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
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.
Original language | English |
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Journal | The Journal of Thoracic and Cardiovascular Surgery |
Volume | 157 |
Issue number | 5 |
Pages (from-to) | 1750-1758 |
ISSN | 0022-5223 |
DOIs | |
Publication status | Published - May 2019 |
- 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
Research areas
ID: 246199472