Does adding an aortic root replacement or sinus repair during arch repair increase postoperative mortality? Evidence from the Canadian Thoracic Aortic Collaborative
Abstract OBJECTIVES The aim of this study was to examine the effect of the addition of an aortic root replacement or sinus repair on mortality and morbidity during aortic arch repair. METHODS A total of 2472 patients underwent proximal or total aortic arch repair with hypothermic circulatory arres...
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Veröffentlicht in: | European journal of cardio-thoracic surgery 2021-09, Vol.60 (3), p.623-630 |
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creator | Hage, Fadi Hage, Ali Dagenais, Francois Cartier, Andreanne Ouzounian, Maral Chung, Jennifer El-Hamamsy, Ismail Chauvette, Vincent Peterson, Mark D Lachapelle, Kevin Ridwan, Khalid Boodhwani, Munir Guo, Ming Bozinovski, John Moon, Michael C White, Abigail Yamashita, Michael Lodewyks, Carly Atoui, Rony Payne, Darrin Chu, Michael W A |
description | Abstract
OBJECTIVES
The aim of this study was to examine the effect of the addition of an aortic root replacement or sinus repair on mortality and morbidity during aortic arch repair.
METHODS
A total of 2472 patients underwent proximal or total aortic arch repair with hypothermic circulatory arrest between 2002 and 2018 at 12 centres. Multivariable logistic regressions (MV) and propensity score (PS) with inverse probability of treatment weighting (IPTW) analyses were performed.
RESULTS
A total of 1099 (44.5%) patients had additional aortic root replacement (n = 934) or sinus repair (n = 165). Those with aortic root interventions were younger (61 ± 13 vs 64 ± 13 years, P |
doi_str_mv | 10.1093/ejcts/ezab125 |
format | Article |
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OBJECTIVES
The aim of this study was to examine the effect of the addition of an aortic root replacement or sinus repair on mortality and morbidity during aortic arch repair.
METHODS
A total of 2472 patients underwent proximal or total aortic arch repair with hypothermic circulatory arrest between 2002 and 2018 at 12 centres. Multivariable logistic regressions (MV) and propensity score (PS) with inverse probability of treatment weighting (IPTW) analyses were performed.
RESULTS
A total of 1099 (44.5%) patients had additional aortic root replacement (n = 934) or sinus repair (n = 165). Those with aortic root interventions were younger (61 ± 13 vs 64 ± 13 years, P < 0.001) and had less females (23% vs 35%, P < 0.001), less dissection (31% vs 36%, P = 0.004), less urgent cases (35% vs 39%, P = 0.047), more connective tissue disease (7% vs 3%, P < 0.001) and less total arch replacements (14% vs 22%, P < 0.001). On adjusted analyses, the addition of aortic root procedure was associated with increased mortality [MV: odds ratio (OR) 1.41, 95% confidence interval (CI) 1.03–1.92; PS-IPTW: risk increased by 3.7%, 95% CI 1.2–6.3%, P = 0.004]. Reoperation for bleeding was also increased with the addition of aortic root intervention (MV: OR 1.48, 95% 1.10–1.99; PS-IPTW: risk increased by 3.2%, 95% CI 0.8–5.6%, P = 0.009). The risks of stroke and dialysis-dependent renal failure were similar. When looking only at non-elective cases, the increased risk of mortality was more pronounced (MV: OR 1.60, 95% CI 1.11–2.32, P = 0.013; PS-IPTW: risk increased by 6.8%, 95 CI 1.7–11.8%, P = 0.008, and a number need to harm of 15 patients to cause 1 additional death).
