Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program

Neil Parikh; Santi Trimarchi; Thomas G Gleason; Arnoud V Kamman; Marco di Eusanio; Truls Myrmel; Amit Korach; Hersh Maniar; Takeyoshi Ota; Ali Khoynezhad; Daniel G Montgomery; Nimesh D Desai; Kim A Eagle; Christoph A Nienaber; Eric M Isselbacher; Joseph Bavaria; Thoralf M Sundt; Himanshu J Patel

doi:10.1016/j.jtcvs.2016.12.029

Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program

Neil Parikh, Santi Trimarchi, Thomas G Gleason, Arnoud V Kamman, Marco di Eusanio, Truls Myrmel, Amit Korach, Hersh Maniar, Takeyoshi Ota, Ali Khoynezhad, Daniel G Montgomery, Nimesh D Desai, Kim A Eagle, Christoph A Nienaber, Eric M Isselbacher, Joseph Bavaria, Thoralf M Sundt, Himanshu J Patel

IRCCS Policlinico San Donato

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVE: Advancements in cardiothoracic surgery prompted investigation into changes in operative management for acute type A aortic dissections over time.

METHODS: One thousand seven hundred thirty-two patients undergoing surgery for type A aortic dissection were identified from the International Registry of Acute Aortic Dissection Interventional Cohort Database. Patients were divided into time tertiles (T) (T1: 1996-2003, T2: 2004-2010, and T3: 2011-2016).

RESULTS: Frequency of valve sparing procures increased (T1: 3.9%, T2: 18.6%, and T3: 26.7%; trend P < .001). Biologic valves were increasingly utilized (T1: 35.6%, T2; 40.6%, and T3: 52.0%; trend P = .009), whereas mechanical valve use decreased (T1: 57.6%, T2: 58.0%, and T3: 45.4%; trend P = .027) for aortic valve replacement. Adjunctive cerebral perfusion use increased (T1: 67.1%, T2: 89.5%, and T3: 84.8%; trend P < .001), with increase in antegrade cerebral techniques (T1: 55.9%, T2: 58.8%, and T3: 66.1%; trend P = .005) and hypothermic circulatory arrest (T1: 80.1%, T2: 85.9%, and T3: 86.8%; trend P = .030). Arterial perfusion through axillary cannulation increased (T1: 18.0%, T2: 33.2%, and T3: 55.7%), whereas perfusion via a femoral approach diminished (T1: 76.0%, T2: 53.3%, and T3: 30.1%) (both P values < .001). Hemiarch replacement was utilized more frequently (T1: 27.0%, T2: 63.3%, and T3: 51.7%; trend P = .001) and partial arch was utilized less frequently (T1: 20.7%, T2: 12.0%, and T3: 8.4%; trend P < .001), whereas complete arch replacement was used similarly (P = .131). In-hospital mortality significantly decreased (T1: 17.5%, T2: 15.8%, and T3: 12.2%; trend P = .017).

CONCLUSIONS: There have been significant changes in operative strategy over time in the management of type A aortic dissection, with more frequent use of valve-sparing procedures, bioprosthetic aortic valve substitutes, antegrade cerebral perfusion strategies, and hypothermic circulatory arrest. Most importantly, a significant decrease of in-hospital mortality was observed during the 20-year timespan.

Original language	English
Pages (from-to)	S74-S79
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	153
Issue number	4
DOIs	https://doi.org/10.1016/j.jtcvs.2016.12.029
Publication status	Published - Apr 2017

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Parikh, N., Trimarchi, S., Gleason, T. G., Kamman, A. V., di Eusanio, M., Myrmel, T., Korach, A., Maniar, H., Ota, T., Khoynezhad, A., Montgomery, D. G., Desai, N. D., Eagle, K. A., Nienaber, C. A., Isselbacher, E. M., Bavaria, J., Sundt, T. M., & Patel, H. J. (2017). Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. Journal of Thoracic and Cardiovascular Surgery, 153(4), S74-S79. https://doi.org/10.1016/j.jtcvs.2016.12.029

Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. / Parikh, Neil; Trimarchi, Santi; Gleason, Thomas G; Kamman, Arnoud V; di Eusanio, Marco; Myrmel, Truls; Korach, Amit; Maniar, Hersh; Ota, Takeyoshi; Khoynezhad, Ali; Montgomery, Daniel G; Desai, Nimesh D; Eagle, Kim A; Nienaber, Christoph A; Isselbacher, Eric M; Bavaria, Joseph; Sundt, Thoralf M; Patel, Himanshu J.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 153, No. 4, 04.2017, p. S74-S79.

