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  1. Article ; Online: Access site complications in thoracic endovascular aortic repair.

    Dahlbacka, Sebastian / Nykänen, Antti I / Juvonen, Tatu / Jormalainen, Mikko

    Journal of vascular surgery

    2023  Volume 79, Issue 4, Page(s) 740–747.e2

    Abstract: Background: Percutaneous access and use of vascular closure devices facilitate thoracic endovascular aortic repair (TEVAR) procedures during local anesthesia and allow immediate detection of signs of spinal ischemia. However, the very large bore access ( ...

    Abstract Background: Percutaneous access and use of vascular closure devices facilitate thoracic endovascular aortic repair (TEVAR) procedures during local anesthesia and allow immediate detection of signs of spinal ischemia. However, the very large bore access (usually ≥22F sheath) associated with TEVAR increases the risk of vascular complications. In this study, we sought to define the safety and feasibility of two percutaneous femoral artery closure devices during TEVAR, in terms of access site vascular complications and major, life-threatening, or fatal bleeding (≥major) within 48 hours. Access site vascular complications were defined as technical failure of vascular closure or later formation of pseudoaneurysm.
    Methods: From March 2010 to December 2022, 199 transfemoral TEVAR were performed at Helsinki University Central Hospital, Finland. We retrospectively categorized these into three groups, based on surgeon preference for the access technique and femoral artery closure method: (1) surgical cut-down and vessel closure, n = 85 (42.7%), (2) percutaneous access and vascular closure with suture-based ProGlide, n = 56 (28.1%), or (3) percutaneous access and vascular closure with ultrasound-guided plug-based MANTA, n = 58 (29.1%). The primary outcome measure was technical success of vascular closure and access site vascular complications during index hospitalization. Secondary outcome measures were ≥major bleeding, early mortality, and hospital stay.
    Results: The technical success rate was 97.6% vs 91.1% vs 93.1% for surgical cut-down, ProGlide, and MANTA, respectively (P = .213). The rate of access site vascular complication was 3.5% vs 8.9% vs 10.3%, respectively (P = .290), with two pseudoaneurysms detected postoperatively and conservatively managed in the MANTA group. The vascular closure method was not associated with increased risk of ≥major bleeding, early mortality, or hospital stay on univariate analysis. Predictors for ≥major bleeding after TEVAR in multivariable analysis were urgent procedure (odds ratio: 2.8, 95% confidence interval: 1.4-5.5; P = .003) and simultaneous aortic branch revascularization (odds ratio: 2.7, 95% confidence interval: 1.3-5.4; P = .008).
    Conclusions: In this study, the technical success rates of the percutaneous techniques demonstrated their feasibility during TEVAR. However, the number of access site complications for percutaneous techniques was higher compared with open approach, although the difference was not statistically significant. In the lack of evidence, the safety of the new MANTA plug-based vascular closure for TEVAR warrants further investigation.
    MeSH term(s) Humans ; Endovascular Aneurysm Repair ; Endovascular Procedures ; Retrospective Studies ; Treatment Outcome ; Hemorrhage/etiology ; Hemorrhage/surgery ; Vascular Closure Devices ; Femoral Artery/diagnostic imaging ; Femoral Artery/surgery ; Hemostatic Techniques/adverse effects ; Catheterization, Peripheral/adverse effects
    Language English
    Publishing date 2023-12-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605700-7
    ISSN 1097-6809 ; 0741-5214
    ISSN (online) 1097-6809
    ISSN 0741-5214
    DOI 10.1016/j.jvs.2023.11.046
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  2. Article ; Online: Impact of high-risk features on outcome of acute type B aortic dissection.

    Herajärvi, Johanna / Mustonen, Caius / Kesävuori, Risto / Raivio, Peter / Biancari, Fausto / Jormalainen, Mikko / Juvonen, Tatu

    JTCVS open

    2023  Volume 13, Page(s) 20–31

    Abstract: Background: Acute type B aortic dissection (TBAD) is a severe condition associated with significant morbidity and mortality. The optimal classification and treatment strategy of TBAD remain controversial and inconsistent.: Methods: This analysis ... ...