CONCLUSIONS
The addition of aortic root replacement or sinus repair during proximal or total aortic arch repair seems to increase postoperative mortality only in non-elective cases.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezab125</identifier><identifier>PMID: 33769490</identifier><language>eng</language><publisher>CARY: Oxford University Press</publisher><subject>Cardiac & Cardiovascular Systems ; Cardiovascular System & Cardiology ; Life Sciences & Biomedicine ; Respiratory System ; Science & Technology ; Surgery</subject><ispartof>European journal of cardio-thoracic surgery, 2021-09, Vol.60 (3), p.623-630</ispartof><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>4</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000697389800026</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c365t-50ee84e1d29ff487771de15ac58b17420c5f0b35239e734523487e9448bb86113</citedby><cites>FETCH-LOGICAL-c365t-50ee84e1d29ff487771de15ac58b17420c5f0b35239e734523487e9448bb86113</cites><orcidid>0000-0003-1318-6273 ; 0000-0002-6699-0938 ; 0000-0002-2772-5816 ; 0000-0003-0487-8059 ; 0000-0002-9872-399X ; 0000-0003-0708-8917 ; 0000-0001-8195-4399</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,1586,27931,27932,39265</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33769490$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hage, Fadi</creatorcontrib><creatorcontrib>Hage, Ali</creatorcontrib><creatorcontrib>Dagenais, Francois</creatorcontrib><creatorcontrib>Cartier, Andreanne</creatorcontrib><creatorcontrib>Ouzounian, Maral</creatorcontrib><creatorcontrib>Chung, Jennifer</creatorcontrib><creatorcontrib>El-Hamamsy, Ismail</creatorcontrib><creatorcontrib>Chauvette, Vincent</creatorcontrib><creatorcontrib>Peterson, Mark D</creatorcontrib><creatorcontrib>Lachapelle, Kevin</creatorcontrib><creatorcontrib>Ridwan, Khalid</creatorcontrib><creatorcontrib>Boodhwani, Munir</creatorcontrib><creatorcontrib>Guo, Ming</creatorcontrib><creatorcontrib>Bozinovski, John</creatorcontrib><creatorcontrib>Moon, Michael C</creatorcontrib><creatorcontrib>White, Abigail</creatorcontrib><creatorcontrib>Yamashita, Michael</creatorcontrib><creatorcontrib>Lodewyks, Carly</creatorcontrib><creatorcontrib>Atoui, Rony</creatorcontrib><creatorcontrib>Payne, Darrin</creatorcontrib><creatorcontrib>Chu, Michael W A</creatorcontrib><creatorcontrib>Canadian Thoracic Aortic</creatorcontrib><creatorcontrib>the Canadian Thoracic Aortic Collaborative</creatorcontrib><title>Does adding an aortic root replacement or sinus repair during arch repair increase postoperative mortality? Evidence from the Canadian Thoracic Aortic Collaborative</title><title>European journal of cardio-thoracic surgery</title><addtitle>EUR J CARDIO-THORAC</addtitle><addtitle>Eur J Cardiothorac Surg</addtitle><description>Abstract
OBJECTIVES
The aim of this study was to examine the effect of the addition of an aortic root replacement or sinus repair on mortality and morbidity during aortic arch repair.
METHODS
A total of 2472 patients underwent proximal or total aortic arch repair with hypothermic circulatory arrest between 2002 and 2018 at 12 centres. Multivariable logistic regressions (MV) and propensity score (PS) with inverse probability of treatment weighting (IPTW) analyses were performed.
RESULTS
A total of 1099 (44.5%) patients had additional aortic root replacement (n = 934) or sinus repair (n = 165). Those with aortic root interventions were younger (61 ± 13 vs 64 ± 13 years, P < 0.001) and had less females (23% vs 35%, P < 0.001), less dissection (31% vs 36%, P = 0.004), less urgent cases (35% vs 39%, P = 0.047), more connective tissue disease (7% vs 3%, P < 0.001) and less total arch replacements (14% vs 22%, P < 0.001). On adjusted analyses, the addition of aortic root procedure was associated with increased mortality [MV: odds ratio (OR) 1.41, 95% confidence interval (CI) 1.03–1.92; PS-IPTW: risk increased by 3.7%, 95% CI 1.2–6.3%, P = 0.004]. Reoperation for bleeding was also increased with the addition of aortic root intervention (MV: OR 1.48, 95% 1.10–1.99; PS-IPTW: risk increased by 3.2%, 95% CI 0.8–5.6%, P = 0.009). The risks of stroke and dialysis-dependent renal failure were similar. When looking only at non-elective cases, the increased risk of mortality was more pronounced (MV: OR 1.60, 95% CI 1.11–2.32, P = 0.013; PS-IPTW: risk increased by 6.8%, 95 CI 1.7–11.8%, P = 0.008, and a number need to harm of 15 patients to cause 1 additional death).
