Long-term effectiveness of operations for ascending aortic dissections

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Presentation transcript:

Long-term effectiveness of operations for ascending aortic dissections Joseph F. Sabik, MD, Bruce W. Lytle, MD, Eugene H. Blackstone, MD, Patrick M. McCarthy, MD, Floyd D. Loop, MD, Delos M. Cosgrove, MD The Journal of Thoracic and Cardiovascular Surgery Volume 119, Issue 5, Pages 946-964 (May 2000) DOI: 10.1016/S0022-5223(00)70090-0 Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Cumulative distribution of the interval between onset of symptoms and operation in patients with acute ascending aortic dissection. The vertical axis is the percent of patients with intervals smaller than the values stated on the horizontal axis. The inset shows various percentiles; for clarity, some of these are presented in terms of hours (h) rather than days (d). The Journal of Thoracic and Cardiovascular Surgery 2000 119, 946-964DOI: (10.1016/S0022-5223(00)70090-0) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 Mortality after operations for ascending aortic dissection. A, Overall survival. Each symbol represents a death, positioned according to the Kaplan-Meier estimator. The vertical bars are asymmetric confidence limits of the estimates. Superimposed are parametric survival estimates and their confidence limits (solid line and dashed line, respectively). The inset tabulates the number of patients traced beyond the indicated interval after operation (n) and the parametric survival estimate. B, Hazard function. The Journal of Thoracic and Cardiovascular Surgery 2000 119, 946-964DOI: (10.1016/S0022-5223(00)70090-0) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Survival after operations for ascending aortic dissection stratified by type of repair: resuspension and graft (triangles), aortic valve replacement (AVR) and graft (squares), and composite graft (circles). The nonparametric estimates are presented as in Fig 2. The numbers of patients surviving at 1 year for each of the three types of repair, respectively, were 99, 21, and 32; at 5 years, 43, 11, and 14; and at 10 years, 11, 5, and 3. The Journal of Thoracic and Cardiovascular Surgery 2000 119, 946-964DOI: (10.1016/S0022-5223(00)70090-0) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Survival after operation for ascending aortic dissection, stratified according to the use (squares) or not (circles) of aortic arch replacement with or without distal extension to proximal descending aorta. The nonparametric estimates are presented as in Fig 2. However, because the last death was in the longest-term survivor, Nelson-Aalen estimates are shown. The numbers of patients alive at 1 year for each group, respectively, were 18 and 136; at 5 years, 5 and 63; and at 10 years, 0 and 18. The Journal of Thoracic and Cardiovascular Surgery 2000 119, 946-964DOI: (10.1016/S0022-5223(00)70090-0) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 5 Survival after operations for ascending aortic dissection stratified according to acuity of the dissection (acute, squares; chronic, circles ). The nonparametric estimates are presented as in Fig 2. The Journal of Thoracic and Cardiovascular Surgery 2000 119, 946-964DOI: (10.1016/S0022-5223(00)70090-0) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 6 Freedom from reoperation for aortic valve or proximal aortic problems, stratified by preservation (squares, n = 135) or not (circles, n = 73) of the native aortic valve. Note the expanded vertical axis. The numbers of patients alive without reoperation at 1 year were 97 and 50, respectively; at 5 years, 40 and 23; and at 10 years, 10 and 6. The Journal of Thoracic and Cardiovascular Surgery 2000 119, 946-964DOI: (10.1016/S0022-5223(00)70090-0) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Fig. 7 Freedom from reoperation for distal aortic problems, stratified by completeness (circles, n = 76) or not (squares, n = 132) of distal lumen repair. Note the expanded vertical axis. The numbers of patients alive and without reoperation at 1 year were 94 and 53; at 5 years, 40 and 23; and at 10 years, 9 and 7, respectively. The Journal of Thoracic and Cardiovascular Surgery 2000 119, 946-964DOI: (10.1016/S0022-5223(00)70090-0) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions

Appendix Fig. 1. Trends across time in management of patients with ascending aortic dissection. In these graphs, each circle represents a yearly proportion. The solid line is the continuous probability by logistic regression. A, Proportion of patients whose repair included the composite aortic valve and ascending aortic graft replacement technique. B, Proportion of patients in whom circulatory arrest was used. C, Proportion of patients in whom the aortic arch was replaced. The Journal of Thoracic and Cardiovascular Surgery 2000 119, 946-964DOI: (10.1016/S0022-5223(00)70090-0) Copyright © 2000 American Association for Thoracic Surgery Terms and Conditions