    Abstract Background: Acute type B aortic dissection (TBAD) is a severe condition associated with significant morbidity and mortality. The optimal classification and treatment strategy of TBAD remain controversial and inconsistent.
    Methods: This analysis includes patients treated for acute TBAD at the Helsinki University Hospital, Finland between 2007 and 2019. The endpoints were early and late mortality, intervention of the aorta, and a composite of death and aortic intervention in uncomplicated patients and high-risk patients.
    Results: This study included 162 consecutive TBAD patients (27.8% females), 114 in the high-risk group and 48 in the uncomplicated group, with a mean age of 67.6 ± 13.9 years. Intramural hematoma was reported in 63 cases (38.9%). The mean follow-up was 5.1 ± 3.9 years. In-hospital/30-day mortality (n = 4; 3.5%) occurred solely in the high-risk group (
    Conclusions: Recognition of risk factors underlying adverse events related to TBAD is essential because the disease progression impacts both early and late outcomes. Early aortic repair in high-risk TBAD may reduce long-term morbidity and mortality.
    Language English
    Publishing date 2023-01-16
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2666-2736
    ISSN (online) 2666-2736
    DOI 10.1016/j.xjon.2023.01.005
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  3. Article ; Online: 13-year single-center experience with the treatment of acute type B aortic dissection.

    Herajärvi, Johanna / Jormalainen, Mikko / Mustonen, Caius / Kesävuori, Risto / Raivio, Peter / Biancari, Fausto / Juvonen, Tatu

    Scandinavian cardiovascular journal : SCJ

    2022  Volume 56, Issue 1, Page(s) 360–367

    Abstract: ... Background ... Acute type B aortic dissection (TBAD) is catastrophic event associated with significant mortality and lifelong morbidity. The optimal treatment strategy of TBAD is still controversial. ... Methods ... This analysis includes patients ... ...

    Abstract Background. Acute type B aortic dissection (TBAD) is catastrophic event associated with significant mortality and lifelong morbidity. The optimal treatment strategy of TBAD is still controversial. Methods. This analysis includes patients treated for TBAD at the Helsinki University Hospital, Finland in 2007-2019. The endpoints were early and late mortality, and intervention of the aorta. Results. There were 205 consecutive TBAD patients, 59 complicated and 146 uncomplicated patients (mean age of 66 ± 14, females 27.8%). In-hospital and 30-day mortality rates were higher in complicated patients compared with uncomplicated patients with a statistically significant difference (p = 0.035 and p = 0.015, respectively). After a mean follow-up of 4.9 ± 3.8 years, 36 (25.0%) and 22 (37.9%) TBAD -related adverse events occurred in the uncomplicated and complicated groups, respectively (p = 0.066). Freedom from composite outcome was 83 ± 3% and 69 ± 6% at 1 year, 75 ± 4% and 63 ± 7% at 5 years, 70 ± 5% and 59 ± 7% at 10 years in the uncomplicated group and in the complicated group, respectively (p = 0.052). There were 25 (39.1%) TBAD-related deaths in the overall series and prior aortic aneurysm was the only risk factor for adverse aortic-related events in multivariate analysis (HR 3.46, 95% CI 1.72-6.96, p < 0.001). Conclusion. TBAD is associated with a significant risk of early and late adverse events. Such a risk tends to be lower among patients with uncomplicated dissection, still one fourth of them experience TBAD-related event. Recognition of risk factors in the uncomplicated group who may benefit from early aortic repair would be beneficial.
    MeSH term(s) Aged ; Aged, 80 and over ; Aneurysm, Dissecting/diagnostic imaging ; Aneurysm, Dissecting/surgery ; Aortic Aneurysm, Thoracic/diagnostic imaging ; Aortic Aneurysm, Thoracic/surgery ; Blood Vessel Prosthesis Implantation/adverse effects ; Endovascular Procedures/adverse effects ; Female ; Humans ; Middle Aged ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2022-10-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 1379906-x
    ISSN 1651-2006 ; 1401-7431
    ISSN (online) 1651-2006
    ISSN 1401-7431
    DOI 10.1080/14017431.2022.2127873
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  4. Article ; Online: Ultrasound-guided closure of the femoral artery during venoarterial decannulation using a large-bore closure device.