CONCLUSIONS
The addition of aortic root replacement or sinus repair during proximal or total aortic arch repair seems to increase postoperative mortality only in non-elective cases.</description><subject>Cardiac & Cardiovascular Systems</subject><subject>Cardiovascular System & Cardiology</subject><subject>Life Sciences & Biomedicine</subject><subject>Respiratory System</subject><subject>Science & Technology</subject><subject>Surgery</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><recordid>eNqNkctu1TAQhi0EoqWwZIu8REKhviW2V6gK5SJVYlMkdpHjTDiuEjvYTlF5nj5ofZrTsoTVjEbf_HP5EXpNyXtKND-FK5vTKfwxPWX1E3RMleSV5OLH05ITSiqpBTlCL1K6IoQ0nMnn6Ihz2WihyTG6_RggYTMMzv_ExmMTYnYWxxAyjrBMxsIMPuMQcXJ-TfuicREPa7zviHb3UHLeRjAJ8BJSDgtEk9014Lkomsnlmw_4_NoN4C3gMYYZ5x3g1ngzuDL3cheisWXy2bZAG6bJ9GHTeImejWZK8OoQT9D3T-eX7Zfq4tvnr-3ZRWV5U-eqJgBKAB2YHkehpJR0AFobW6ueSsGIrUfS85pxDeVDJRYItBCq71VDKT9BbzfdJYZfK6TczS5ZKJt4CGvqWE0appiQvKDVhtoYUoowdkt0s4k3HSXd3pju3pjuYEzh3xyk136G4ZF-cKIAagN-Qx_GZN3-UY_Y3jotudKqZKxpXS6PCb4Nq8-l9d3_t_49MqzLP5a-Aw0zvQg</recordid><startdate>20210911</startdate><enddate>20210911</enddate><creator>Hage, Fadi</creator><creator>Hage, Ali</creator><creator>Dagenais, Francois</creator><creator>Cartier, Andreanne</creator><creator>Ouzounian, Maral</creator><creator>Chung, Jennifer</creator><creator>El-Hamamsy, Ismail</creator><creator>Chauvette, Vincent</creator><creator>Peterson, Mark D</creator><creator>Lachapelle, Kevin</creator><creator>Ridwan, Khalid</creator><creator>Boodhwani, Munir</creator><creator>Guo, Ming</creator><creator>Bozinovski, John</creator><creator>Moon, Michael C</creator><creator>White, Abigail</creator><creator>Yamashita, Michael</creator><creator>Lodewyks, Carly</creator><creator>Atoui, Rony</creator><creator>Payne, Darrin</creator><creator>Chu, Michael W A</creator><general>Oxford University Press</general><general>Oxford Univ Press</general><scope>95M</scope><scope>AFTVD</scope><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1318-6273</orcidid><orcidid>https://orcid.org/0000-0002-6699-0938</orcidid><orcidid>https://orcid.org/0000-0002-2772-5816</orcidid><orcidid>https://orcid.org/0000-0003-0487-8059</orcidid><orcidid>https://orcid.org/0000-0002-9872-399X</orcidid><orcidid>https://orcid.org/0000-0003-0708-8917</orcidid><orcidid>https://orcid.org/0000-0001-8195-4399</orcidid></search><sort><creationdate>20210911</creationdate><title>Does adding an aortic root replacement or sinus repair during arch repair increase postoperative mortality? Evidence from the Canadian Thoracic Aortic Collaborative</title><author>Hage, Fadi ; Hage, Ali ; Dagenais, Francois ; Cartier, Andreanne ; Ouzounian, Maral ; Chung, Jennifer ; El-Hamamsy, Ismail ; Chauvette, Vincent ; Peterson, Mark D ; Lachapelle, Kevin ; Ridwan, Khalid ; Boodhwani, Munir ; Guo, Ming ; Bozinovski, John ; Moon, Michael C ; White, Abigail ; Yamashita, Michael ; Lodewyks, Carly ; Atoui, Rony ; Payne, Darrin ; Chu, Michael W A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-50ee84e1d29ff487771de15ac58b17420c5f0b35239e734523487e9448bb86113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Cardiac & Cardiovascular Systems</topic><topic>Cardiovascular System & Cardiology</topic><topic>Life Sciences & Biomedicine</topic><topic>Respiratory System</topic><topic>Science & Technology</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hage, Fadi</creatorcontrib><creatorcontrib>Hage, Ali</creatorcontrib><creatorcontrib>Dagenais, Francois</creatorcontrib><creatorcontrib>Cartier, Andreanne</creatorcontrib><creatorcontrib>Ouzounian, Maral</creatorcontrib><creatorcontrib>Chung, Jennifer</creatorcontrib><creatorcontrib>El-Hamamsy, Ismail</creatorcontrib><creatorcontrib>Chauvette, Vincent</creatorcontrib><creatorcontrib>Peterson, Mark D</creatorcontrib><creatorcontrib>Lachapelle, Kevin</creatorcontrib><creatorcontrib>Ridwan, Khalid</creatorcontrib><creatorcontrib>Boodhwani, Munir</creatorcontrib><creatorcontrib>Guo, Ming</creatorcontrib><creatorcontrib>Bozinovski, John</creatorcontrib><creatorcontrib>Moon, Michael C</creatorcontrib><creatorcontrib>White, Abigail</creatorcontrib><creatorcontrib>Yamashita, Michael</creatorcontrib><creatorcontrib>Lodewyks, Carly</creatorcontrib><creatorcontrib>Atoui, Rony</creatorcontrib><creatorcontrib>Payne, Darrin</creatorcontrib><creatorcontrib>Chu, Michael