Impact of perfusion strategy on outcome after repair for acute type a aortic dissection.

Abstract

BACKGROUND:

The impact of antegrade versus retrograde perfusion during cardiopulmonary bypass on short- and long-term outcome after repair for acute type A aortic dissection is controversial.

METHODS:

We reviewed 401 consecutive patients (age, 59.2 ± 14 years) with acute type A aortic dissection who underwent aggressive resection of the intimal tear and aortic replacement (March 1995 through July 2011). Arterial perfusion was antegrade in 78% (n = 311), either by means of the right axillary artery (n = 297) or through direct aortic cannulation (n = 15). Retrograde perfusion through the femoral artery was used in 22% (n = 90).

RESULTS:

Of the 401 patients with acute type A aortic dissection, 16% (n = 64) presented in critical condition and 10% (n = 39) entered the operating room under cardiopulmonary resuscitation. In 14% (n = 54) the dissection did not extend beyond the ascending aorta (DeBakey II); 82% of dissections did involve at least the aortic arch (n = 326, DeBakey I+III). Mean age was not significantly different between patients undergoing antegrade (59.4 ± 14 years) versus retrograde (59.2 ± 13 years; p = 0.489) perfusion. Operative mortality was 20% and did not differ significantly between the groups (p = 0.766); postoperative stroke occurred also with a similar prevalence (antegrade, 15% versus retrograde, 18%; p = 0.623). Patients undergoing antegrade perfusion had a better long-term survival. Survival at 10 years after discharge was 71% versus 51% (p = 0.025) in favor of antegrade perfusion. Retrograde perfusion was identified to be an independent risk factor for late mortality in multivariate analysis (hazard ratio = 2; p = 0.009).

CONCLUSIONS:

Survival during the initial perioperative period was equivalent comparing antegrade and retrograde perfusion. Antegrade perfusion to the true lumen, however, appears to be associated with superior long-term survival after hospital discharge.

• Authors: Christian D Etz, Konstantin von Aspern, Jaqueline da Rocha E Silva, Felix F Girrbach, Sergey Leontyev, Maximilian Luehr, Martin Misfeld, Michael A Borger, Friedrich W Mohr
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 97 Issue 1 Pg. 78-85 (Jan 2014) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 24070704 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Acute Disease
• Adult
• Aged
• Aortic Dissection (diagnostic imaging, mortality, surgery)
• Angiography (methods)
• Aortic Aneurysm, Thoracic (diagnostic imaging, mortality, surgery)
• Axillary Artery
• Blood Vessel Prosthesis Implantation (methods, mortality)
• Cardiopulmonary Bypass (methods)
• Catheterization (methods)
• Cohort Studies
• Female
• Femoral Artery
• Follow-Up Studies
• Hospital Mortality (trends)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Perfusion (methods)
• Postoperative Complications (mortality, physiopathology)
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Statistics, Nonparametric
• Survival Analysis
• Tomography, X-Ray Computed (methods)
• Treatment Outcome
• Vascular Surgical Procedures (methods)