    Rahman, Tasnia / Herajärvi, Johanna / Ahonen, Henri / Jormalainen, Mikko / Syrjälä, Simo / Järvinen, Tommi / Juvonen, Tatu / Dahlbacka, Sebastian

    Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society

    2023  Volume 112, Issue 4, Page(s) 256–264

    Abstract: Background: Peripheral femoro-femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is viable for fast hemodynamic assistance during cardiogenic shock. Ultrasound-guided closure with a large-bore device (MANTA: Methods: This ... ...

    Abstract Background: Peripheral femoro-femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is viable for fast hemodynamic assistance during cardiogenic shock. Ultrasound-guided closure with a large-bore device (MANTA
    Methods: This retrospective study included patients weaning from percutaneously inserted femoro-femoral VA-ECMO at the Helsinki University Hospital, Finland in 2012-2020. The primary endpoints were access-site complications, a composite of hematomas/seromas/surgical site infections (SSIs), and the safety endpoint of vascular complications (VCs).
    Results: A total of 100 consecutive percutaneously implanted and weaned VA-ECMO patients were stratified into two groups by decannulation strategy: percutaneous ultrasound-guided MANTA device (
    Conclusions: Percutaneous ultrasound-guided MANTA closure of the femoral artery after VA-ECMO decannulation was associated with high technical success rate and low incidence of VCs. Compared to surgical closure, access-site complications were significantly less frequent, along with access-site complications necessitating interventions.
    MeSH term(s) Female ; Humans ; Adult ; Middle Aged ; Femoral Artery/diagnostic imaging ; Femoral Artery/surgery ; Retrospective Studies ; Seroma ; Catheterization, Peripheral/methods ; Hematoma/etiology ; Surgical Wound Infection ; Ultrasonography, Interventional ; Treatment Outcome
    Language English
    Publishing date 2023-07-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 2077691-3
    ISSN 1799-7267 ; 1457-4969
    ISSN (online) 1799-7267
    ISSN 1457-4969
    DOI 10.1177/14574969231181232
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  5. Article ; Online: Long-term outcomes after ascending aortic replacement and aortic root replacement for type A aortic dissection.

    Jormalainen, Mikko / Kesävuori, Risto / Raivio, Peter / Vento, Antti / Mustonen, Caius / Honkanen, Hannu-Pekka / Rosato, Stefano / Simpanen, Jarmo / Teittinen, Kari / Biancari, Fausto / Juvonen, Tatu

    Interactive cardiovascular and thoracic surgery

    2022  Volume 34, Issue 3, Page(s) 453–461

    Abstract: Objectives: We investigated whether the selective use of supracoronary ascending aorta replacement achieves late outcomes comparable to those of aortic root replacement for acute Stanford type A aortic dissection (TAAD).: Methods: Patients who ... ...

