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Porto A, Omnes V, Bartoli MA, Azogui R, Resseguier N, De Masi M, Bal L, Imbert L, Jaussaud N, Morera P, Jacquier A, Barral PA, Gariboldi V, Gaudry M. Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years. J Clin Med 2023; 12:jcm12062363. [PMID: 36983363 PMCID: PMC10054589 DOI: 10.3390/jcm12062363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Background After a type A aortic dissection repair, a patent false lumen in the descending aorta is the most common situation encountered, and is a well-known risk factor for aortic growth, reinterventions and mortality. The aim of this study was to analyze the long-term results of residual aortic dissection (RAD) at a high-volume aortic center with prospective follow-up. Methods In this prospective single-center study, all patients operated for type A aortic dissection between January 2017 and December 2022 were included. Patients without postoperative computed tomography scans or during follow-up at our center, and patients without RAD were excluded. The primary endpoint was all-cause mortality during follow-up for patients with RAD. The secondary endpoints were perioperative mortality, rate of distal aneurysmal evolution, location of distal aneurysmal evolution, rate of distal reinterventions, outcomes of distal reinterventions, and aortic-related death during follow-up. Results In total, 200 survivors of RAD comprised the study group. After a mean follow-up of 27.2 months (1-66), eight patients (4.0%) died and 107 (53.5%) had an aneurysmal progression. The rate of distal reintervention was 19.5% (39/200), for malperfusion syndrome in seven cases (3.5%) and aneurysmal evolution in 32 cases (16.0%). Most reinterventions occurred during the first 2 years (82.1%). Twenty-seven patients were treated for an aneurysmal evolution of RAD including aortic arch with hybrid repair in 21 cases and branched aortic arch endoprosthesis in six cases. In the hybrid repair group, there was no death, and the rate of morbidity was 28.6% (6/21) (one minor stroke, one pulmonary complication, one recurrent paralysis with complete recovery and three major bleeding events). In the branched endograft group, there was no death, no stroke, and no paraplegia. There was one case (16.7%) of carotid dissection. Complete aortic remodeling or complete FL thrombosis on the thoracic aorta was found in 18 cases (85.7%) and in five cases (83.3%) in the hybrid and branched endograft groups, respectively. Conclusions: Despite a critical course in most cases of RAD, with a high rate of aneurysmal evolution and reintervention, the long-term mortality rate remains low with a close follow-up and a multidisciplinary management in an expert center.
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Affiliation(s)
- Alizée Porto
- Department of Cardiac Surgery, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Virgile Omnes
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Michel A Bartoli
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Ron Azogui
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Noémie Resseguier
- Department of Epidemiology and Public Health Cost, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Mariangela De Masi
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Laurence Bal
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Laura Imbert
- Department of Epidemiology and Public Health Cost, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Nicolas Jaussaud
- Department of Cardiac Surgery, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Pierre Morera
- Department of Cardiac Surgery, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Alexis Jacquier
- Department of Radiology, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Pierre-Antoine Barral
- Department of Radiology, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Marine Gaudry
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
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Czerny M, Kreibich M, Morlock J, Kondov S, Scheumann J, Schröfel H, Kari FA, Berger T, Siepe M, Beyersdorf F, Rylski B. Chronic type B "residual" after type A: what I would do? J Vis Surg 2018; 4:14. [PMID: 29445600 DOI: 10.21037/jovs.2017.12.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/05/2017] [Indexed: 11/06/2022]
Abstract
"The major goal of surgery for acute type A aortic dissection is to have an alive patient." This motto still remains the most important directive. However, also depending onto the extent of the underlying pathology and consecutively depending onto the extent of primary surgery, there is and will be need for additional classical surgical or interventional treatment sooner or later during follow-up in a substantial number of patients having had surgery for acute type A aortic dissection. This article shall guide the interested reader through the underlying mechanisms as well as treatment options in patients with chronic type B "residual" after type A repair and shall finally suggest preventive strategies to reduce the occurrence of this pathology to a minimum.
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Affiliation(s)
- Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Albert Ludwigs University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Albert Ludwigs University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Morlock
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Albert Ludwigs University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Albert Ludwigs University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Scheumann
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Albert Ludwigs University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger Schröfel
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Albert Ludwigs University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian A Kari
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Albert Ludwigs University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tim Berger
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Albert Ludwigs University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Albert Ludwigs University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Albert Ludwigs University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Albert Ludwigs University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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