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The fate of residual aortic regurgitation after ascending aorta replacement in type A aortic dissection

Authors
 Do Jung Kim  ;  Sak Lee  ;  Seung Hyun Lee  ;  Young-Nam Youn  ;  Byung-Chul Chang  ;  Kyung-Jong Yoo  ;  Hyun-Chel Joo 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.160(6) : 1421-1430, 2020-12 
Journal Title
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
ISSN
 0022-5223 
Issue Date
2020-12
MeSH
Aneurysm, Dissecting / diagnosis ; Aneurysm, Dissecting / surgery* ; Aorta / diagnostic imaging ; Aorta / surgery* ; Aortic Aneurysm, Thoracic / diagnosis ; Aortic Aneurysm, Thoracic / surgery* ; Aortic Valve Insufficiency / diagnosis ; Aortic Valve Insufficiency / etiology* ; Aortic Valve Insufficiency / surgery ; Blood Vessel Prosthesis Implantation / adverse effects* ; Disease Progression ; Echocardiography, Transesophageal / methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications* ; Prognosis ; Retrospective Studies ; Time Factors ; Tomography, X-Ray Computed
Keywords
aortic dissection ; aortic valve insufficiency
Abstract
Objective: This study aimed to evaluate the changes in postoperative aortic regurgitation (AR) and determine the predictors of significant AR and root reoperation after ascending aortic replacement (AAR) in patients with acute type A aortic dissection. Methods: From January 1995 to December 2017, 271 consecutive patients underwent valve/root-preserving AAR (n = 225) and root replacement (n = 46). AR grade trend over time was analyzed by the ordinal mixed-effects model. Significant AR was defined as AR grade ≥3+ during the follow-up period. Predischarge and follow-up echocardiograms were obtained in 95.6% and 88.8% of enrolled patients, respectively. Results: At predischarge, postoperative ≥2+ AR was present in 20 (9.3%) and 1 (2.3%) patients in the AAR and root replacement groups, respectively. With increasing time after surgery, the grade of AR increased. At 10 years, 4.6% of patients had developed 3+ or 4+ AR. Considering death as the competing risk, the 10-year cumulative incidence of significant AR was significantly higher in the AAR than in the root replacement group (12.3% vs 2.2%; P = .047). The risk of root reoperation at 10 years was not different between the groups (P = .118). On Cox analysis, preoperative ≥3+ AR (P = .002), postoperative ≥2+ AR (P = .040), and false to true lumen ratio (P = .005) were associated predictors of significant AR. Conclusions: Although valve/root-preserving AAR demonstrated reasonable long-term outcomes when compared with root replacement, preoperative ≥3+ AR, postoperative ≥2+ AR, and high false to true lumen ratio significantly increased the risk of significant AR. Therefore, careful echocardiographic surveillance may be warranted in patients with postoperative ≥2+ AR and small true lumen.
Files in This Item:
T202006307.pdf Download
DOI
10.1016/j.jtcvs.2019.12.118
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0002-0311-6565
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182600
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