    Abstract Objectives: We investigated whether the selective use of supracoronary ascending aorta replacement achieves late outcomes comparable to those of aortic root replacement for acute Stanford type A aortic dissection (TAAD).
    Methods: Patients who underwent surgery for acute type A aortic dissection from 2005 to 2018 at the Helsinki University Hospital, Finland, were included in this analysis. Late mortality was evaluated with the Kaplan-Meier method and proximal aortic reoperation, i.e. operation on the aortic root or aortic valve, with the competing risk method.
    Results: Out of 309 patients, 216 underwent supracoronary ascending aortic replacement and 93 had aortic root replacement. At 10 years, mortality was 33.8% after aortic root replacement and 35.2% after ascending aortic replacement (P = 0.806, adjusted hazard ratio 1.25, 95% confidence interval, 0.77-2.02), and the cumulative incidence of proximal aortic reoperation was 6.0% in the aortic root replacement group and 6.2% in the ascending aortic replacement group (P = 0.65; adjusted subdistributional hazard ratio 0.53, 95% confidence interval 0.15-1.89). Among 71 propensity score matched pairs, 10-year survival was 34.4% after aortic root replacement and 36.2% after ascending aortic replacement surgery (P = 0.70). Cumulative incidence of proximal aortic reoperation was 7.0% after aortic root replacement and 13.0% after ascending aortic replacement surgery (P = 0.22). Among 102 patients with complete imaging data [mean follow-up, 4.7 (3.2) years], the estimated growth rate of the aortic root diameter was 0.22 mm/year, that of its area 7.19 mm2/year and that of its perimeter 0.43 mm/year.
    Conclusions: When stringent selection criteria were used to determine the extent of proximal aortic reconstruction, aortic root replacement and ascending aortic replacement for type A aortic dissection achieved comparable clinical outcomes.
    MeSH term(s) Aneurysm, Dissecting/diagnostic imaging ; Aneurysm, Dissecting/surgery ; Aorta, Thoracic/surgery ; Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Humans ; Reoperation ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2022-02-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 2095298-3
    ISSN 1569-9285 ; 1569-9293
    ISSN (online) 1569-9285
    ISSN 1569-9293
    DOI 10.1093/icvts/ivab324
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    Zs.A 5730: Show issues Location:
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  6. Article: Late Outcome after Surgery for Type-A Aortic Dissection.

    Jormalainen, Mikko / Raivio, Peter / Biancari, Fausto / Mustonen, Caius / Honkanen, Hannu-Pekka / Venermo, Maarit / Vento, Antti / Juvonen, Tatu

    Journal of clinical medicine

    2020  Volume 9, Issue 9

    Abstract: The aim of this study was to evaluate all-cause mortality and aortic reoperations after surgery for Stanford type A aortic dissection (TAAD). We evaluated the late outcome of patients who underwent surgery for acute TAAD from January 2005 to December ... ...

    Abstract The aim of this study was to evaluate all-cause mortality and aortic reoperations after surgery for Stanford type A aortic dissection (TAAD). We evaluated the late outcome of patients who underwent surgery for acute TAAD from January 2005 to December 2017 at the Helsinki University Hospital, Finland. We studied 309 patients (DeBakey type I TAAD: 89.3%) who underwent repair of TAAD. Aortic root repair was performed in 94 patients (30.4%), hemiarch repair in 264 patients (85.4%) and partial/total aortic arch repair in 32 patients (10.4%). Hospital mortality was 13.6%. At 10 years, all-cause mortality was 34.9%, and the cumulative incidence of aortic reoperation or late aortic-related death was 15.6%, of any aortic reoperation 14.6%, reoperation on the aortic root 6.6%, on the aortic arch, descending thoracic and/or abdominal aorta 8.7%, on the descending thoracic and/or abdominal aorta 6.4%, and on the abdominal aorta 3.8%. At 10 years, cumulative incidence of reoperation on the distal aorta was higher in patients with a diameter of the descending thoracic aorta ≥35 mm at primary surgery (cumulative incidence in the overall series: 13.2% vs. 4.0%, SHR 3.993, 95%CI 1.316-12.120; DeBakey type I aortic dissection: 13.6% vs. 4.5%, SHR 3.610, 95%CI 1.193-10.913; patients with dissected descending thoracic aorta: 15.8% vs. 5.9%, SHR 3.211, 95%CI 1.067-9.664). In conclusion, surgical repair of TAAD limited to the aortic segments involved by the intimal tear was associated with favorable survival and a low rate of aortic reoperations. However, patients with enlarged descending thoracic aorta at primary surgery had higher risk of late reoperation. Half of the distal aortic reinterventions were performed on the abdominal aorta.
    Language English
    Publishing date 2020-08-24
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm9092731
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  7. Article ; Online: Cerebral Oximetry Monitoring in Patients Undergoing Surgery for Stanford Type A Aortic Dissection.

