초록접수 현황
| 20F-166 | 구연 발표 |
Comparative Outcomes of Total Arch versus Hemiarch Repair in Acute DeBakey Type I Aortic Dissection : Impact of 21-year experience
You Jung Ok, Ho Jin Kim, Suk Jung Choo, Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Purpose : With the interest of evaluating the impact of center experiences on comparative outcomes between total-arch and hemiarch repairs, we reviewed our 21 year-experiences on surgeries for acute type I AD.
Methods : Between 1999 and 2019, 365 patients (177 women; mean age, 56.8±12.9 years) with acute type I AD undergoing hemiarch (n=248) or total arch replacement (n=117) were evaluated.
Results : Over time, deep hypothermic circulatory arrest and retrograde cerebral perfusion were replaced by moderate hypothermia and antegrade cerebral perfusion. Overall, operative mortality rates decreased from 11.0% in time-quartile 1 to 2.2% in time-quartile 4 (P=0.09). After adjustment, the total arch group as compared with the hemiarch group, was at a similar risk of mortality (Odds ratio [OR] =0.80; 95% confidence interval [CI], 0.22 - 2.43; P=0.71) but with a greater risk of neurologic deficit (OR=3.28; 95% CI, 1.23 – 8.98; P=0.017) in the earlier half period (1999-2009). In the later period (2009-2019), however, both the risks of mortality (OR=0.32; 95% CI, 0.03-1.59; P=0.23) and neurologic injuries (OR=0.42; 95% CI, 0.12-1.18; P=0.13) were similar between the two groups (P for interaction in the term of neurologic deficit=0.007). Final multivariable logistic regression model revealed dedicated aortic surgeon contributed to decreased risk of mortality (OR=0.30, 95% CI, 0.09-0.84, P=0.036).
Conclusion : Improvements of surgical techniques and perioperative management strategies have led to better treatment outcomes of acute type I AD. The most important contributing factors may be emergence of dedicated surgeons and institutional experiences in the setting of acute aortic dissection.
Methods : Between 1999 and 2019, 365 patients (177 women; mean age, 56.8±12.9 years) with acute type I AD undergoing hemiarch (n=248) or total arch replacement (n=117) were evaluated.
Results : Over time, deep hypothermic circulatory arrest and retrograde cerebral perfusion were replaced by moderate hypothermia and antegrade cerebral perfusion. Overall, operative mortality rates decreased from 11.0% in time-quartile 1 to 2.2% in time-quartile 4 (P=0.09). After adjustment, the total arch group as compared with the hemiarch group, was at a similar risk of mortality (Odds ratio [OR] =0.80; 95% confidence interval [CI], 0.22 - 2.43; P=0.71) but with a greater risk of neurologic deficit (OR=3.28; 95% CI, 1.23 – 8.98; P=0.017) in the earlier half period (1999-2009). In the later period (2009-2019), however, both the risks of mortality (OR=0.32; 95% CI, 0.03-1.59; P=0.23) and neurologic injuries (OR=0.42; 95% CI, 0.12-1.18; P=0.13) were similar between the two groups (P for interaction in the term of neurologic deficit=0.007). Final multivariable logistic regression model revealed dedicated aortic surgeon contributed to decreased risk of mortality (OR=0.30, 95% CI, 0.09-0.84, P=0.036).
Conclusion : Improvements of surgical techniques and perioperative management strategies have led to better treatment outcomes of acute type I AD. The most important contributing factors may be emergence of dedicated surgeons and institutional experiences in the setting of acute aortic dissection.
책임저자: Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
발표자: You Jung Ok, E-mail : keinmiel@hanmail.net