TY - JOUR

T1 - Predictors of Lethality, Remodeling, and Aorta-Related Events in Different Types of Proximal Aortic Dissection Surgery

AU - Sirota, D A

AU - Zhulkov, М О

AU - Khvan, D S

AU - Caus, T

AU - Kozlov, B N

AU - Lukinov, V L

AU - Lyashenko, М М

AU - Makaev, A G

AU - Protopopov, A V

AU - Agaeva, Kh A

AU - Fomichev, A V

AU - Мagbulova, S A

AU - Limansky, A D

AU - Chernyavsky, A М

N1 - Study funding. The study was carried out within the framework of project No. 22-15-20005 (Agreement No.22-15-20005 of March 22, 2022 with the Russian Science Foundation, Agreement No.R-12 of April 6, 2022 with the Ministry of Science and Innovation Policy of the Novosibirsk Region).

PY - 2023

Y1 - 2023

N2 - UNLABELLED: The aim of the study is to analyze predictors of lethality, false lumen thrombosis, enlargement of aortic diameter, and frequency of aorta-related events in the early and remote postoperative periods for various types of proximal aortic dissection surgery using the logistic regression method.MATERIALS AND METHODS: A retrospective observational comparison of the results of surgical treatment of 213 patients with the diagnosis of "DeBakey type I aortic dissection" has been carried out. The participants were divided into three groups: group 1 underwent classic aortic arch reconstruction using hemiarch technique or total reconstruction of the aortic arch with a multiple-branch prosthesis (n=121); group 2 was subjected to the hemiarch technique and implantation of bare-metal (uncoated) stents (n=55); in group 3, the "frozen elephant trunk" correction technique was used (n=37). The diagnosis of all patients included into the study was preoperatively confirmed by ultrasound and tomographic examination. Predictors of negative events have been identified by building the models of logistic regressions.RESULTS: The multivariate model of logistic regression has revealed multiplicative significant predictors of lethality: postoperative neurological complications increased the probability of lethality by 3.39 (1.24-9.18) times and presence of a patent false lumen by 4.17 (1.49-13.68) times.Among the predictors of aorta-related events, the most important were connective tissue diseases (the probability increased by 6.68 (2.98-15.62) times), presence of partial thrombosis of the false lumen (the probability of event development increased by 2.39 (1.07-5.44) times), and aortic valve repair (the probability aorta-event occurrence increased by 2.84 (1.13-7.17) times).Hybrid prosthesis implantation appeared to be the most significant predictor of false lumen thrombosis increasing its probability by 4.19 (1.90-9.44) times among aortic repair methods, while a bare-metal stent implantation in contrast reduced the likelihood of false lumen thrombosis by 0.17 (0.03-0.62) times. Eventually, the type of repair had not any significant impact on the aorta-related events and lethality in the long-term period.

AB - UNLABELLED: The aim of the study is to analyze predictors of lethality, false lumen thrombosis, enlargement of aortic diameter, and frequency of aorta-related events in the early and remote postoperative periods for various types of proximal aortic dissection surgery using the logistic regression method.MATERIALS AND METHODS: A retrospective observational comparison of the results of surgical treatment of 213 patients with the diagnosis of "DeBakey type I aortic dissection" has been carried out. The participants were divided into three groups: group 1 underwent classic aortic arch reconstruction using hemiarch technique or total reconstruction of the aortic arch with a multiple-branch prosthesis (n=121); group 2 was subjected to the hemiarch technique and implantation of bare-metal (uncoated) stents (n=55); in group 3, the "frozen elephant trunk" correction technique was used (n=37). The diagnosis of all patients included into the study was preoperatively confirmed by ultrasound and tomographic examination. Predictors of negative events have been identified by building the models of logistic regressions.RESULTS: The multivariate model of logistic regression has revealed multiplicative significant predictors of lethality: postoperative neurological complications increased the probability of lethality by 3.39 (1.24-9.18) times and presence of a patent false lumen by 4.17 (1.49-13.68) times.Among the predictors of aorta-related events, the most important were connective tissue diseases (the probability increased by 6.68 (2.98-15.62) times), presence of partial thrombosis of the false lumen (the probability of event development increased by 2.39 (1.07-5.44) times), and aortic valve repair (the probability aorta-event occurrence increased by 2.84 (1.13-7.17) times).Hybrid prosthesis implantation appeared to be the most significant predictor of false lumen thrombosis increasing its probability by 4.19 (1.90-9.44) times among aortic repair methods, while a bare-metal stent implantation in contrast reduced the likelihood of false lumen thrombosis by 0.17 (0.03-0.62) times. Eventually, the type of repair had not any significant impact on the aorta-related events and lethality in the long-term period.

KW - Humans

KW - Aorta

KW - Aortic Dissection/surgery

KW - Artificial Limbs

KW - Embryo Implantation

KW - Postoperative Complications

KW - Retrospective Studies

KW - stents

KW - thoracic aorta

KW - aorta dissection

KW - substantial hemorrhage

KW - thrombosis

KW - “frozen elephant trunk”

KW - aortic arch

UR - https://www.scopus.com/record/display.uri?eid=2-s2.0-85150027809&origin=inward&txGid=c17fb01b90137504c7cc9e02765a6ab8

UR - https://www.elibrary.ru/item.asp?id=50366908

UR - https://www.mendeley.com/catalogue/ceb421b9-6544-3341-a7b7-4410305db452/

U2 - 10.17691/stm2023.15.1.05

DO - 10.17691/stm2023.15.1.05

M3 - Article

C2 - 37388755

VL - 15

SP - 38

EP - 50

JO - Современные технологии в медицине

JF - Современные технологии в медицине

SN - 2076-4243

IS - 1

M1 - 5

ER -