The Clinical Impact of the Extension of Acute Type A Aortic Surgery on Long-Term Outcomes: Should We Tend to Be Conservative?
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Surgical Procedure
2.3. Definitions and Study Endpoints
2.4. Quality of Life Survey
2.5. Statistical Analyses
3. Results
3.1. Demographic and Preoperative Data
3.2. Intraoperative Data
3.3. Perioperative Outcomes
3.4. Long-Term Outcomes
3.5. Quality of Life
4. Discussion
Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Ascending Aorta Replacement n = 108 | Hemiarch and Arch n = 57 | p Value | ||
---|---|---|---|---|
Age | 58.3 ± 9.7 | 58.1 ± 10.4 | 0.906 | |
Gender | male | 87 (80.6) | 42 (73.7) | 0.310 |
female | 21 (19.4) | 15 (26.3) | ||
Hypertension | 5 (4.6) | 4 (7) | 0.331 | |
Diabetes mellitus | 9 (8.3) | 5 (8.8) | 0.521 | |
Chronic obstructive pulmonary disease | 15 (13.9) | 4 (7) | 0.923 | |
Atrial fibrillation | 4 (3.7) | 6 (10.5) | 0.189 | |
Cardiogenic shock | 5 (4.6) | 2 (3.5) | 0.734 | |
Cardiac tamponade | 18 (16.6) | 9 (18.8) | 0.857 | |
Pericardial effusion | 35(32.4) | 22 (38.6) | 0.238 | |
Previous cardiac surgery | 4 (2.4) | 6 (5.6) | 0.141 | |
Mechanical ventilation | 5 (4.6) | 0 (0) | 0.099 | |
Neurological deficit (all) | 15 (13.9) | 10 (17.6) | 0.561 | |
Hemiparesis or hemiplegia | 10 (9.2) | 7 (12.2) | 0.348 | |
Coma | 5 (4.6) | 3 (5.3) | 0.301 |
Ascending Aorta Replacement n = 108 | Hemiarch and Arch n = 57 | p | ||
---|---|---|---|---|
Intraoperative characteristics | ||||
Cannulation site | Femoral artery | 22 (20.3) | 13 (22.8) | 0.522 |
Right axillary artery | 17 (15.7) | 10 (17.5) | ||
Brachiocephalic trunk | 69 (64) | 34 (59.7) | ||
Cardiopulmonary bypass (min) | 175 ± 52 | 241 ± 65 | 0.013 | |
Aortic cross-clamp (min) | 89 ± 21 | 98 ± 51 | 0.532 | |
Circulatory arrest (min) | 20 ± 7 | 34 ± 20 | 0.015 | |
Cerebral perfusion | 86 (79.6) | 44 (77.2) | 0.638 | |
Bentall procedure | 25 (23.1) | 10 (17.5) | 0.452 | |
Coronary artery bypass grafting | 6 (5.5) | 3(5.7) | 0.428 |
Ascending Aorta Replacement n = 108 | Hemiarch and Arch n = 57 | p | |
---|---|---|---|
Postoperative complications | |||
Re-exploration for bleeding | 23 (21.5) | 6 (10.7) | 0.087 |
Acute kidney injury | 14 (13.1) | 9 (16.1) | 0.603 |
Haemodialysis | 6 (5.6) | 4 (7.1) | 0.698 |
New neurological deficit | 9 (8.4) | 10 (17.5) | 0.045 |
Stroke | 7 (6.5) | 9 (15.7) | 0.031 |
Coma | 3 (2.8) | 4 (7.1) | 0.014 |
Pneumonia | 3 (2.8) | 4 (7.1) | 0.194 |
Sepsis | 21 (19.6) | 12 (21.4) | 0.786 |
Wound infectious | 3 (2.8) | 2 (3.5) | 0.206 |
Lower limb ischemia | 3 (2.8) | 2 (3.6) | 0.787 |
Gastrointestinal bleeding | 7 (6.5) | 4 (7.1) | 0.885 |
In-hospital mortality | 20 (18.5) | 16 (28.1) | 0.035 |
Follow up characteristics | |||
Reoperation | 10 (9.2) | 4 (7.1) | 0.354 |
Cardiovascular event | 10 (13.2) | 8 (25) | 0.132 |
Stroke | 2 (2.6) | 1 (3.1) | 0.887 |
B | HR | 95.0% CI for Exp(B) | p Value | ||
---|---|---|---|---|---|
Lower | Upper | ||||
Age | 0.087 | 1.090 | 1.052 | 1.131 | <0.001 |
Coronary artery disease | 1.847 | 6.340 | 2.851 | 14.095 | <0.001 |
Hemiarch and arch group | 1.237 | 3.446 | 1.848 | 6.426 | <0.001 |
Re-exploration for bleeding | 0.790 | 2.204 | 1.011 | 4.807 | 0.047 |
Acute kidney injury | 1.011 | 2.749 | 1.153 | 6.552 | 0.023 |
Haemodialysis | 1.511 | 4.530 | 1.377 | 14.898 | 0.013 |
Paresis | 0.943 | 2.568 | 1.005 | 6.560 | 0.049 |
Stroke | 1.278 | 3.590 | 1.646 | 7.829 | 0.001 |
Coma | 2.786 | 16.214 | 5.252 | 50.058 | <0.001 |
Pneumonia | 1.663 | 5.277 | 2.054 | 13.561 | 0.001 |
Sepsis | 0.716 | 2.046 | 1.043 | 4.013 | 0.037 |
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Jankovic, N.; Matkovic, M.; Bilbija, I.; Milicevic, V.; Zlatkovic, M.; Aleksic, N.; Cvetic, V.; Milin-Lazovic, J.; Putnik, S. The Clinical Impact of the Extension of Acute Type A Aortic Surgery on Long-Term Outcomes: Should We Tend to Be Conservative? Medicina 2024, 60, 35. https://doi.org/10.3390/medicina60010035
Jankovic N, Matkovic M, Bilbija I, Milicevic V, Zlatkovic M, Aleksic N, Cvetic V, Milin-Lazovic J, Putnik S. The Clinical Impact of the Extension of Acute Type A Aortic Surgery on Long-Term Outcomes: Should We Tend to Be Conservative? Medicina. 2024; 60(1):35. https://doi.org/10.3390/medicina60010035
Chicago/Turabian StyleJankovic, Natasa, Milos Matkovic, Ilija Bilbija, Vladimir Milicevic, Mina Zlatkovic, Nemanja Aleksic, Vladimir Cvetic, Jelena Milin-Lazovic, and Svetozar Putnik. 2024. "The Clinical Impact of the Extension of Acute Type A Aortic Surgery on Long-Term Outcomes: Should We Tend to Be Conservative?" Medicina 60, no. 1: 35. https://doi.org/10.3390/medicina60010035