Table 5. Outcome of conservative versus extensive root and distal repairs in first time repair acute TAAD patients.
| Variables | Root management (n=182) | Distal extent (n=170) | |||||
|---|---|---|---|---|---|---|---|
| Conservative (N=103) | Extensive (N=79) | P value | Conservative (N=149) | Extensive (N=21) | P value | ||
| Pre-operative risk factors | |||||||
| Age (mean ± SD) | 66.8±13.8 | 60.9±13.7 | 0.002 | 63.1 (14.4) | 67.9 (10.9) | 0.117 | |
| Male | 75 (72.8%) | 53 (67.1%) | 0.402 | 107 (71.8%) | 14 (66.7%) | 0.626 | |
| Marfan Syndrome | 0 (0.0%) | 4 (5.1%) | 0.034 | 4 (2.7%) | 0 (0.0%) | 1.000 | |
| BMI (mean ± SD) | 27.2 ±5.4 | 29.2±7.7 | 0.103 | 28.0 (5.4) | 28.1 (6.0) | 0.950 | |
| Smoker | 52 (50.5%) | 45 (57.0%) | 0.385 | 82 (55.4%) | 11 (52.4%) | 0.794 | |
| Diabetes mellitus | 6 (5.8%) | 8 (10.1%) | 0.401 | 7 (4.7%) | 1 (4.8%) | 1.000 | |
| Dyslipidemia | 42 (40.8%) | 36 (45.6%) | 0.517 | 56 (37.8%) | 11 (52.4%) | 0.202 | |
| Hypertension | 76 (73.8%) | 54 (68.4%) | 0.421 | 103 (69.1%) | 17 (81.0%) | 0.266 | |
| Chronic lung disease | 8 (10.4%) | 3 (5.5%) | 0.359 | 9 (7.6%) | 1 (5.3%) | 1.000 | |
| Peripheral arterial disease | 19 (18.6%) | 11 (14.3%) | 0.441 | 22 (15.1%) | 4 (19.0%) | 0.638 | |
| Had previous heart disease | 15 (14.6%) | 19 (24.1%) | 0.104 | 19 (12.8%) | 4 (19.0%) | 0.430 | |
| Urgent surgery | 95 (92.2%) | 70 (88.6%) | 0.448 | 141 (94.6%) | 18 (85.7%) | 0.139 | |
| NYHA ≥3 | 75 (76.5%) | 57 (74.0%) | 0.702 | 109 (75.2%) | 11 (55.0%) | 0.058 | |
| Aortic regurgitation ≥3 | 46 (47.9%) | 56 (71.8%) | 0.001 | 64 (48.5%) | 8 (44.4%) | 0.748 | |
| Cardiogenic shock | 8 (7.8%) | 7 (9.0%) | 0.791 | 12 (8.2%) | 1 (4.8%) | 1.000 | |
| Intra-operative data | |||||||
| Total perfusion time (min) (mean ± SD) | 172.4±59.3 | 209.3±75.1 | <0.001 | 181.9±64.6 | 207.0±78.3 | 0.123 | |
| Cross clamp time (min) (mean ± SD) | 89.4±39.4 | 126.6±48.7 | <0.001 | 100.6±50.5 | 106.8±64.9 | 0.865 | |
| Circulatory arrest time (min) (mean ± SD) | 30.1±16.8 | 30.1±18.0 | 0.656 | 29.0±13.0 | 44.7±25.4 | 0.009 | |
| Root repair—conservative | |||||||
| Valve-resuspension | 78 (75.7%) | 0 | |||||
| Wall repair | 14 (13.6%) | 0 | |||||
| Wheat procedure | 3 (2.9%) | 0 | |||||
| Root repair—extensive | |||||||
| Bentall procedure | 0 | 58 (73.4%) | |||||
| Valve sparing root replacement | 0 | 21 (26.6%) | |||||
| Post-operative data/morbidity | |||||||
| IABP inserted | 1 (1.0%) | 8 (10.1%) | 0.011 | 5 (3.4%) | 0 (0.0%) | 1.000 | |
| ECMO inserted | 1 (1.0%) | 4 (5.1%) | 0.168 | 2 (1.3%) | 0 (0.0%) | 1.000 | |
| Total ICU stay (hrs) | 136.4±249.8 | 125.2±166.9 | 0.678 | 162.7±321.1 | 90.1±54.3 | 0.772 | |
| Prolonged mechanical ventilator | 46 (44.7%) | 36 (46.2%) | 0.842 | 66 (44.3%) | 12 (57.1%) | 0.269 | |
| Reoperation for bleeding | 6 (5.8%) | 9 (11.5%) | 0.184 | 11 (7.4%) | 0 (0.0%) | 0.363 | |
| Sternal infection—superficial | 3 (2.9%) | 1 (1.3%) | 0.635 | 2 (1.3%) | 0 (0.0%) | 1.000 | |
| Sternal infection—deep | 1 (1.0%) | 0 (0.0%) | 1.000 | 1 (0.7%) | 0 (0.0%) | 1.000 | |
| Permanent stroke | 14 (13.6%) | 7 (9.0%) | 0.361 | 3 (2.0%) | 0 (0.0%) | 1.000 | |
| Transient stroke | 2 (1.9%) | 2 (2.6%) | 1.000 | 7 (4.8%) | 2 (9.5%) | 0.318 | |
| Pulmonary embolism | 1 (1.0%) | 0 (0.0%) | 1.000 | 16 (10.7%) | 2 (9.5%) | 1.000 | |
| Pulmonary pneumonia | 9 (8.7%) | 7 (9.0%) | 1.000 | 1 (0.7%) | 0 (0.0%) | 1.000 | |
| ARDS | 0 (0.0%) | 1 (1.3%) | 0.429 | 23 (15.4%) | 3 (14.3%) | 1.000 | |
| Renal failure | 16 (15.5%) | 10 (12.8%) | 0.673 | 15 (10.1%) | 0 (0.0%) | 0.221 | |
| Dialysis required | 9 (8.7%) | 4 (5.1%) | 0.400 | 1 (0.7%) | 0 (0.0%) | 1.000 | |
| Heart block (pacemaker) | 0 (0.0%) | 2 (2.6%) | 0.184 | 1 (0.7%) | 0 (0.0%) | 1.000 | |
| Anticoagulation complication | 0 (0.0%) | 1 (1.3%) | 0.431 | 27 (18.4%) | 3 (14.3%) | 0.770 | |
| 30 day mortality | 16 (15.7%) | 15 (19.0%) | 0.559 | 13.2 (22.4) | 9.5 (4.8) | 0.638 | |
| Hospital day (mean ± SD) | 12.7 (19.7) | 11.6 (11.4) | 0.888 | 24 (17.3%) | 2 (10.5%) | 0.742 | |
| Readmission in 30 day | 11 (11.1%) | 4 (5.6%) | 0.278 | 28 (17.1%) | 2 (8.3%) | 0.379 | |
TAAD, type A aortic dissection; SD, standard deviation; IABP, intra-aortic balloon pump; ECMO, extra-corporeal membrane oxygenation; ICU, intensive care unit; ARDS, acute respiratory distress syndrome.