Authors
Mamilov M-B.T., Mironenko V.A., Garmanov S.V.
A.N. Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow
Abstract
Objectives: comparison of the results of surgical intervention with and without aortic arch dilation in patients with acute type I aortic dissection.
Patients and methods: The study included 157 patients (from 2011 to 2021) with acute type I aortic dissection. The average age of patients in the general group was 51 [49.8–65.0] years, the most part of patients were men n = 127 (81%). The patients were divided into 2 groups: group 1 included 104 (66.2%) patients who underwent surgery only on the ascending section (supracoronary prosthetics of the ascending aorta and Bentall DeBono surgery); in the group 2, n = 53 (33.8%) patients with prosthetics of the ascending aorta in combination with interventions on the aortic arch, of which n = 14 (8.9%) patients with complete prosthetics of the aortic arch according to the “elephant trunk” type. After pseudorandomization (PSM), 70 patients with acute aortic dissection of type I aorta were included in the analysis. 35 (50%) patients underwent surgery on the ascending aorta (group Asc. A) 35 (50%) patients underwent extended surgery (group Asc. A+arch), including 26 (37.1%) — on the ascending aorta and hemiarch, 9 (12.9%) — on the ascending aorta and total arch.
Results: Statistically significant differences were revealed in group II (Asc. A+arch) with a longer time of surgery, time of the CPB, cross clamp time of the aorta and less hypothermia, also in this group, perfusion through the right subclavian artery was statistically significantly more often performed and less often perfusion of the left common femoral artery. In the postoperative period, complications were assessed in patients in both groups: cardiac arrhythmias, acute respiratory and heart failure, acute kidney injury, bleeding, multiple organ failure syndrome and 30-day mortality. There were no statistically significant differences between the groups. There were no statistically significant differences between the groups. In comparing groups of patients with intervention only on the ascending aorta and with the extension of the intervention to the arch, no statistically significant difference in mortality was revealed (17.1% vs. 5.7%. p = 0.1572). The hospital mortality after PSM was 11.4%.
Conclusion: This study showed possibility of expansion scope of surgery with prosthetics of the aortic arch without increasing the risk of death.
Keywords: acute aortic dissection, prosthetics of the aortic arch, hemiarch, elephant trunk, malperfusion, adaptive perfusion.
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