Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

Fausto Biancari^{1

2}, Javier Rodriguez Lega³, Giovanni Mariscalco⁴, Sven Peterss⁵, Joscha Buech^{5

6}, Antonio Fiore⁷, Andrea Perrotti⁸, Andreas Rukosujew⁹, Angel G Pinto³, Till Demal¹⁰, Konrad Wisniewski⁹, Marek Pol¹¹, Giuseppe Gatti¹², Igor Vendramin¹³, Mauro Rinaldi¹⁴, Robert Pruna-Guillen¹⁵, Dario Di Perna¹⁶, Zein El-Dean⁴, Hiwa Sherzad⁴, Francesco Nappi¹⁷, Mark Field¹⁸, Matteo Pettinari¹⁹, Mikko Jormalainen², Angelo M Dell'Aquila^{9

20}, Francesco Onorati²¹, Eduard Quintana¹⁵, Tatu Juvonen^{2

22}, Timo Mäkikallio¹

Affiliations

¹ Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
² Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
³ Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain.
⁴ Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK.
⁵ Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany.
⁶ German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
⁷ Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France.
⁸ Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France.
⁹ Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
¹⁰ Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
¹¹ Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
¹² Division of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.
¹³ Cardiothoracic Department, University Hospital, Udine, Italy.
¹⁴ Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy.
¹⁵ Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
¹⁶ Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France.
¹⁷ Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France.
¹⁸ Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK.
¹⁹ Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium.
²⁰ Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany.
²¹ Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
²² Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland.

PMID: 38768283
PMCID: PMC11104530
DOI: 10.1093/bjsopen/zrae047

Multicenter Study

Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

Fausto Biancari et al. BJS Open. 2024.

. 2024 May 8;8(3):zrae047.

doi: 10.1093/bjsopen/zrae047.

Authors

Affiliations

¹ Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
² Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
³ Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain.
⁴ Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK.
⁵ Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany.
⁶ German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
⁷ Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France.
⁸ Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France.
⁹ Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
¹⁰ Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
¹¹ Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
¹² Division of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.
¹³ Cardiothoracic Department, University Hospital, Udine, Italy.
¹⁴ Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy.
¹⁵ Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
¹⁶ Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France.
¹⁷ Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France.
¹⁸ Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK.
¹⁹ Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium.
²⁰ Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany.
²¹ Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
²² Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland.

PMID: 38768283
PMCID: PMC11104530
DOI: 10.1093/bjsopen/zrae047

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.

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Figures

**Fig. 2**
Cumulative incidences of distal aortic reoperations after ascending aortic repair and total aortic arch repair for acute DeBakey type 1 aortic dissection.

See this image and copyright information in PMC

References

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1. Uehara K, Matsuda H, Matsuo J, Inoue Y, Omura A, Seike Y et al. Acute type A aortic dissection repair in younger patients. J Card Surg 2018;33:184–189 - PubMed
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1. Ma WG, Chen Y, Zhang W, Li Q, Li JR, Zheng J et al. Extended repair for acute type A aortic dissection: long-term outcomes of the frozen elephant trunk technique beyond 10 years. J Cardiovasc Surg 2020;61:292–300 - PubMed

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Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

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Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger

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