    Biancari, Fausto / Jormalainen, Mikko / Raivio, Peter / Mustonen, Caius / Honkanen, Hannu-Pekka / Valo, Johanna / Vento, Antti / Juvonen, Tatu

    Journal of cardiothoracic and vascular anesthesia

    2020  Volume 35, Issue 7, Page(s) 2019–2025

    Abstract: Objectives: The aim of this study was to evaluate the prognostic impact of cerebral regional oxygen saturation (crSO: Design: Observational, retrospective, institutional study.: Setting: University hospital.: Participants: A total of 152 ... ...

    Abstract Objectives: The aim of this study was to evaluate the prognostic impact of cerebral regional oxygen saturation (crSO
    Design: Observational, retrospective, institutional study.
    Setting: University hospital.
    Participants: A total of 152 patients who underwent surgery for TAAD from June 2009 to December 2018 at the authors' institution.
    Interventions: Surgery for TAAD using continuous perioperative monitoring of crSO
    Measurements and results: The rates of postoperative stroke/global brain ischemia were 22.4% and of hospital mortality 14.5%. Age, hemoglobin, and cardiogenic shock were independent predictors of nadir crSO
    Conclusions: Derangements in crSO
    MeSH term(s) Aneurysm, Dissecting/diagnosis ; Aneurysm, Dissecting/surgery ; Brain/diagnostic imaging ; Cerebrovascular Circulation ; Humans ; Oximetry ; Oxygen ; Retrospective Studies ; Spectroscopy, Near-Infrared
    Chemical Substances Oxygen (S88TT14065)
    Language English
    Publishing date 2020-10-13
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2020.10.011
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  8. Article ; Online: Direct Aortic Versus Peripheral Arterial Cannulation in Surgery for Type A Aortic Dissection.

    Jormalainen, Mikko / Raivio, Peter / Mustonen, Caius / Honkanen, Hannu-Pekka / Vento, Antti / Biancari, Fausto / Juvonen, Tatu

    The Annals of thoracic surgery

    2020  Volume 110, Issue 4, Page(s) 1251–1258

    Abstract: Background: It is controversial whether peripheral arterial cannulation may achieve better results than direct aortic cannulation during surgery for Stanford type A aortic dissection.: Methods: From January 2005 to December 2017, 309 consecutive ... ...

    Abstract Background: It is controversial whether peripheral arterial cannulation may achieve better results than direct aortic cannulation during surgery for Stanford type A aortic dissection.
    Methods: From January 2005 to December 2017, 309 consecutive patients underwent surgical repair for acute type A aortic dissection at Helsinki University Hospital, Finland. The early outcomes of patients who underwent surgery with direct aortic cannulation were compared with those of patients in whom peripheral arterial cannulation was used.
    Results: Direct aortic cannulation was used in 80 patients and peripheral arterial cannulation in 229 patients. Patients who underwent surgery with direct aortic cannulation had hospital mortality (13.8% vs 13.5%, P = .962) and stroke/global brain ischemia (22.3% vs 25%, P = .617) similar to that of patients who had peripheral arterial cannulation. The other secondary outcomes were equally distributed between the unmatched study cohorts. Among 74 propensity score matched pairs, direct aortic cannulation had hospital mortality rates (12.2% vs 9.5%, P = .804) and stroke/global brain ischemia rates (21.6% vs 21.6%, P = 1.000) comparable to those for peripheral arterial cannulation. The composite outcome of hospital mortality/stroke/global brain ischemia (29.7% vs 27%, P = .855), multiple stroke (16.2% vs 17.6%, P = 1.000), renal replacement therapy (11.8% vs 13%, P = 1.000) and length of stay in the intensive care unit (mean, 4.9 ± 4.5 vs 4.8 ± 4.9 days, P = .943) were also equally distributed between these matched cohorts.
    Conclusions: In this institutional series, central arterial cannulation allowed a straightforward surgical repair of type A aortic dissection and achieved early outcomes similar to those of peripheral arterial cannulation.
    MeSH term(s) Aged ; Aneurysm, Dissecting/surgery ; Aortic Aneurysm, Thoracic/surgery ; Blood Vessel Prosthesis Implantation ; Catheterization, Peripheral ; Female ; Finland ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2020-03-10
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 211007-6
    ISSN 1552-6259 ; 0003-4975
    ISSN (online) 1552-6259
    ISSN 0003-4975
    DOI 10.1016/j.athoracsur.2020.02.010
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  9. Article ; Online: Nature of Neurological Complications and Outcome After Surgery for Type A Aortic Dissection.

