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. 2022 Mar 21;22(1):117.
doi: 10.1186/s12872-022-02511-1.

Partial upper sternotomy for extensive arch repair in older acute type A aortic dissection patients

Zhihuang Qiu #  1   2   3 , Jun Xiao #  1   2   3 , Qingsong Wu  1   2   3 , Tianci Chai  1   2   3 , Li Zhang  4 , Yumei Li  5 , Liangwan Chen  6   7   8
Affiliations

Partial upper sternotomy for extensive arch repair in older acute type A aortic dissection patients

Zhihuang Qiu et al. BMC Cardiovasc Disord. .

Abstract

Objectives: The partial upper sternotomy (PUS) approach is acceptable for aortic valve replacement, and even aortic root operation. However, the efficiency of PUS for extensive arch repair of acute type A aortic dissection (AAAD) in older adult patients has not been well investigated.

Methods: Between January 2014 and December 2019, 222 older adult patients (≥ 65 years) diagnosed with AAAD went through extensive arch repair, among which 127 received PUS, and 95 underwent full sternotomy (FS). Logistic regression analysis was used to identify risk factors for early death, and negative binomial regression analysis was applied to explore risk factors related to post-operative ventilator-supporting time and intensive care unit stay time.

Results: Total early mortality was 8.1% (18/222 patients). The PUS group had shorter Cardiopulmonary bypass time (133.0 vs.155.0 min, P < 0.001), cross-clamp time (44.0 vs. 61.0 min, P < 0.001) and shorter selective cerebral perfusion time (11.0 vs. 21.0 min, P < 0.001) than the FS group. Left ventricle ejection fraction < 50% (odds ratio [OR] 17.05; 95% confidence interval [CI] 1.87-155.63; P = 0.012) and malperfusion syndromes (OR 65.83; 95% CI 11.53-375.86; P < 0.001) were related to early death. In the multivariate model, the PUS approach contributed to shorter ventilator-supporting time (incidence rate ratio [IRR] 0.76; 95% CI 0.64-0.91; P = 0.003), when compared with the FS group.

Conclusions: The early results of emergency extensive arch repair of AAAD via PUS in older adult patients were satisfactory. However, the long-term results remain to be investigated.

Keywords: Acute type A aortic dissection; Full sternotomy; Older patients; Partial upper sternotomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The modified triple-branched stent graft is comprised of a main graft and three sidearm grafts
Fig. 2
Fig. 2
Partial upper sternotomy incision for extensive arch repair of acute type A aortic dissection
Fig. 3
Fig. 3
Excellent exposure of acute type A aortic dissection is achieved through a partial upper sternotomy approach
Fig. 4
Fig. 4
There were 257 patients with acute type A aortic dissection who underwent the surgical procedure between January 2014 and December 2019
Fig. 5
Fig. 5
Kaplan–Meier estimates of survival for patients with acute type A aortic dissection who underwent extensive arch repair with modified triple-branched stent graft
See this image and copyright information in PMC

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