Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection

Arnar Geirsson, Kayoko Shioda, Christian Olsson, Anders Ahlsson, Jarmo Gunn, Emma C. Hansson, Vibeke Hjortdal, Anders Jeppsson, Ari Mennander, Anders Wickbom, Igor Zindovic, Tomas Gudbjartsson

Rannsóknarafurð: Framlag til fræðitímaritsGreinritrýni

6 Tilvitnanir (Scopus)

Útdráttur

Objectives: Open-distal anastomosis is the preferred technique over clamp-on technique for surgical repair of acute type A aortic dissection (ATAAD). The aim of this study was to define how outcomes of ATAAD were affected by the use of either technique. Methods: Nordic Consortium for Acute Type A Aortic Dissection includes 8 academic cardiothoracic hospitals in 4 Nordic countries. The cohort consisted of 1134 patients, 153 clamp-on and 981 open-distal, from 2005 to 2014. Results: Patients who underwent operation with the clamp-on were younger, more frequently had coronary artery disease, bicuspid aortic valve, hypotension/shock or syncope, and a greater PennClass than open-distal patients. Postoperative cerebral vascular accident occurred less frequently in clamp-on (14/153, 10%) compared with the open-distal group (190/981, 20%). Clamp-on had greater 30-day mortality (39/153, 25%) than the open-distal group (158/981, 16%), and 5-year survival was also worse in clamp-on (61.8% ± 4.4%) compared with the open-distal group (73.0% ± 1.6%). The open-distal technique was used more frequently in greater-volume hospitals but was not independently associated with 30-day mortality. Preoperative condition was an independent risk factor whereas hospital volume and later year of operation were beneficial in regard to short-term outcome. Open-distal was independently associated with improved mid-term survival. Conclusions: Patients who underwent operation with the clamp-on were sicker on presentation and had worse short- and mid-term survival compared with the open-distal group. Patients in the open-distal group had greater rates of cerebrovascular complications. The results support the routine use of open-distal anastomosis as the primary operative strategy for ATAAD, although clamp-on can be performed successfully in select cases.

Upprunalegt tungumálEnska
Síður (frá-til)1750-1758
Síðufjöldi9
FræðitímaritJournal of Thoracic and Cardiovascular Surgery
Bindi157
Númer tölublaðs5
DOI
ÚtgáfustaðaÚtgefið - maí 2019

Athugasemd

Funding Information:
Funding: Reykjavik: University of Iceland Research Fund and Landspitali Research Fund; Stockholm: The Mats Kleberg Foundation. NORCAAD research group: Arnar Geirsson, MD, Tomas Gudbjartsson, MD, PhD, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Vibeke Hjortdal, MD, PhD, Simon Fuglsang MD, Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark; Ari Mennander, MD, PhD, Kati Jarvela, MD, PhD, Heart Center Tampere University Hospital, Tampere, Finland; Jarmo Gunn, MD, PhD, Emily Pan, MD, Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Anders Ahlsson, MD, PhD, Anders Wickbom MD, Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital and School of Health and Medicine, Orebro University, Orebro, Sweden; Emma C. Hansson, MD, PhD, Anders Jeppsson, MD, PhD, Department of Cardiothoracic Surgery, Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Shahab Nozohoor, MD, PhD, Igor Zindovic, MD, Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden; Anders Franco-Cereceda, MD, PhD, Christian Olsson, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden. The following individuals also contributed to the study: Erik Bj?rklund, MD, Josefine Carrell, RN, Erik Herou, MD, Sigrun H. Lund, PhD, Inga H. Melvinsdottir, MD, Emily Pan, BM, Johan Sj?gren, MD, PhD, and Khalil Ahmad, MD.

Publisher Copyright:
© 2018

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