Journal article
Recurrent aortic insufficiency after emergency surgery for acute type A aortic dissection with aortic root preservation
The Journal of thoracic and cardiovascular surgery, v 161(6), pp 1989-2000
Jun 2021
PMID: 32631661
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Patients with acute type A aortic dissection demonstrate a wide range of aortic insufficiency. Outcomes after valve resuspension and root repair are not well studied in the long term. We evaluated the long-term effects of preoperative aortic insufficiency in patients undergoing emergency root-preserving surgery for acute type A aortic dissection.
From 2002 to 2017, 558 of 776 patients with acute type A aortic dissection underwent native aortic valve resuspension and root reconstruction. Patients were stratified into 4 groups by preoperative aortic insufficiency grade (n = 539): aortic insufficiency less than 2+ (n = 348), aortic insufficiency = 2+ (n = 72), aortic insufficiency = 3+ (n = 49), and aortic insufficiency = 4+ (n = 70). Multivariable ordinal longitudinal mixed effects and multi-state transition models were used to assess risk factors for recurrent aortic insufficiency.
The prevalence of cardiogenic shock in patients presenting with preoperative aortic insufficiency less than 2+, 2+, 3+, and 4+ was 53 of 348 (15.2%), 12 of 72 (16.7%), 10 of 49 (20.4%), and 24 of 70 (34.3%), respectively (P = .002). Postoperatively, 94.0% of patients had aortic insufficiency 1+ or less at discharge. Operative mortality was 34 of 348 (9.8%), 10 of 72 (13.9%), 6 of 49 (12.2%), and 12 of 70 (17.1%) (P = .303). In an ordinal mixed effects model, preoperative aortic insufficiency was associated with more severe postoperative aortic insufficiency. The multi-state transition model demonstrated that severe aortic insufficiency was associated with progression from no to mild aortic insufficiency (hazard ratio, 2.14; 95% confidence interval, 1.35-3.38), and progression from mild to moderate aortic insufficiency (hazard ratio, 5.70; 95% confidence interval, 1.88-17.30).
Preoperative aortic insufficiency is an important predictor of recurrent aortic insufficiency in patients undergoing valve resuspension with root reconstruction for emergency acute type A aortic dissection repair. Increased echocardiographic surveillance for recurrent aortic insufficiency may be warranted in this cohort.
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Details
- Title
- Recurrent aortic insufficiency after emergency surgery for acute type A aortic dissection with aortic root preservation
- Creators
- Markian M. Bojko - Drexel UniversityAndreas Habertheuer - University of PennsylvaniaJoseph E. Bavaria - University of PennsylvaniaMaham Suhail - Richmond University Medical CenterRobert W. Hu - University of PennsylvaniaJoey Harmon - University of PennsylvaniaNimesh D. Desai - University of PennsylvaniaRita K. Milewski - University of PennsylvaniaMatthew L. Williams - University of PennsylvaniaWilson Y. Szeto - University of PennsylvaniaJana Mossey - Drexel UniversityPrashanth Vallabhajosyula - Yale University
- Publication Details
- The Journal of thoracic and cardiovascular surgery, v 161(6), pp 1989-2000
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- [Retired Faculty]
- Web of Science ID
- WOS:000651593700041
- Scopus ID
- 2-s2.0-85080071258
- Other Identifier
- 991019168434104721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery