title: Total Arch versus Hemiarch Replacement for Type A Acute Aortic Dissection: A Single-Center Experience.
abstract: We retrospectively evaluated early and intermediate outcomes of aortic arch surgery in patients with type A acute aortic dissection (AAD), investigating the effect of arch surgery extension on postoperative results. From January 2006 through July 2013, 201 patients with type A AAD underwent urgent corrective surgery at our institution. Of the 92 patients chosen for this study, 59 underwent hemiarch replacement (hemiarch group), and 33 underwent total arch replacement (total arch group) in conjunction with ascending aorta replacement. The operative mortality rate was 22%. Total arch replacement was associated with a 33% risk of operative death, versus 15% for hemiarch (P=0.044). Multivariable analysis found these independent predictors of operative death: age (odds ratio [OR]=1.13/yr; 95% confidence interval [CI], 1.04-1.23;P=0.002), body mass index >30 kg/m2(OR=9.9; 95% CI, 1.28-19;P=0.028), postoperative low cardiac output (OR=10.6; 95% CI, 1.18-25;P=0.035), and total arch replacement (OR=8.8; 95% CI, 1.39-15;P=0.021) The mean overall 5-year survival rate was 59.3% ± 5.5%, and mean 5-year freedom from distal reintervention was 95.4% ± 3.2% (P=NS). In type A AAD, aortic arch surgery is still associated with high operative mortality rates; hemiarch replacement can be performed more safely than total arch replacement. Rates of distal aortic reoperation were not different between the 2 surgical strategies.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lio
authors.forename: Francesca
authors.initials: F
authors.lastname: Nicolò
authors.forename: Emanuele
authors.initials: E
authors.lastname: Bovio
authors.forename: Andrea
authors.initials: A
authors.lastname: Serrao
authors.forename: Jacob
authors.initials: J
authors.lastname: Zeitani
authors.forename: Antonio
authors.initials: A
authors.lastname: Scafuri
authors.forename: Luigi
authors.initials: L
authors.lastname: Chiariello
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ruvolo
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D012384:Rome; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aneurysm, dissecting/epidemiology/mortality; aorta, thoracic/surgery; aortic aneurysm/epidemiology/mortality/surgery; cardiac surgical procedures/methods; hospital mortality; logistic models; prognosis; retrospective studies; severity of illness index; survival analysis