    Biancari, Fausto / Onorati, Francesco / Peterss, Sven / Buech, Joscha / Mariscalco, Giovanni / Lega, Javier Rodriguez / Pinto, Angel G / Fiore, Antonio / Perrotti, Andrea / Hérve, Amelié / Rukosujew, Andreas / Demal, Till / Conradi, Lenard / Wisniewski, Konrad / Pol, Marek / Kacer, Petr / Gatti, Giuseppe / Mazzaro, Enzo / Vendramin, Igor /
    Piani, Daniela / Rinaldi, Mauro / Ferrante, Luisa / Pruna-Guillen, Robert / Di Perna, Dario / Gerelli, Sebastien / El-Dean, Zein / Nappi, Francesco / Field, Mark / Kuduvalli, Manoj / Pettinari, Matteo / Francica, Alessandra / Jormalainen, Mikko / Dell'Aquila, Angelo M / Mäkikallio, Timo / Juvonen, Tatu / Quintana, Eduard

    The American journal of cardiology

    2024  Volume 219, Page(s) 85–91

    Abstract: Surgery for type A aortic dissection (TAAD) is frequently complicated by neurologic complications. The prognostic impact of neurologic complications of different nature has been investigated in this study. The subjects of this analysis were 3,902 ... ...

    Abstract Surgery for type A aortic dissection (TAAD) is frequently complicated by neurologic complications. The prognostic impact of neurologic complications of different nature has been investigated in this study. The subjects of this analysis were 3,902 patients who underwent surgery for acute TAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD). During the index hospitalization, 722 patients (18.5%) experienced stroke/global brain ischemia. Ischemic stroke was detected in 539 patients (13.8%), hemorrhagic stroke in 76 patients (1.9%) and global brain ischemia in 177 patients (4.5%), with a few patients having had findings of more than 1 of these conditions. In-hospital mortality was increased significantly in patients with postoperative ischemic stroke (25.6%, adjusted odds ratio [OR] 2.422, 95% confidence interval [CI] 1.825 to 3.216), hemorrhagic stroke (48.7%, adjusted OR 4.641, 95% CI 2.524 to 8.533), and global brain ischemia (74.0%, adjusted OR 22.275, 95% CI 14.537 to 35.524) compared with patients without neurologic complications (13.5%). Similarly, patients who experienced ischemic stroke (46.3%, adjusted hazard ratio [HR] 1.719, 95% CI 1.434 to 2.059), hemorrhagic stroke (62.8%, adjusted HR 3.236, 95% CI 2.314 to 4.525), and global brain ischemia (83.9%, adjusted HR 12.777, 95% CI 10.325 to 15.810) had significantly higher 5-year mortality than patients without postoperative neurologic complications (27.5%). The negative prognostic effect of neurologic complications on survival vanished about 1 year after surgery. In conclusion, postoperative ischemic stroke, hemorrhagic stroke, and global cerebral ischemia increased early and midterm mortality after surgery for acute TAAD. The magnitude of risk of mortality increased with the severity of the neurologic complications, with postoperative hemorrhagic stroke and global brain ischemia being highly lethal complications.
    MeSH term(s) Humans ; Aortic Dissection/surgery ; Aortic Dissection/mortality ; Male ; Female ; Middle Aged ; Postoperative Complications/epidemiology ; Registries ; Aortic Aneurysm, Thoracic/surgery ; Aortic Aneurysm, Thoracic/mortality ; Hospital Mortality/trends ; Aged ; Ischemic Stroke/epidemiology ; Prognosis ; Hemorrhagic Stroke/epidemiology ; Brain Ischemia/etiology ; Brain Ischemia/epidemiology ; Risk Factors ; Europe/epidemiology ; Retrospective Studies ; Survival Rate/trends
    Language English
    Publishing date 2024-03-06
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 80014-4
    ISSN 1879-1913 ; 0002-9149
    ISSN (online) 1879-1913
    ISSN 0002-9149
    DOI 10.1016/j.amjcard.2024.03.001
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  10. Article ; Online: Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger.

