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Aortic root repair in acute type A aortic dissection: Neomedia or no neomedia

Read at The American Association for Thoracic Surgery Aortic Symposium Workshop, Boston, Massachusetts, May 13-14, 2022.
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Abstract

Objective

Neomedia has been frequently used for aortic root repair in acute type A aortic dissection. We aimed to determine the efficacy and necessity of neomedia during acute type A aortic dissection root repair.

Methods

From January 2010 to February 2021, 308 patients with acute type A aortic dissection underwent aortic root repair with neomedia (n = 132) or without neomedia (n = 176). Of these, 121 matched pairs were identified using propensity score matching based on age, sex, coronary artery disease, preoperative renal failure, acute stroke, prior cardiac surgery, cardiogenic shock, coronary malperfusion, preoperative cardiopulmonary resuscitation, and severe aortic insufficiency.

Results

After matching, the preoperative demographics and comorbidities were well balanced in both groups. Compared with the neomedia group, the no neomedia group had less hemiarch (57% vs 69%, P = .05) and more zone 1 arch replacements (12% vs 4.1%, P = .03), shorter hypothermic circulatory arrest time (28 vs 36 minutes, P < .001), and shorter crossclamp time (120 vs 131 minutes, P = .02). Postoperative outcomes were similar, and the odds ratio by univariable logistic model of no neomedia for operative mortality was 0.83 (P = .76). Aortic root growth over 11 years (0.11 vs 0.16 mm/year, P = .66), 5-year freedom from greater than mild aortic insufficiency (84% vs 85%, P = .80), reoperation for root pathology (1 patient in each group), and 8-year survival (80% [95% confidence interval, 69-97] vs 71% [95% confidence interval, 55-82], P = .26) were similar between the neomedia and no neomedia groups.

Conclusions

In patients with acute type A aortic dissection, aortic root repair with or without neomedia was equally safe and effective. Neomedia use could be avoided in acute type A aortic dissection repair.

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).

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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.

References (19)

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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.

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