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Chronic Type I and Type III aortic dissections: a propensity analysis of outcomes after open distal repair
Ourania Preventza1,2, Matt D Price1, Hiruni S Amarasekara1
1Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Insights
Outcomes for chronic Type I and Type III aortic dissections requiring surgery were similar, with comparable survival and reintervention rates. However, chronic Type I aortic dissections were linked to higher rates of respiratory failure.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease Management
Background:
- Chronic aortic dissections, specifically Type I and Type III, present complex surgical challenges.
- Thoraco-abdominal aortic aneurysm repair is a critical intervention for these conditions.
- Understanding comparative outcomes is essential for optimizing patient care.
Purpose of the Study:
- To compare short-term outcomes, long-term survival, and reintervention rates in patients undergoing surgery for chronic Type I versus chronic primary Type III aortic dissections.
- To identify specific risk factors associated with each type of aortic dissection repair.
Main Methods:
- A cohort of 466 patients undergoing thoraco-abdominal aortic aneurysm repair for chronic Type I (n=227) or Type III (n=239) aortic dissections over 11 years.
- Multivariable regression analysis for the entire group and propensity matching to create 169 comparable pairs for detailed outcome analysis.
- Evaluation of mortality, stroke, spinal cord deficits, respiratory failure, and reintervention rates.
Main Results:
- Overall mortality was 6%, with no significant difference between Type I (6.2%) and Type III (5.9%) dissections.
- Neurological outcomes were similar between groups in propensity-matched patients.
- Respiratory failure was significantly more frequent in the chronic Type I group (30.2% vs 15.4%).
- Chronic Type I dissection was an independent risk factor for postoperative pulmonary complications and was associated with stroke.
- Six-year survival rates were comparable: 74.4% ± 4.1% for Type I and 74.4% ± 4.6% for Type III.
Conclusions:
- Short- and long-term mortality and reintervention rates are comparable after open repair for chronic Type I and primary chronic Type III aortic dissections.
- Respiratory failure represents a significantly higher risk in patients with chronic Type I aortic dissections.
- These findings aid in risk stratification and perioperative management for aortic dissection repair.
Objectives:
To compare short-term outcomes, long-term survival and reinterventions in patients requiring surgery after chronic Type I and chronic primary Type III aortic dissections.
Methods:
Over an 11-year period, 466 patients underwent thoraco-abdominal aortic aneurysm repair for chronic Type III (n = 239) and Type I (n = 227) aortic dissections. Short-term outcomes and reinterventions were evaluated by multivariable regression analysis for the entire group; propensity matching produced 169 pairs.
Results:
Mortality was 6% (n = 28) in the overall cohort and 6.2% (n = 14) and 5.9% (n = 14) in those with chronic Type I and Type III aortic dissections, respectively. Overall stroke and persistent spinal cord deficit rates were 4.0% and 2.6%, respectively, in the Type I group and 1.3% and 3.8% in the Type III group. In the propensity-matched patients, analysis showed no neurological differences between the 2 groups, but respiratory failure was significantly more frequent in the chronic Type I group (30.2% vs 15.4%; P = 0.001). Multivariable analysis identified chronic Type I dissection as an independent risk factor for postoperative pulmonary complications (odds ratio 1.612; 95% confidence interval 1.060-2.452; P = 0.026) and an association between chronic Type I dissection and stroke (odds ratio 4.013; 95% confidence interval 1.026-15.698; P = 0.046). Six-year survival was 74.4% ± 4.1% and 74.4% ± 4.6% in the chronic Type I and Type III groups, respectively (P = 0.87).
Conclusions:
Short- and long-term mortality and reintervention rates were comparable after open repair for chronic Type I and primary chronic Type III aortic dissections. Respiratory failure was more frequent in the chronic Type I aortic dissection group.
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