Research output: Contribution to journal › Article › peer-review

Parikh, N, Trimarchi, S, Gleason, TG, Kamman, AV, di Eusanio, M, Myrmel, T, Korach, A, Maniar, H, Ota, T, Khoynezhad, A, Montgomery, DG, Desai, ND, Eagle, KA, Nienaber, CA, Isselbacher, EM, Bavaria, J, Sundt, TM & Patel, HJ 2017, 'Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program', Journal of Thoracic and Cardiovascular Surgery, vol. 153, no. 4, pp. S74-S79. https://doi.org/10.1016/j.jtcvs.2016.12.029

Parikh, Neil ; Trimarchi, Santi ; Gleason, Thomas G ; Kamman, Arnoud V ; di Eusanio, Marco ; Myrmel, Truls ; Korach, Amit ; Maniar, Hersh ; Ota, Takeyoshi ; Khoynezhad, Ali ; Montgomery, Daniel G ; Desai, Nimesh D ; Eagle, Kim A ; Nienaber, Christoph A ; Isselbacher, Eric M ; Bavaria, Joseph ; Sundt, Thoralf M ; Patel, Himanshu J. / Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. In: Journal of Thoracic and Cardiovascular Surgery. 2017 ; Vol. 153, No. 4. pp. S74-S79.

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title = "Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program",

abstract = "OBJECTIVE: Advancements in cardiothoracic surgery prompted investigation into changes in operative management for acute type A aortic dissections over time.METHODS: One thousand seven hundred thirty-two patients undergoing surgery for type A aortic dissection were identified from the International Registry of Acute Aortic Dissection Interventional Cohort Database. Patients were divided into time tertiles (T) (T1: 1996-2003, T2: 2004-2010, and T3: 2011-2016).RESULTS: Frequency of valve sparing procures increased (T1: 3.9%, T2: 18.6%, and T3: 26.7%; trend P < .001). Biologic valves were increasingly utilized (T1: 35.6%, T2; 40.6%, and T3: 52.0%; trend P = .009), whereas mechanical valve use decreased (T1: 57.6%, T2: 58.0%, and T3: 45.4%; trend P = .027) for aortic valve replacement. Adjunctive cerebral perfusion use increased (T1: 67.1%, T2: 89.5%, and T3: 84.8%; trend P < .001), with increase in antegrade cerebral techniques (T1: 55.9%, T2: 58.8%, and T3: 66.1%; trend P = .005) and hypothermic circulatory arrest (T1: 80.1%, T2: 85.9%, and T3: 86.8%; trend P = .030). Arterial perfusion through axillary cannulation increased (T1: 18.0%, T2: 33.2%, and T3: 55.7%), whereas perfusion via a femoral approach diminished (T1: 76.0%, T2: 53.3%, and T3: 30.1%) (both P values < .001). Hemiarch replacement was utilized more frequently (T1: 27.0%, T2: 63.3%, and T3: 51.7%; trend P = .001) and partial arch was utilized less frequently (T1: 20.7%, T2: 12.0%, and T3: 8.4%; trend P < .001), whereas complete arch replacement was used similarly (P = .131). In-hospital mortality significantly decreased (T1: 17.5%, T2: 15.8%, and T3: 12.2%; trend P = .017).CONCLUSIONS: There have been significant changes in operative strategy over time in the management of type A aortic dissection, with more frequent use of valve-sparing procedures, bioprosthetic aortic valve substitutes, antegrade cerebral perfusion strategies, and hypothermic circulatory arrest. Most importantly, a significant decrease of in-hospital mortality was observed during the 20-year timespan.",

author = "Neil Parikh and Santi Trimarchi and Gleason, {Thomas G} and Kamman, {Arnoud V} and {di Eusanio}, Marco and Truls Myrmel and Amit Korach and Hersh Maniar and Takeyoshi Ota and Ali Khoynezhad and Montgomery, {Daniel G} and Desai, {Nimesh D} and Eagle, {Kim A} and Nienaber, {Christoph A} and Isselbacher, {Eric M} and Joseph Bavaria and Sundt, {Thoralf M} and Patel, {Himanshu J}",

