊
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
卷 155, 期 1, 页码 1-+出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jtcvs.2017.08.137
关键词
aorta; aortic dissection; aortic root replacement; aortic root repair; reoperation; outcomes
资金
- National Institutes of Health, National Center for Advancing Translational Science, Clinical and Translational Science Award [KL2 TR000083, TL1 TR000084, UL1 TR001085]
Objective: Management of the aortic root is a challenge for surgeons treating acute type A aortic dissection. Methods: We performed a retrospective review of the acute type A aortic dissection experience at Stanford Hospital between 2005 and 2015 and identified patients who underwent either limited root repair or aortic root replacement. Differences in baseline characteristics were balanced with inverse probability weighting to estimate the average treatment effect on the controls. Weighted logistic regression was used to evaluate in-hospital mortality. Weighted Cox proportional hazards regression was used to evaluate differences in the hazard for mid-term death. Reoperation was evaluated with death as a competing risk with the Fine-Gray subdistribution hazard. Results: After we excluded patients managed either nonoperatively or with definitive endovascular repair, there were 293 patients without connective tissue disease who underwent either limited root repair or aortic root replacement. There was no difference in weighted perioperative mortality, odds ratio 0.89 (95% confidence interval [CI], 0.44-1.76, P=.7), and there was no difference in weighted survival, hazard ratio 1.12 (95% CI, 0.54-2.31, P=.8). Risk of reoperation was greater in limited root repair (11.8%, 95% CI, 0.0%-23.8%) than for root replacement (0%), P<.001. Conclusions: Limited root repair was associated with increased risk of late reoperation after repair of acute type A aortic dissection. Surgeons with adequate experience may consider aortic root replacement in well-selected patients. However, given good outcomes after limited root repair, surgeons should not feel compelled to perform this more-complex operation.
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