Proximal vs Extensive Repair in Acute Type A Aortic Dissection Surgery

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Acute type A aortic dissection (aTAAD) is a life-threatening condition requiring surgical intervention.
• Surgical strategies for aTAAD include proximal and extensive aortic repair.
• The comparative impact of these repair strategies on patient outcomes remains an area of investigation.

Purpose of the Study:

• To evaluate the impact of proximal versus extensive repair on mortality in patients with aTAAD.
• To determine how patient characteristics influence the mortality associated with different repair strategies.

Main Methods:

• A retrospective analysis of 5510 patients with aTAAD from 13 Chinese hospitals (2016-2021).
• Development and validation of a risk prediction model using eXtreme gradient boosting (XGBoost) based on 4038 derivation and 1472 validation patients.
• Identification of key predictors for mortality including age, BMI, PLR, albumin, hemoglobin, creatinine, and preoperative malperfusion.

Main Results:

• Operative mortality was significantly higher for extensive repair (10.4%) compared to proximal repair (2.9%; OR, 3.833).
• A risk prediction model demonstrated good performance (AUC 0.767 derivation, 0.727 validation).
• Higher mortality risk with extensive repair was observed only when predicted risk exceeded 4.5%.

Conclusions:

• Extensive repair is associated with increased mortality compared to proximal repair, but this risk is stratified by predicted patient risk.
• Individualized risk prediction is essential for guiding surgical strategy selection in aTAAD.
• The findings underscore the importance of tailoring treatment to patient-specific factors for optimal outcomes in aTAAD surgery.