Abstract
Aim. To compare the shortand medium-term outcomes of hemiarch and nonhemiarch replacement for ascending aortic aneurysm (AAA).Material and methods. The study included 151 patients with non-syndromic AAA who underwent an elective replacement. Patients were divided into two groups: group 1 (non-hemiarch, n=40) — standard ascending aortic replacement; group 2 (hemiarch, n=111) — ascending aortic replacement with the hemiarch anastomosis in conditions of moderate hypothermia and circulatory arrest with unilateral antegrade cerebral perfusion. To eliminate systematic differences between the compared groups, the propensity score matching (PSM) method was used.Results. Before PSM, there were no significant intergroup differences in the incidence of neurological complications, myocardial infarction, prolonged ventilation, or acute kidney injury. Bleeding-related reoperation rates and hospital mortality significantly differed between groups. After pseudo-randomization between the non-hemiarch and hemiarch groups, there were no significant differences in the incidence of neurological events, myocardial infarction, prolonged ventilation, reoperations for bleeding, acute renal injury, and hospital mortality. Median-term survival and freedom from aortic reoperations also did not show significant intergroup differences.Conclusion. Hemiarch replacement for AAA does not lead to an increase in the incidence of postoperative complications, as well as the risk of shortand mediumterm mortality compared with non-hemiarch.
Highlights
After pseudo-randomization between the non-hemiarch and hemiarch groups, there were no significant differences in the incidence of neurological events, myocardial infarction, prolonged ventilation, reoperations for bleeding, acute renal injury, and hospital mortality
В группе Hemiarch было статистически значимо больше пациентов с тяжелым аортальным стенозом по сравнению с группой nonHemiarch (9,9% vs 5%, p
После propensity score matching (PSM) в группах non-Hemiarch и Hemiarch также не было статистически значимых различий по частоте развития послеоперационного делирия (13,9% vs 3,6%, р=0,219), инфаркта миокарда (ИМ) (8,3% vs 0%, р=0,250), продленной вентиляции легких (13,9% vs 17,9%, р=0,737) и острого повреждения почек (5,6% vs 3,6%, р>0,999), соответственно
Summary
После PSM non-Hemiarch (n=36) 54,5 [49,3;62,3] 29 (80,6) 26,2 [24;30,3] 20 (55,6) 7 (19,4) 3 (8,3) 2 (5,6). Исходно между анализируемыми группами были выявлены статистически значимые различия по выраженности аортального стеноза и регургитации, а также по диаметру дуги аорты. В группе Hemiarch было статистически значимо больше пациентов с тяжелым аортальным стенозом по сравнению с группой nonHemiarch (9,9% vs 5%, p
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