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General Thoracic and Cardiovascular Surgery

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06-02-2023 | Aortic Aneurysm | Original Article

The effect of adding an open distal anastomosis to proximal aneurysm repairs in bicuspid aortopathy

Authors: Christian Pearsall, Philip M. Allen, Yanling Zhao, Ilya Kim, Casidhe Bethancourt, Diane Hu, Paul A. Kurlansky, Isaac George, Craig R. Smith, Hiroo Takayama

Published in: General Thoracic and Cardiovascular Surgery | Issue 8/2023

Abstract

Objectives

To determine the role of adding open distal anastomosis to proximal aortic aneurysm repairs in bicuspid aortic valve (BAV) patients.

Methods

Retrospective review was performed of 1132 patients at our Aortic Center between 2005 and 2019. Inclusion criteria were all patients diagnosed with a BAV who underwent proximal aortic aneurysm repair with open or clamped distal anastomosis. Exclusion criteria were patients without a BAV, age < 18 years, aortic arch diameter ≥ 4.5 cm, type A aortic dissection, previous ascending aortic replacement, ruptured aneurysm, and endocarditis. Propensity score matching in a 2:1 ratio (220 clamped: 121 open repairs) on 18 variables was performed.

Results

Median follow-up time was 45.6 months (range 7.2–143.4 months). In the matched groups, no significant differences were observed between the respective open and clamped distal anastomosis groups for Kaplan Meier 10-year survival (86.9% vs. 92.9%; p = 0.05) and landmark survival analysis after 1 year (90.6%; vs. 93.3%; p = 0.39). Overall incidence of aortic arch-related reintervention was low (n = 3 total events). In-hospital complications were not significantly different in the open with respect to the clamped repair group, including in-hospital mortality (2.5% vs. 0.5%; p = 0.13) and stroke (0% vs. 0.9%; p = 0.54). In multivariable analysis, open distal anastomosis repair was not associated with long-term mortality (Hazard Ratio (HR) 1.98; p = 0.06).

Conclusion

We found no significant inter-group differences in survival, reintervention, or in-hospital complication rates, with low rates of mortality, and aortic arch-related reintervention, suggesting adding open distal anastomosis may not provide benefit in BAV patients undergoing proximal aortic aneurysm repairs.

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Title: The effect of adding an open distal anastomosis to proximal aneurysm repairs in bicuspid aortopathy
Authors: Christian Pearsall
Philip M. Allen
Yanling Zhao
Ilya Kim
Casidhe Bethancourt
Diane Hu
Paul A. Kurlansky
Isaac George
Craig R. Smith
Hiroo Takayama
Publication date: 06-02-2023
Publisher: Springer Nature Singapore
Keywords: Aortic Aneurysm
Aneurysm
Aortic Aneurysm
Aneurysm
Circulatory Arrest
Published in: General Thoracic and Cardiovascular Surgery / Issue 8/2023
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-023-01907-w

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The effect of adding an open distal anastomosis to proximal aneurysm repairs in bicuspid aortopathy

Abstract

Objectives

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

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