    Biancari, Fausto / Lega, Javier Rodriguez / Mariscalco, Giovanni / Peterss, Sven / Buech, Joscha / Fiore, Antonio / Perrotti, Andrea / Rukosujew, Andreas / Pinto, Angel G / Demal, Till / Wisniewski, Konrad / Pol, Marek / Gatti, Giuseppe / Vendramin, Igor / Rinaldi, Mauro / Pruna-Guillen, Robert / Di Perna, Dario / El-Dean, Zein / Sherzad, Hiwa /
    Nappi, Francesco / Field, Mark / Pettinari, Matteo / Jormalainen, Mikko / Dell'Aquila, Angelo M / Onorati, Francesco / Quintana, Eduard / Juvonen, Tatu / Mäkikallio, Timo

    BJS open

    2024  Volume 8, Issue 3

    Abstract: Background: Extended aortic repair is considered a key issue for the long-term durability of surgery for DeBakey type 1 aortic dissection. The risk of aortic degeneration may be higher in young patients due to their long life expectancy. The early ... ...

    Abstract Background: Extended aortic repair is considered a key issue for the long-term durability of surgery for DeBakey type 1 aortic dissection. The risk of aortic degeneration may be higher in young patients due to their long life expectancy. The early outcome and durability of aortic surgery in these patients were investigated in the present study.
    Methods: The subjects of the present analysis were patients under 60 years old who underwent surgical repair for acute DeBakey type 1 aortic dissection at 18 cardiac surgery centres across Europe between 2005 and 2021. Patients underwent ascending aortic repair or total aortic arch repair using the conventional technique or the frozen elephant trunk technique. The primary outcome was 5-year cumulative incidence of reoperation on the distal aorta.
    Results: Overall, 915 patients underwent surgical ascending aortic repair and 284 patients underwent surgical total aortic arch repair. The frozen elephant trunk procedure was performed in 128 patients. Among 245 propensity score-matched pairs, total aortic arch repair did not decrease the rate of distal aortic reoperation compared to ascending aortic repair (5-year cumulative incidence, 6.7% versus 6.7%, subdistributional hazard ratio 1.127, 95% c.i. 0.523 to 2.427). Total aortic arch repair increased the incidence of postoperative stroke/global brain ischaemia (25.7% versus 18.4%, P = 0.050) and dialysis (19.6% versus 12.7%, P = 0.003). Five-year mortality was comparable after ascending aortic repair and total aortic arch repair (22.8% versus 27.3%, P = 0.172).
    Conclusions: In patients under 60 years old with DeBakey type 1 aortic dissection, total aortic arch replacement compared with ascending aortic repair did not reduce the incidence of distal aortic operations at 5 years. When feasible, ascending aortic repair for DeBakey type 1 aortic dissection is associated with satisfactory early and mid-term outcomes.
    Trial registration: ClinicalTrials.gov Identifier: NCT04831073.
    MeSH term(s) Humans ; Aortic Dissection/surgery ; Aortic Dissection/mortality ; Male ; Female ; Middle Aged ; Aorta, Thoracic/surgery ; Reoperation/statistics & numerical data ; Postoperative Complications/epidemiology ; Blood Vessel Prosthesis Implantation/methods ; Blood Vessel Prosthesis Implantation/adverse effects ; Blood Vessel Prosthesis Implantation/mortality ; Aortic Aneurysm, Thoracic/surgery ; Aortic Aneurysm, Thoracic/mortality ; Adult ; Retrospective Studies ; Treatment Outcome ; Europe/epidemiology ; Propensity Score
    Language English
    Publishing date 2024-05-20
    Publishing country England
    Document type Journal Article ; Multicenter Study
    ISSN 2474-9842
    ISSN (online) 2474-9842
    DOI 10.1093/bjsopen/zrae047
    Database MEDical Literature Analysis and Retrieval System OnLINE

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