医学
四分位间距
危险系数
主动脉夹层
外科
比例危险模型
主动脉瓣
主动脉瓣置换术
置信区间
相对风险
心脏病学
主动脉
内科学
狭窄
作者
James A. Brown,Jianhui Zhu,Forozan Navid,Derek Serna‐Gallegos,Rishabh Sehra,Nav Warraich,Valentino Bianco,Edgar Aranda‐Michel,Ibrahim Sultan
标识
DOI:10.1016/j.jtcvs.2022.04.053
摘要
Abstract
Objective
To determine the impact of aortic root preservation versus aortic root replacement (ARR) after acute type A aortic dissection (ATAAD) repair. Methods
In this observational study of consecutive aortic surgeries between 2007 and 2021, patients with ATAAD were identified via a prospectively maintained institutional database and were stratified by root preservation versus ARR (including valve-sparing and complete ARR). Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed. Results
Among the 601 patients underwent aortic arch reconstruction for ATAAD, 370 (61.6%) underwent root preservation and the other 231 (38.4%) underwent ARR, with a median follow-up of 6.3 years (interquartile range, 3.8-9.6 years). Cardiopulmonary bypass and ischemic times were longer in the ARR group, but intraoperative variables were otherwise similar between the groups, including cannulation strategy and extent of distal repair. There were no between-group differences in postoperative outcomes, including operative mortality, stroke, mechanical ventilation time, renal failure, reexploration for bleeding, and total length of stay. At a 1-year follow-up, the incidence of aortic regurgitation (moderate or greater) was similar in the 2 groups. On multivariable Cox regression, ARR was not associated with improved long-term survival compared with root preservation (hazard ratio, 1.13; 95% confidence interval, 0.82-1.56; P = .44). Late reinterventions on the aortic root or valve were similar in the 2 groups and was 2.0% for the overall cohort. Conclusions
These findings suggest that aortic root preservation may achieve similar midterm outcomes as ARR after ATAAD repair.
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