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Limited vs. Extended Resection of Stanford Type A Acute Aortic Dissections
Suvitesh Luthra1,2, Pietro G Malvindi1,3, Miguel M Leiva-Juárez4
1Division of Cardiac Surgery, Wessex Cardiothoracic Centre University Hospital Southampton, Southampton SO16 6YD, UK.
Medicina (Kaunas, Lithuania)
|August 29, 2024
Summary
Limited resection for acute type A aortic dissection offers better long-term survival compared to extended resection. Extended resection is linked to worse perioperative outcomes and survival in patients with acute type A aortic dissection.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease
Background:
- Acute type A aortic dissection (AAAD) repair remains a high-risk procedure.
- Surgical strategies, including limited resection (LR) and extended resection (ER), vary.
- Optimizing surgical approaches is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the outcomes of limited resection versus extended resection for AAAD.
- To evaluate the impact of surgical extent on in-hospital mortality, long-term survival, and composite outcomes.
Main Methods:
- Retrospective analysis of 440 patients undergoing AAAD repair.
- Propensity-matched analysis of 109 pairs comparing LR and ER.
- Multivariate analysis for mortality and composite outcomes.
- Kaplan-Meier survival analysis with log-rank testing.
Main Results:
- In-hospital mortality was 10% (LR 6% vs. ER 13.8%).
- Propensity-matched analysis showed no significant differences in TIA/stroke, LOS, inpatient mortality, or composite outcomes.
- Limited resection demonstrated significantly better long-term survival (LR 77.1% vs. ER 51.4% at 15 years).
- Extended resection was a predictor of worse long-term survival.
Conclusions:
- AAAD repair has significant mortality and morbidity, despite improvements.
- Extended resection is associated with poorer perioperative results and long-term survival compared to limited resection.
- Further research may refine surgical strategies for AAAD.
