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Clinical outcomes of different surgical approaches for proximal descending thoracic aneurysm involving the distal arch

Authors
 Hyun-Chel Joo  ;  Young-Nam Youn  ;  Seung-Hyun Lee  ;  Sak Lee  ;  Byung-Chul Chang  ;  Kyung-Jong Yoo 
Citation
 Journal of Thoracic and Cardiovascular Surgery, Vol.155(6) : 2289-2298, 2018 
Journal Title
 Journal of Thoracic and Cardiovascular Surgery 
ISSN
 0022-5223 
Issue Date
2018
Keywords
aneurysm ; different approaches ; distal arch ; proximal descending
Abstract
BACKGROUND: The aim of this study was to evaluate clinical outcomes of different approaches to patients with proximal descending thoracic aneurysm (DTA) involving the distal arch. METHODS: From January 2002 to December 2016, 229 consecutive patients with proximal descending aorta aneurysm involving the distal arch underwent surgery using different approaches: total arch and DTA replacement via sternotomy (TAR group; n = 98), hemiarch and DTA replacement via thoracotomy (DTR group; n = 84), or hybrid arch repair (HAR group; n = 47). We retrospectively evaluated the outcomes of the 3 groups with a mean follow-up duration of 60.2 months. RESULTS: The in-hospital mortality rate was 3.1% (3/98) in the TAR group, 11.9% (10/84) in the DTR group, and 4.3% (2/47) in the HAR group (P = .04). The TAR group had a lower incidence of stroke (3.1%, 3/98) compared with the DTR (13.1%, 11/84) and HAR (10.6%, 5/47) groups (P = .03). The overall survival rate at 10 years was 82.8% ± 5.6% for the TAR group, 61.0% ± 8.6% for the DTR group, and 55.9% ± 9.0% for the HAR group (vs DTR [P = .03] and HAR [P < .01]). The freedom from composite of aortic events at 10 years was 75.6% ± 8.1% in the TAR group, 43.6% ± 14.9% in the DTR group, and 31.1% ± 11.5% in the HAR group (P < .01). CONCLUSIONS: The sternotomy approach showed better outcomes in terms of operative mortality, stroke, and long-term survival compared with the thoracotomy or hybrid approaches. This study suggests that the sternotomy approach is the superior option for patients with proximal descending aneurysm involving the distal arch.
Full Text
https://www.sciencedirect.com/science/article/pii/S0022522318304045
DOI
10.1016/j.jtcvs.2017.12.152
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
유경종(Yoo, Kyung Jong) ORCID logo https://orcid.org/0000-0002-9858-140X
윤영남(Youn, Young Nam)
이삭(Lee, Sak) ORCID logo https://orcid.org/0000-0001-6130-2342
이승현(Lee, Seung Hyun) ORCID logo https://orcid.org/0000-0002-0311-6565
장병철(Chang, Byung Chul)
주현철(Joo, Hyun Chel) ORCID logo https://orcid.org/0000-0002-6842-2942
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/163280
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