Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection

Research output: Contribution to journal › Journal article › Research › peer-review

Standard

Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection. / Geirsson, Arnar; Shioda, Kayoko; Olsson, Christian; Ahlsson, Anders; Gunn, Jarmo; Hansson, Emma C; Hjortdal, Vibeke; Jeppsson, Anders; Mennander, Ari; Wickbom, Anders; Zindovic, Igor; Gudbjartsson, Tomas.

In: The Journal of Thoracic and Cardiovascular Surgery, Vol. 157, No. 5, 05.2019, p. 1750-1758.

Research output: Contribution to journal › Journal article › Research › peer-review

Harvard

Geirsson, A, Shioda, K, Olsson, C, Ahlsson, A, Gunn, J, Hansson, EC, Hjortdal, V, Jeppsson, A, Mennander, A, Wickbom, A, Zindovic, I & Gudbjartsson, T 2019, 'Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection', The Journal of Thoracic and Cardiovascular Surgery, vol. 157, no. 5, pp. 1750-1758. https://doi.org/10.1016/j.jtcvs.2018.09.020

APA

Geirsson, A., Shioda, K., Olsson, C., Ahlsson, A., Gunn, J., Hansson, E. C., Hjortdal, V., Jeppsson, A., Mennander, A., Wickbom, A., Zindovic, I., & Gudbjartsson, T. (2019). Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection. The Journal of Thoracic and Cardiovascular Surgery, 157(5), 1750-1758. https://doi.org/10.1016/j.jtcvs.2018.09.020

Vancouver

Geirsson A, Shioda K, Olsson C, Ahlsson A, Gunn J, Hansson EC et al. Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection. The Journal of Thoracic and Cardiovascular Surgery. 2019 May;157(5):1750-1758. https://doi.org/10.1016/j.jtcvs.2018.09.020

Author

Geirsson, Arnar ; Shioda, Kayoko ; Olsson, Christian ; Ahlsson, Anders ; Gunn, Jarmo ; Hansson, Emma C ; Hjortdal, Vibeke ; Jeppsson, Anders ; Mennander, Ari ; Wickbom, Anders ; Zindovic, Igor ; Gudbjartsson, Tomas. / Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection. In: The Journal of Thoracic and Cardiovascular Surgery. 2019 ; Vol. 157, No. 5. pp. 1750-1758.

Bibtex

@article{912f795691fe43fea39d96ed4ca78e8c,

title = "Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection",

abstract = "OBJECTIVES: Open-distal anastomosis is the preferred technique over clamp-on technique for surgical repair of acute type A aortic dissection (ATAAD). The aim of this study was to define how outcomes of ATAAD were affected by the use of either technique.METHODS: Nordic Consortium for Acute Type A Aortic Dissection includes 8 academic cardiothoracic hospitals in 4 Nordic countries. The cohort consisted of 1134 patients, 153 clamp-on and 981 open-distal, from 2005 to 2014.RESULTS: Patients who underwent operation with the clamp-on were younger, more frequently had coronary artery disease, bicuspid aortic valve, hypotension/shock or syncope, and a greater PennClass than open-distal patients. Postoperative cerebral vascular accident occurred less frequently in clamp-on (14/153, 10%) compared with the open-distal group (190/981, 20%). Clamp-on had greater 30-day mortality (39/153, 25%) than the open-distal group (158/981, 16%), and 5-year survival was also worse in clamp-on (61.8% ± 4.4%) compared with the open-distal group (73.0% ± 1.6%). The open-distal technique was used more frequently in greater-volume hospitals but was not independently associated with 30-day mortality. Preoperative condition was an independent risk factor whereas hospital volume and later year of operation were beneficial in regard to short-term outcome. Open-distal was independently associated with improved mid-term survival.CONCLUSIONS: Patients who underwent operation with the clamp-on were sicker on presentation and had worse short- and mid-term survival compared with the open-distal group. Patients in the open-distal group had greater rates of cerebrovascular complications. The results support the routine use of open-distal anastomosis as the primary operative strategy for ATAAD, although clamp-on can be performed successfully in select cases.",

keywords = "Acute Disease, Adult, Age Factors, Aged, Anastomosis, Surgical, Aortic Aneurysm/diagnostic imaging, Comorbidity, Constriction, Female, Humans, Male, Middle Aged, Postoperative Complications/mortality, Retrospective Studies, Risk Assessment, Risk Factors, Scandinavian and Nordic Countries/epidemiology, Time Factors, Treatment Outcome, Vascular Surgical Procedures/adverse effects",

author = "Arnar Geirsson and Kayoko Shioda and Christian Olsson and Anders Ahlsson and Jarmo Gunn and Hansson, {Emma C} and Vibeke Hjortdal and Anders Jeppsson and Ari Mennander and Anders Wickbom and Igor Zindovic and Tomas Gudbjartsson",