W A</creatorcontrib><creatorcontrib>Canadian Thoracic Aortic</creatorcontrib><creatorcontrib>the Canadian Thoracic Aortic Collaborative</creatorcontrib><collection>Conference Proceedings Citation Index - Science (CPCI-S)</collection><collection>Conference Proceedings Citation Index - Science (CPCI-S) 2021</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hage, Fadi</au><au>Hage, Ali</au><au>Dagenais, Francois</au><au>Cartier, Andreanne</au><au>Ouzounian, Maral</au><au>Chung, Jennifer</au><au>El-Hamamsy, Ismail</au><au>Chauvette, Vincent</au><au>Peterson, Mark D</au><au>Lachapelle, Kevin</au><au>Ridwan, Khalid</au><au>Boodhwani, Munir</au><au>Guo, Ming</au><au>Bozinovski, John</au><au>Moon, Michael C</au><au>White, Abigail</au><au>Yamashita, Michael</au><au>Lodewyks, Carly</au><au>Atoui, Rony</au><au>Payne, Darrin</au><au>Chu, Michael W A</au><aucorp>Canadian Thoracic Aortic</aucorp><aucorp>the Canadian Thoracic Aortic Collaborative</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does adding an aortic root replacement or sinus repair during arch repair increase postoperative mortality? Evidence from the Canadian Thoracic Aortic Collaborative</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><stitle>EUR J CARDIO-THORAC</stitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2021-09-11</date><risdate>2021</risdate><volume>60</volume><issue>3</issue><spage>623</spage><epage>630</epage><pages>623-630</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><abstract>Abstract
OBJECTIVES
The aim of this study was to examine the effect of the addition of an aortic root replacement or sinus repair on mortality and morbidity during aortic arch repair.
METHODS
A total of 2472 patients underwent proximal or total aortic arch repair with hypothermic circulatory arrest between 2002 and 2018 at 12 centres. Multivariable logistic regressions (MV) and propensity score (PS) with inverse probability of treatment weighting (IPTW) analyses were performed.
RESULTS
A total of 1099 (44.5%) patients had additional aortic root replacement (n = 934) or sinus repair (n = 165). Those with aortic root interventions were younger (61 ± 13 vs 64 ± 13 years, P < 0.001) and had less females (23% vs 35%, P < 0.001), less dissection (31% vs 36%, P = 0.004), less urgent cases (35% vs 39%, P = 0.047), more connective tissue disease (7% vs 3%, P < 0.001) and less total arch replacements (14% vs 22%, P < 0.001). On adjusted analyses, the addition of aortic root procedure was associated with increased mortality [MV: odds ratio (OR) 1.41, 95% confidence interval (CI) 1.03–1.92; PS-IPTW: risk increased by 3.7%, 95% CI 1.2–6.3%, P = 0.004]. Reoperation for bleeding was also increased with the addition of aortic root intervention (MV: OR 1.48, 95% 1.10–1.99; PS-IPTW: risk increased by 3.2%, 95% CI 0.8–5.6%, P = 0.009). The risks of stroke and dialysis-dependent renal failure were similar. When looking only at non-elective cases, the increased risk of mortality was more pronounced (MV: OR 1.60, 95% CI 1.11–2.32, P = 0.013; PS-IPTW: risk increased by 6.8%, 95 CI 1.7–11.8%, P = 0.008, and a number need to harm of 15 patients to cause 1 additional death).
CONCLUSIONS
The addition of aortic root replacement or sinus repair during proximal or total aortic arch repair seems to increase postoperative mortality only in non-elective cases.</abstract><cop>CARY</cop><pub>Oxford University Press</pub><pmid>33769490</pmid><doi>10.1093/ejcts/ezab125</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-1318-6273</orcidid><orcidid>https://orcid.org/0000-0002-6699-0938</orcidid><orcidid>https://orcid.org/0000-0002-2772-5816</orcidid><orcidid>https://orcid.org/0000-0003-0487-8059</orcidid><orcidid>https://orcid.org/0000-0002-9872-399X</orcidid><orcidid>https://orcid.org/0000-0003-0708-8917</orcidid><orcidid>https://orcid.org/0000-0001-8195-4399</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Life Sciences & Biomedicine Respiratory System Science & Technology Surgery |
title | Does adding an aortic root replacement or sinus repair during arch repair increase postoperative mortality? Evidence from the Canadian Thoracic Aortic Collaborative |
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