Comparison of outcomes in DeBakey type I versus DeBakey type II aortic dissection: a 17-year single center experience

Abstract Background The DeBakey classification divides Stanford acute type A aortic dissection (ATAAD) into DeBakey type I (D1) and type II (D2) according to the extent of acute aortic dissection (AAD). This retrospective study aimed to compare the early and late outcomes of D1-AAD and D2-AAD through a propensity score-matched analysis. Methods Between January 2009 and April 2020, 599 consecutive patients underwent ATAAD repair at our institution, and were dichotomized into D1 (n = 543; 90.7%) and D2 (n = 56; 9.3%) groups. Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 56 patients per group. The clinical features, postoperative complications, 5-year cumulative survival and freedom from reoperation rates were compared. Results In the overall cohort, the D1 group had a lower rate of preoperative shock and more aortic arch replacement with longer cardiopulmonary bypass time. The D1 group had a higher in-hospital mortality rate than the D2 group in overall (15.8% vs 5.4%; P = 0.036) and matched cohorts (19.6% vs 5.4%; P = 0.022). For patients that survived to discharge, the D1 and D2 groups demonstrated similar 5-year survival rates in overall (77.0% vs 85.2%; P = 0.378) and matched cohorts (79.1% vs 85.2%; P = 0.425). The 5-year freedom from reoperation rates for D1 and D2 groups were 80.0% and 97.1% in overall cohort (P = 0.011), and 93.6% and 97.1% in matched cohort (P = 0.474), respectively. Conclusions Patients with D1-AAD had a higher risk of in-hospital mortality than those with D2-AAD. However, for patients who survived to discharge, the 5-year survival rates were comparable between both groups.

Download Full-text

A Long-Time Follow-Up Study of a Single-Center Endovascular Aneurysm Repair (Evar) Endoleak Outcomes

Vascular and Endovascular Surgery ◽

10.1177/1538574418779667 ◽

2018 ◽

Vol 52 (7) ◽

pp. 505-511 ◽

Cited By ~ 4

Author(s):

Rosa Marie Andersen ◽

Daniel P. Henriksen ◽

Hossein Mohit Mafi ◽

Sten Langfeldt ◽

Jacob Budtz-Lilly ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Plasma Creatinine ◽

National Database ◽

Type I ◽

Type Ii ◽

Single Center ◽

Iliac Arteries ◽

Internal Iliac ◽

Aneurysm Repair

Purpose: The aim of this study was to evaluate the incidence, risk factors, and outcome of endoleaks related to endovascular aneurysm repair (EVAR) procedure at a single center with up to 10 years’ surveillance. Materials and Methods: All patients treated with EVAR for an abdominal aorta or iliac aneurysm in a 10-year period at a single cardiovascular center in Denmark were included. Data were collected from a national database and patient journals. Follow-up computed tomography angiography and plain abdominal X-ray reports were reviewed. Results: A total of 421 patients were included. There were 125 endoleaks observed in 117 (27.8%) patients after a median 95 days (interquartile range: 90-106 days). There were 16 type I, 107 type II, 1 type III, and 1 type V endoleaks. A total of 33 (7.8%) patients had at least 1 reintervention. Patients with type II endoleaks had significantly fewer active smokers and lower plasma creatinine at baseline. They also more often had one, or both, internal iliac arteries embolized as well as an identified endoleak at the procedural completion angiogram. Non-type II endoleaks were associated with internal iliac artery embolization. There was no association between the occurrence of endoleaks and increased mortality. Conclusion: Type II endoleaks are common after EVAR, yet few lead to reintervention. Absence of smoking, low plasma creatinine, embolized iliac arteries, and endoleak on completion angiogram were associated with type II endoleaks, whereas only embolized iliac arteries were associated with non-type II endoleaks. Overall, endoleaks are not associated with increased mortality.

Download Full-text

Outcomes of Patients with Acute Type B Aortic Dissection – A 15-Years, Single-Center Experience

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.06.507 ◽

2019 ◽

Vol 58 (6) ◽

pp. e7

Author(s):

Elsa Faure ◽

Pierre Alric

Keyword(s):

Aortic Dissection ◽

Acute Type ◽

Type B ◽

Single Center ◽

Type B Aortic Dissection ◽

Single Center Experience

Download Full-text

P93 BELSEY MARK IV: STILL A VALID OPTION. SINGLE CENTER EXPERIENCE OF 100 CONSECUTIVE CASES

Diseases of the Esophagus ◽

10.1093/dote/doz092.93 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Ovaere Sander ◽

Depypere Lieven ◽

Van Veer Hans ◽

Nafteux Philippe ◽

Coosemans Willy

Keyword(s):

Recurrence Rate ◽

Antireflux Surgery ◽

Clinical Symptoms ◽

Antireflux Procedure ◽

Barium Swallow ◽

Type I ◽

Single Center ◽

Respiratory Complications ◽

Single Center Experience ◽

Belsey Mark Iv

Abstract Aim To share the single-center experience of a tertiary referral center using the Belsey Mark IV operation in the treatment of large primary hiatal hernias (PHH) and recurrent hernias after failed antireflux surgery. Background & Methods We conducted a retrospective analysis of all patients with PHH or recurrent hernia after antireflux surgery operated between May 1, 2012 and December 31, 2016 who received a Belsey-Mark IV antireflux procedure. Data on patient demographics, surgical history, pre-operative work-up, indication, short- and long-term complications graded by the Clavien-Dindo classification (CDC) and recurrence rate, defined as clinical symptoms confirmed with barium swallow test, were collected and analyzed. Results A total of 100 consecutive cases were included in this analysis. Median age at time of surgery was 67 years (range 0 - 86). Seventy-two were female. Indications were: PHH Type I (n = 2), Type II (n = 1); Type III (n = 55), Type IV (n = 3), redo after previous antireflux surgery (n = 39). Median follow-up was 23 months (range 4-80). Major peri-operative short-term morbidity (defined as CDC 3-4) was present in 14 cases, with respiratory complications being the most prevalent. Fundoplication leakage was present in five cases and managed conservatively in three of those. Hernia recurrence rate was 31% in the redo group (12/39) and 10% in the PHH group (6/61). Median time-to-recurrence was 22 months (range 2-78). Post thoracotomy pain syndrome requiring treatment (CDC 2) was present in 12 cases. One patient deceased due to respiratory complications after emergency Belsey Mark IV repair following early recurrence after laparoscopic Nissen fundoplication and two reinterventions. Conclusion The Belsey Mark IV repair is a safe and effective procedure in experienced hands, with well-defined risks and an acceptable recurrence rate, given the nature of the condition and patient’s comorbidities.

Download Full-text