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Low rate of reoperations after acute type A aortic dissection repair from The Nordic Consortium Registry
Heart Center, Turku University Hospital, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland.
Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Orebro, Sweden; School of Health and Medicine, Orebro University, Orebro, Sweden.
Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark.
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2018 (English)In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 156, no 3, p. 939-948Article in journal (Refereed) Published
Abstract [en]

Objectives: To describe the relationship between the extent of primary aortic repair and the incidence of reoperations after surgery for type A aortic dissection.

Methods: A retrospective cohort of 1159 patients treated for type A aortic dissection at eight Nordic low-to medium-sized cardiothoracic centers from 2005 to 2014. Data were gathered from patient records and national registries. Patients were separately divided into 3 groups according to the distal anastomoses technique (ascending aorta [n = 791], hemiarch [n = 247], and total arch [n = 66]), and into 2 groups for proximal repair (aortic root replacement [n = 285] and supracoronary repair [n = 832]). Freedom from reoperation was estimated with cumulative incidence survival and Fine-Gray competing risk regression model was used to identify independent risk factors for reoperation.

Results: The median follow-up was 2.7 years (range, 0-10 years). Altogether 51 out of 911 patients underwent reoperation. Freedom from distal reoperation at 5 years was 96.9%, with no significant difference between the groups (P = .22). Freedom from proximal reoperation at 5 years was 97.8%, with no difference between the groups (P = .84). Neither DeBakey classification nor the extent of proximal or distal repair predicted freedom from a later reoperation. The only independent risk factor associated with a later proximal reoperation was a history of connective tissue disease.

Conclusions: Type A aortic dissection repair in low-to medium-volume centers was associated with a low reoperation rate and satisfactory midterm survival. The extent of the primary repair had no significant influence on reoperation rate or midterm survival.

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 156, no 3, p. 939-948
Keywords [en]
aortic dissection, reoperation, midterm, outcome
National Category
Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy Surgery
Identifiers
URN: urn:nbn:se:oru:diva-68647DOI: 10.1016/j.jtcvs.2018.03.144ISI: 000441556000007PubMedID: 29753501Scopus ID: 2-s2.0-85046699116OAI: oai:DiVA.org:oru-68647DiVA, id: diva2:1243926
Note

Funding Agency:

Finnish governmental research funding 

Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-09-14Bibliographically approved

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Wickbom, Anders

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