The Journal of Thoracic and Cardiovascular Surgery
AdultAortic root repair in acute type A aortic dissection: Neomedia or no neomedia
Video Abstract
Graphical abstract
Patients with ATAAD who underwent root repair with no neomedia had minimal growth of their aortic root, similar freedom from greater than mild aortic insufficiency, very low reoperation rate, and midterm survival outcomes compared with patients with neomedia. Neomedia could be avoided in the aortic root repair in patients with ATAAD (95% CI).
Section snippets
Materials and Methods
This study was approved by the Institutional Review Board at Michigan Medicine (HUM00133791, 12/3/2017) and follows the Health Insurance Portability and Accountability Act regulations. A waiver of informed consent was obtained.
Preoperative Demographics Data
After the propensity score match, compared with the neomedia group, the no neomedia group had a lower proportion of patients with celiac malperfusion (0% vs 4.1%, P = .03). All malperfusion were resolved by endovascular fenestration/stenting before open aortic repair. All other preoperative demographics and comorbidities were well balanced in both groups, including median age, connective tissue disorder, aortic insufficiency, acute renal insufficiency, and baseline aortic measurements, among
Discussion
Previously, we reported the short-term outcomes of 94 consecutive patients with ATAAD from 2012 to 2016 who underwent root repair without any surgical adjuncts, including neomedia.7 In this study, with more patients, a control group (neomedia group), and longer follow-up, we found that the operative mortality, growth of the aortic root, freedom from greater than mild aortic insufficiency, incidence of reoperation for root pathology, and midterm survival outcomes were similar between patients
Conclusions
In the surgical repair of ATAAD, aortic root repair with or without neo-media both achieved similar excellent short- and midterm outcomes. The neomedia was not necessary for ATAAD repair and could be avoided in aortic root repair in patients with ATAAD.
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B.Y. is supported by the National Heart, Lung, and Blood Institute of National Institutes of Health K08HL130614, R01HL141891, and R01HL151776, Phil Jenkins and Darlene & Stephen J. Szatmari Funds.
Date and number of Institutional Review Board Approval: HUM00133791; December 3, 2017. A waiver of informed consent was obtained.