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• W4295903669 abstract "Objectives To evaluate the long-term outcomes of a conservative approach (with proximal aortic replacement with or without hemiarch replacement) versus an aggressive approach (with total aortic arch replacement) in the treatment of acute type A aortic dissection (ATAAD). Methods We performed a pooled analysis of Kaplan–Meier-derived individual patient data from studies with follow-up comparing the aforementioned approaches to treat patients with ATAAD. Results Eighteen studies met our eligibility criteria, comprising 5243 patients with follow-up (Conservative: 3676 patients; Aggressive: 1567 patients). We observed a statistically significant difference in overall survival favoring the aggressive approach (hazard ratios [HR] 0.86, 95% confidence interval [CI] 0.76–0.98, p = .022), but no statistically significant difference in the risk of reoperation (HR 0.89, 95% CI 0.66–1.2, p = .439) in the overall follow-up. Landmark analyses revealed that, in the first 3 months after the procedure, mortality rates were comparable between conservative and aggressive approaches (HR 1.04, 95% CI 0.88–1.24, p = .627), but the results beyond 3 months showed improved survival in patients undergoing the aggressive surgical procedure (HR 0.71, 95% CI 0.59–0.85, p < .001). The landmark analyses also revealed that, in the first 7 years after the procedure, reoperation rates were comparable between the approaches (HR 1.03, 95% CI 0.76–1.40, p = .848), but the results beyond 7 years showed a lower risk of reoperation in patients undergoing the aggressive surgical procedure (HR 0.10, 95% CI 0.01–0.75, p = .025). Conclusion The aggressive approach seems to confer better long-term survival and lower risk of the need for reoperation in the follow-up of patients treated for ATAAD." @default.
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• W4295903669 date "2022-09-10" @default.
• W4295903669 modified "2023-10-18" @default.
• W4295903669 title "Long‐term outcomes of total arch replacement versus proximal aortic replacement in acute type A aortic dissection: Meta‐analysis of Kaplan–Meier‐derived individual patient data" @default.
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• W4295903669 doi "https://doi.org/10.1111/jocs.16852" @default.
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