Distal aortic interventions after repair of ascending dissection: The argument for a more aggressive approach Eric E. Roselli, MD, Gabriel Loor, MD,

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Presentation transcript:

Distal aortic interventions after repair of ascending dissection: The argument for a more aggressive approach Eric E. Roselli, MD, Gabriel Loor, MD, Jiayan He, ScD, Aldo E. Rafael, MD, Jeevanantham Rajeswaran, PhD, Penny L. Houghtaling, MS, Lars G. Svensson, MD, PhD, Eugene H. Blackstone, MD, Bruce W. Lytle, MD The Journal of Thoracic and Cardiovascular Surgery Volume 149, Issue 2, Pages S117-S124.e3 (February 2015) DOI: 10.1016/j.jtcvs.2014.11.029 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Subsequent reinterventions after index operation and the competing risk of death without these reinterventions. The Journal of Thoracic and Cardiovascular Surgery 2015 149, S117-S124.e3DOI: (10.1016/j.jtcvs.2014.11.029) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Cumulative number of subsequent reinterventions after the index operation. Each circle represents a reintervention; vertical bars show asymmetric 68% confidence limits equivalent to ±1 standard error. The solid line represents parametric estimates of the cumulative number of reinterventions enclosed within a 68% confidence band. Numbers in parentheses are patients remaining at risk. The Journal of Thoracic and Cardiovascular Surgery 2015 149, S117-S124.e3DOI: (10.1016/j.jtcvs.2014.11.029) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Survival after index operation. Each circle represents a death; vertical bars show asymmetric 68% confidence limits equivalent to ±1 standard error. Solid line represents parametric estimates of survival enclosed within a 68% confidence band. Numbers in parentheses are patients remaining at risk. The Journal of Thoracic and Cardiovascular Surgery 2015 149, S117-S124.e3DOI: (10.1016/j.jtcvs.2014.11.029) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Two superimposed competing-risks analyses illustrating the likelihood of occurrence of subsequent reinterventions or interperiod death without reintervention. Horizontal axis restarts at the time of each successive reintervention. Solid lines represent parametric estimates enclosed within dashed 68% confidence band equivalent to ±1 standard error. Symbols are nonparametric estimates with 68% confidence bars. The Journal of Thoracic and Cardiovascular Surgery 2015 149, S117-S124.e3DOI: (10.1016/j.jtcvs.2014.11.029) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Segmental analyses of aorta. Landmarks for each of 9 segments were: (1) brachiocephalic artery, (2) left common carotid artery, (3) left subclavian artery, (4) proximal descending, (5) mid-descending, (6) supraceliac, (7) renal, (8) infrarenal, and (9) ileofemorals. The Journal of Thoracic and Cardiovascular Surgery 2015 149, S117-S124.e3DOI: (10.1016/j.jtcvs.2014.11.029) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Instantaneous risk (hazard function) of any subsequent reintervention after the index operation. Solid line depicts the parametric estimates of hazard enclosed within dashed 68% confidence bands. The Journal of Thoracic and Cardiovascular Surgery 2015 149, S117-S124.e3DOI: (10.1016/j.jtcvs.2014.11.029) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Six-month and 8-year freedom from first reintervention according to size of the aorta distal to site of repair. This is a nomogram solved for the multivariable equation for a patient who did not undergo an elephant trunk procedure. The Journal of Thoracic and Cardiovascular Surgery 2015 149, S117-S124.e3DOI: (10.1016/j.jtcvs.2014.11.029) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Instantaneous risk (hazard function) of death after first reoperation. Solid line represents parametric estimates of hazard enclosed within a dashed 68% confidence band. The Journal of Thoracic and Cardiovascular Surgery 2015 149, S117-S124.e3DOI: (10.1016/j.jtcvs.2014.11.029) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure E5 Survival after index operation according to site of procedure, demonstrating lower early survival after combined arch and descending aorta procedures. Kaplan–Meier estimates with a symbol at each death; vertical bars represent 68% confidence limits. The Journal of Thoracic and Cardiovascular Surgery 2015 149, S117-S124.e3DOI: (10.1016/j.jtcvs.2014.11.029) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure E6 Survival after index operation. Each symbol represents a Kaplan–Meier nonparametric estimate with 68% confidence limits equivalent to ±1 standard error. The Journal of Thoracic and Cardiovascular Surgery 2015 149, S117-S124.e3DOI: (10.1016/j.jtcvs.2014.11.029) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions