Comparison of Extended Arch Versus Hemiarch Replacement in Elderly Patients With Type A Aortic Dissection: The Shizuoka Kokuho Database

TL;DR

This study compares two surgical methods for treating aortic dissection in elderly patients and finds no significant difference in survival, but one method has a higher risk of needing a second operation for bleeding.

Contribution

The study provides new evidence on the comparative effectiveness of extended arch and hemiarch replacement in elderly patients with type A aortic dissection.

Findings

No significant difference in survival was found between extended arch and hemiarch replacement in elderly patients.

Extended arch replacement was associated with a higher incidence of reoperation for bleeding compared to hemiarch replacement.

Abstract

Extended arch replacement (EAR) and hemiarch replacement (HAR) are surgical options for type A acute aortic dissection (AAD). However, the effectiveness of EAR compared with HAR, particularly in elderly patients, remains unclear owing to its invasiveness and complications. This study aimed to compare the postoperative outcomes of EAR and HAR in elderly patients with type A AAD.

This retrospective cohort study used data from the Shizuoka Kokuho Database, a prefecture-wide, multi-institutional administrative claims database managed by the Shizuoka Prefectural Government. We identified patients aged ≥60 years with type A AAD who underwent HAR or EAR between April 2012 and September 2022. Propensity score matching (PSM) was employed to balance the baseline characteristics between the groups. The primary outcome was all-cause mortality. The secondary outcome included the incidence of reoperation for bleeding.

A total of 774 patients were included (174 undergoing EAR and 600 undergoing HAR). After PSM, 167 matched pairs were analysed. Kaplan-Meier curves revealed no significant differences in survival between both procedures (log-rank test, P = .739). Cox proportional hazards analysis also revealed no significant differences in all-cause mortality between the EAR and HAR groups (hazard ratio: 1.08, 95% confidence interval: 0.70-1.66). However, the incidence of reoperation for bleeding was higher in the EAR group than in the HAR group (20 [12.0%] vs 7 [4.2%], P = .012).

Although no statistically significant difference in postoperative mortality was observed between EAR and HAR, the incidence of reoperation for bleeding was higher in the EAR group. Therefore, the indication for EAR in elderly patients with type A AAD should be considered with caution.

Acute aortic dissection (AAD) is a life-threatening condition characterized by tears in the aortic wall that lead to high morbidity and mortality rates.

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