Abstract 17606: Root Replacement versus More Conservative Management During Type A Acute Aortic Dissection Repair: Insights From the International Registry of Acute Aortic Dissection
Background: How to surgically manage the aortic root in type A acute aortic dissection (TAAAD) is controversial. The aim of this study was to compare short- and mid-term outcomes of root replacement (RR) interventions vs. more conservative root management (CRM).
Methods: Out of the 1995 TAAAD enrolled in the International Registry of Acute Dissection (IRAD), 699 (35%) underwent RR management and 1296 (65%) underwent CRM. Primary end-points for comparison were hospital mortality, 3-year survival and 3-year freedom from open aortic re-intervention. Independent predictors of hospital and 3-year survival were identified using multivariate logistic and Cox regression models. Statistical methods were used to control for treatment selection bias.
Results: As compared to CRM, RR patients were younger (56.9 vs. 62.3 years, p=0.023) and more likely to present with larger root diameter (4.7cm vs. 4.0cm, p<0.001), Marfan syndrome (8.7% vs. 2.5%, p<0.001), aortic insufficiency (64.0% vs. 50.3%, p<0.001) and hypotension/shock/tamponade (33.0%vs.26.5%; p=0.003).
RR management did not increase hospital mortality (propensity-adjusted (PS) odds ratio:0.6, p=0.674). On Kaplan-Meier analysis, 3-years survival (RR: 92.5±1.7% vs. CRM: 91.6±1.3%, log-rank p=0.623) and freedom from re-intervention (RR: 93.1±2.7% vs. CRM: 92.5±2.1%, log-rank p=0.489) were similar for the two groups. PS adjusted Cox regression excluded any relationship existing between type of treatment and follow up survival (HR: 1.5; 95%CI: 0.502-5.010, p=0.432). Instead, B-blocker prescription at discharge was protective against 3-year mortality (HR: 0.4; 95%CI: 0.245-0.881; p=0.019).
Conclusions: Our observational data show that in TAAAD patients more extensive RR interventions are not associated with an increased risk of hospital mortality. Similarly favorable mid-term survival and freedom from re-intervention (>90%) of CRM and RR patients suggest a stable behavior of the non replaced aortic sinuses at 3 years. The use of aggressive RR techniques remain determined by specific dissection and non-dissection (young age, connective disease) related factors.
- © 2013 by American Heart Association, Inc.