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Войти в исследования The British journal of surgery · 2026
Open surgery versus branched endovascular repair of the aortic arch in residual dissections after type A surgical repair.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Tinelli Giovanni, Sica Simona, Tsilimparis Nikolaos, Pichlmaier Maximilian, Neri Eugenio, Hostalrich Aurélien, Kölbel Tilo, Sobocinski Jonathan, Di Eusanio Marco, Gatta Emanuele, Schanzer Andres, Guimbretière Guillaume, Giannarelli Diana, Guo Ming Hao, Tshomba Yamume, Massetti Massimo, Haulon Stéphan, International multicenter post-Dissection Arch Repair Study (DARS) Group
Аннотация
BACKGROUND: Redo open arch repair is challenging; arch branched endovascular aortic repair (a-BEVAR) offers a less invasive alternative. However, direct comparisons are lacking. The aim of this study was to compare the outcomes of open arch repair versus a-BEVAR in patients with residual aortic dissection after ascending aorta replacement for acute Stanford type A aortic dissection.
METHODS: This multicentre retrospective study included patients treated for residual dissection after type A aortic dissection in ten high-volume centres from January 2018 to May 2024. Propensity score matching (1 : 1) was used to adjust for baseline differences. Primary endpoints included 30-day mortality and stroke rates, and secondary endpoints included acute kidney injury, spinal cord ischaemia, reintervention, aortic-related mortality, and hospital length of stay.
RESULTS: A total of 183 patients were included: 89 (48.6%) underwent open arch repair and 94 (51.4%) underwent a-BEVAR. After propensity score matching, there were 57 patients in each group. The 30-day mortality rate was 3.5% for open arch repair and 5.3% for a-BEVAR (P = 0.220). The stroke rate was 5.3% for open arch repair and 3.5% for a-BEVAR (P = 0.650). Open arch repair was associated with significantly higher rates of prolonged (>48 h) intubation (28.1% versus 3.5%; P < 0.001), acute kidney injury (31.6% versus 8.8%; P = 0.002), and temporary dialysis (22.8% versus 7.0%; P = 0.002). The median hospital length of stay was 21 days for open arch repair and 10 days for a-BEVAR (P < 0.001). During a median follow-up of 30 months (i.q.r. 7-49), no difference in mortality was observed (10.5% for open arch repair versus 12.3% for a-BEVAR; P = 0.770).
CONCLUSION: a-BEVAR provides a less invasive alternative to open arch repair with reduced complications. Long-term studies are needed.
METHODS: This multicentre retrospective study included patients treated for residual dissection after type A aortic dissection in ten high-volume centres from January 2018 to May 2024. Propensity score matching (1 : 1) was used to adjust for baseline differences. Primary endpoints included 30-day mortality and stroke rates, and secondary endpoints included acute kidney injury, spinal cord ischaemia, reintervention, aortic-related mortality, and hospital length of stay.
RESULTS: A total of 183 patients were included: 89 (48.6%) underwent open arch repair and 94 (51.4%) underwent a-BEVAR. After propensity score matching, there were 57 patients in each group. The 30-day mortality rate was 3.5% for open arch repair and 5.3% for a-BEVAR (P = 0.220). The stroke rate was 5.3% for open arch repair and 3.5% for a-BEVAR (P = 0.650). Open arch repair was associated with significantly higher rates of prolonged (>48 h) intubation (28.1% versus 3.5%; P < 0.001), acute kidney injury (31.6% versus 8.8%; P = 0.002), and temporary dialysis (22.8% versus 7.0%; P = 0.002). The median hospital length of stay was 21 days for open arch repair and 10 days for a-BEVAR (P < 0.001). During a median follow-up of 30 months (i.q.r. 7-49), no difference in mortality was observed (10.5% for open arch repair versus 12.3% for a-BEVAR; P = 0.770).
CONCLUSION: a-BEVAR provides a less invasive alternative to open arch repair with reduced complications. Long-term studies are needed.