year = "2017",

month = apr,

doi = "10.1016/j.jtcvs.2016.12.029",

language = "English",

volume = "153",

pages = "S74--S79",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

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TY - JOUR

T1 - Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program

AU - Parikh, Neil

AU - Trimarchi, Santi

AU - Gleason, Thomas G

AU - Kamman, Arnoud V

AU - di Eusanio, Marco

AU - Myrmel, Truls

AU - Korach, Amit

AU - Maniar, Hersh

AU - Ota, Takeyoshi

AU - Khoynezhad, Ali

AU - Montgomery, Daniel G

AU - Desai, Nimesh D

AU - Eagle, Kim A

AU - Nienaber, Christoph A

AU - Isselbacher, Eric M

AU - Bavaria, Joseph

AU - Sundt, Thoralf M

AU - Patel, Himanshu J

PY - 2017/4

Y1 - 2017/4

N2 - OBJECTIVE: Advancements in cardiothoracic surgery prompted investigation into changes in operative management for acute type A aortic dissections over time.METHODS: One thousand seven hundred thirty-two patients undergoing surgery for type A aortic dissection were identified from the International Registry of Acute Aortic Dissection Interventional Cohort Database. Patients were divided into time tertiles (T) (T1: 1996-2003, T2: 2004-2010, and T3: 2011-2016).RESULTS: Frequency of valve sparing procures increased (T1: 3.9%, T2: 18.6%, and T3: 26.7%; trend P < .001). Biologic valves were increasingly utilized (T1: 35.6%, T2; 40.6%, and T3: 52.0%; trend P = .009), whereas mechanical valve use decreased (T1: 57.6%, T2: 58.0%, and T3: 45.4%; trend P = .027) for aortic valve replacement. Adjunctive cerebral perfusion use increased (T1: 67.1%, T2: 89.5%, and T3: 84.8%; trend P < .001), with increase in antegrade cerebral techniques (T1: 55.9%, T2: 58.8%, and T3: 66.1%; trend P = .005) and hypothermic circulatory arrest (T1: 80.1%, T2: 85.9%, and T3: 86.8%; trend P = .030). Arterial perfusion through axillary cannulation increased (T1: 18.0%, T2: 33.2%, and T3: 55.7%), whereas perfusion via a femoral approach diminished (T1: 76.0%, T2: 53.3%, and T3: 30.1%) (both P values < .001). Hemiarch replacement was utilized more frequently (T1: 27.0%, T2: 63.3%, and T3: 51.7%; trend P = .001) and partial arch was utilized less frequently (T1: 20.7%, T2: 12.0%, and T3: 8.4%; trend P < .001), whereas complete arch replacement was used similarly (P = .131). In-hospital mortality significantly decreased (T1: 17.5%, T2: 15.8%, and T3: 12.2%; trend P = .017).CONCLUSIONS: There have been significant changes in operative strategy over time in the management of type A aortic dissection, with more frequent use of valve-sparing procedures, bioprosthetic aortic valve substitutes, antegrade cerebral perfusion strategies, and hypothermic circulatory arrest. Most importantly, a significant decrease of in-hospital mortality was observed during the 20-year timespan.

AB - OBJECTIVE: Advancements in cardiothoracic surgery prompted investigation into changes in operative management for acute type A aortic dissections over time.METHODS: One thousand seven hundred thirty-two patients undergoing surgery for type A aortic dissection were identified from the International Registry of Acute Aortic Dissection Interventional Cohort Database. Patients were divided into time tertiles (T) (T1: 1996-2003, T2: 2004-2010, and T3: 2011-2016).RESULTS: Frequency of valve sparing procures increased (T1: 3.9%, T2: 18.6%, and T3: 26.7%; trend P < .001). Biologic valves were increasingly utilized (T1: 35.6%, T2; 40.6%, and T3: 52.0%; trend P = .009), whereas mechanical valve use decreased (T1: 57.6%, T2: 58.0%, and T3: 45.4%; trend P = .027) for aortic valve replacement. Adjunctive cerebral perfusion use increased (T1: 67.1%, T2: 89.5%, and T3: 84.8%; trend P < .001), with increase in antegrade cerebral techniques (T1: 55.9%, T2: 58.8%, and T3: 66.1%; trend P = .005) and hypothermic circulatory arrest (T1: 80.1%, T2: 85.9%, and T3: 86.8%; trend P = .030). Arterial perfusion through axillary cannulation increased (T1: 18.0%, T2: 33.2%, and T3: 55.7%), whereas perfusion via a femoral approach diminished (T1: 76.0%, T2: 53.3%, and T3: 30.1%) (both P values < .001). Hemiarch replacement was utilized more frequently (T1: 27.0%, T2: 63.3%, and T3: 51.7%; trend P = .001) and partial arch was utilized less frequently (T1: 20.7%, T2: 12.0%, and T3: 8.4%; trend P < .001), whereas complete arch replacement was used similarly (P = .131). In-hospital mortality significantly decreased (T1: 17.5%, T2: 15.8%, and T3: 12.2%; trend P = .017).CONCLUSIONS: There have been significant changes in operative strategy over time in the management of type A aortic dissection, with more frequent use of valve-sparing procedures, bioprosthetic aortic valve substitutes, antegrade cerebral perfusion strategies, and hypothermic circulatory arrest. Most importantly, a significant decrease of in-hospital mortality was observed during the 20-year timespan.

U2 - 10.1016/j.jtcvs.2016.12.029

DO - 10.1016/j.jtcvs.2016.12.029

M3 - Article

C2 - 28168983

VL - 153

SP - S74-S79

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 4

ER -