note = "Published by Elsevier Inc.",

year = "2019",

month = may,

doi = "10.1016/j.jtcvs.2018.09.020",

language = "English",

volume = "157",

pages = "1750--1758",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

publisher = "Mosby Inc.",

number = "5",

}

RIS

TY - JOUR

T1 - Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection

AU - Geirsson, Arnar

AU - Shioda, Kayoko

AU - Olsson, Christian

AU - Ahlsson, Anders

AU - Gunn, Jarmo

AU - Hansson, Emma C

AU - Hjortdal, Vibeke

AU - Jeppsson, Anders

AU - Mennander, Ari

AU - Wickbom, Anders

AU - Zindovic, Igor

AU - Gudbjartsson, Tomas

N1 - Published by Elsevier Inc.

PY - 2019/5

Y1 - 2019/5

N2 - OBJECTIVES: Open-distal anastomosis is the preferred technique over clamp-on technique for surgical repair of acute type A aortic dissection (ATAAD). The aim of this study was to define how outcomes of ATAAD were affected by the use of either technique.METHODS: Nordic Consortium for Acute Type A Aortic Dissection includes 8 academic cardiothoracic hospitals in 4 Nordic countries. The cohort consisted of 1134 patients, 153 clamp-on and 981 open-distal, from 2005 to 2014.RESULTS: Patients who underwent operation with the clamp-on were younger, more frequently had coronary artery disease, bicuspid aortic valve, hypotension/shock or syncope, and a greater PennClass than open-distal patients. Postoperative cerebral vascular accident occurred less frequently in clamp-on (14/153, 10%) compared with the open-distal group (190/981, 20%). Clamp-on had greater 30-day mortality (39/153, 25%) than the open-distal group (158/981, 16%), and 5-year survival was also worse in clamp-on (61.8% ± 4.4%) compared with the open-distal group (73.0% ± 1.6%). The open-distal technique was used more frequently in greater-volume hospitals but was not independently associated with 30-day mortality. Preoperative condition was an independent risk factor whereas hospital volume and later year of operation were beneficial in regard to short-term outcome. Open-distal was independently associated with improved mid-term survival.CONCLUSIONS: Patients who underwent operation with the clamp-on were sicker on presentation and had worse short- and mid-term survival compared with the open-distal group. Patients in the open-distal group had greater rates of cerebrovascular complications. The results support the routine use of open-distal anastomosis as the primary operative strategy for ATAAD, although clamp-on can be performed successfully in select cases.

AB - OBJECTIVES: Open-distal anastomosis is the preferred technique over clamp-on technique for surgical repair of acute type A aortic dissection (ATAAD). The aim of this study was to define how outcomes of ATAAD were affected by the use of either technique.METHODS: Nordic Consortium for Acute Type A Aortic Dissection includes 8 academic cardiothoracic hospitals in 4 Nordic countries. The cohort consisted of 1134 patients, 153 clamp-on and 981 open-distal, from 2005 to 2014.RESULTS: Patients who underwent operation with the clamp-on were younger, more frequently had coronary artery disease, bicuspid aortic valve, hypotension/shock or syncope, and a greater PennClass than open-distal patients. Postoperative cerebral vascular accident occurred less frequently in clamp-on (14/153, 10%) compared with the open-distal group (190/981, 20%). Clamp-on had greater 30-day mortality (39/153, 25%) than the open-distal group (158/981, 16%), and 5-year survival was also worse in clamp-on (61.8% ± 4.4%) compared with the open-distal group (73.0% ± 1.6%). The open-distal technique was used more frequently in greater-volume hospitals but was not independently associated with 30-day mortality. Preoperative condition was an independent risk factor whereas hospital volume and later year of operation were beneficial in regard to short-term outcome. Open-distal was independently associated with improved mid-term survival.CONCLUSIONS: Patients who underwent operation with the clamp-on were sicker on presentation and had worse short- and mid-term survival compared with the open-distal group. Patients in the open-distal group had greater rates of cerebrovascular complications. The results support the routine use of open-distal anastomosis as the primary operative strategy for ATAAD, although clamp-on can be performed successfully in select cases.

KW - Acute Disease

KW - Adult

KW - Age Factors

KW - Aged

KW - Anastomosis, Surgical

KW - Aortic Aneurysm/diagnostic imaging

KW - Comorbidity

KW - Constriction

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Postoperative Complications/mortality

KW - Retrospective Studies

KW - Risk Assessment

KW - Risk Factors

KW - Scandinavian and Nordic Countries/epidemiology

KW - Time Factors

KW - Treatment Outcome

KW - Vascular Surgical Procedures/adverse effects

U2 - 10.1016/j.jtcvs.2018.09.020

DO - 10.1016/j.jtcvs.2018.09.020

M3 - Journal article

C2 - 30401530

VL - 157

SP - 1750

EP - 1758

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 5

ER -

ID: 246199472