The David Versus the Bentall Procedure for Acute Type A Aortic Dissection
<b>Background</b>: Type A aortic dissection (TAAD) is a life-threatening condition which requires prompt diagnosis and surgical treatment. When TAAD involves the aortic root, aortic valve-sparing or Bentall procedures are the main surgical treatment options. <b>Method:</b> Th...
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2024-11-01
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| author | Fausto Biancari Giorgio Mastroiacovo Mauro Rinaldi Luisa Ferrante Timo Mäkikallio Tatu Juvonen Giovanni Mariscalco Zein El-Dean Matteo Pettinari Javier Rodriguez Lega Angel G. Pinto Andrea Perrotti Francesco Onorati Konrad Wisniewski Till Demal Petr Kacer Jan Rocek Dario Di Perna Igor Vendramin Daniela Piani Eduard Quintana Robert Pruna-Guillen Joscha Buech Caroline Radner Manoj Kuduvalli Amer Harky Antonio Fiore Angelo M. Dell’Aquila Giuseppe Gatti Lenard Conradi Mark Field Arianna Galotta Daniele Fileccia Giuseppe Nanci Sven Peterss |
| author_facet | Fausto Biancari Giorgio Mastroiacovo Mauro Rinaldi Luisa Ferrante Timo Mäkikallio Tatu Juvonen Giovanni Mariscalco Zein El-Dean Matteo Pettinari Javier Rodriguez Lega Angel G. Pinto Andrea Perrotti Francesco Onorati Konrad Wisniewski Till Demal Petr Kacer Jan Rocek Dario Di Perna Igor Vendramin Daniela Piani Eduard Quintana Robert Pruna-Guillen Joscha Buech Caroline Radner Manoj Kuduvalli Amer Harky Antonio Fiore Angelo M. Dell’Aquila Giuseppe Gatti Lenard Conradi Mark Field Arianna Galotta Daniele Fileccia Giuseppe Nanci Sven Peterss |
| author_sort | Fausto Biancari |
| collection | DOAJ |
| description | <b>Background</b>: Type A aortic dissection (TAAD) is a life-threatening condition which requires prompt diagnosis and surgical treatment. When TAAD involves the aortic root, aortic valve-sparing or Bentall procedures are the main surgical treatment options. <b>Method:</b> The subjects of this analysis were 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD). Propensity score matching was performed by estimating a propensity score from being treated with the Bentall or the David procedure using multilevel mixed-effects logistics, considering the cluster effect of the participating hospitals. <b>Results:</b> A Bentall procedure was performed in 862 patients, while a David operation was performed in 139 patients. The proportion of aortic root replacement, as well as the different techniques of aortic root replacement, varied significantly between the participating hospitals (<i>p</i> < 0.001). After propensity score matching, we obtained two groups of 115 patients each, and no statistical differences were reported in terms of postoperative outcomes, except for the rate of dialysis, which was higher in the patients requiring a Bentall procedure (17.4% vs. 7.0%, <i>p</i>-value 0.016). In the unmatched cohorts, the David procedure was associated with a lower 10-year mortality rate compared to the Bentall procedure (30.1% vs. 45.6%, <i>p</i>-value 0.004), but no difference was observed after matching (30.0% vs. 43.9%, <i>p</i>-value 0.082). After 10 years, no differences were observed in terms of proximal aortic reoperation (3.9% vs. 4.1%, <i>p</i>-value 0.954), even after propensity score matching (2.8% vs. 1.8%, <i>p</i>-value 0.994). <b>Conclusions:</b> The David and Bentall procedures are durable treatment methods for TAAD. When feasible, it is advisable that the David procedure is performed for acute TAAD by surgeons with experience with this demanding surgical technique. |
| format | Article |
| id | doaj-art-2e0ff15e8ef24069b4579659a4e5a52f |
| institution | DOAJ |
| issn | 2308-3425 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | MDPI AG |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-2e0ff15e8ef24069b4579659a4e5a52f2025-08-20T02:47:58ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252024-11-01111137010.3390/jcdd11110370The David Versus the Bentall Procedure for Acute Type A Aortic DissectionFausto Biancari0Giorgio Mastroiacovo1Mauro Rinaldi2Luisa Ferrante3Timo Mäkikallio4Tatu Juvonen5Giovanni Mariscalco6Zein El-Dean7Matteo Pettinari8Javier Rodriguez Lega9Angel G. Pinto10Andrea Perrotti11Francesco Onorati12Konrad Wisniewski13Till Demal14Petr Kacer15Jan Rocek16Dario Di Perna17Igor Vendramin18Daniela Piani19Eduard Quintana20Robert Pruna-Guillen21Joscha Buech22Caroline Radner23Manoj Kuduvalli24Amer Harky25Antonio Fiore26Angelo M. Dell’Aquila27Giuseppe Gatti28Lenard Conradi29Mark Field30Arianna Galotta31Daniele Fileccia32Giuseppe Nanci33Sven Peterss34Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, 20138 Milan, ItalyDepartment of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, 20138 Milan, ItalyCardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, ItalyCardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, ItalyDepartment of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, FinlandHeart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, FinlandDepartment of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UKDepartment of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UKDepartment of Cardiac Surgery, Saint Luc Hospital, 1200 Louvain, BelgiumCardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, SpainCardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, SpainDepartment of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25000 Besancon, FranceDivision of Cardiac Surgery, University of Verona Medical School, 37134 Verona, ItalyDepartment of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, GermanyDepartment of Cardiovascular Surgery, University Heart and Vascular Center of Hamburg, 20251 Hamburg, GermanyDepartment of Cardiac Surgery, University Hospital Kralovske Vinohrady, Charles University, 10000 Prague, Czech RepublicDepartment of Cardiac Surgery, University Hospital Kralovske Vinohrady, Charles University, 10000 Prague, Czech RepublicDepartment of Cardiac Surgery, Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, FranceCardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, ItalyCardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, ItalyDepartment of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80336 Munich, GermanyDepartment of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80336 Munich, GermanyLiverpool Heart and Chest Hospital, Liverpool L14 3PE, UKLiverpool Heart and Chest Hospital, Liverpool L14 3PE, UKDepartment of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Créteil, FranceDepartment of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, GermanyDivision of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, ItalyDepartment of Cardiac Surgery, Cologne University Hospital, 50937 Cologne, GermanyLiverpool Heart and Chest Hospital, Liverpool L14 3PE, UKUnit of Biostatistics, Centro Cardiologico Monzino IRCCS, 20138 Milan, ItalyDepartment of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, 20138 Milan, ItalyDepartment of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, 20138 Milan, ItalyDepartment of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80336 Munich, Germany<b>Background</b>: Type A aortic dissection (TAAD) is a life-threatening condition which requires prompt diagnosis and surgical treatment. When TAAD involves the aortic root, aortic valve-sparing or Bentall procedures are the main surgical treatment options. <b>Method:</b> The subjects of this analysis were 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD). Propensity score matching was performed by estimating a propensity score from being treated with the Bentall or the David procedure using multilevel mixed-effects logistics, considering the cluster effect of the participating hospitals. <b>Results:</b> A Bentall procedure was performed in 862 patients, while a David operation was performed in 139 patients. The proportion of aortic root replacement, as well as the different techniques of aortic root replacement, varied significantly between the participating hospitals (<i>p</i> < 0.001). After propensity score matching, we obtained two groups of 115 patients each, and no statistical differences were reported in terms of postoperative outcomes, except for the rate of dialysis, which was higher in the patients requiring a Bentall procedure (17.4% vs. 7.0%, <i>p</i>-value 0.016). In the unmatched cohorts, the David procedure was associated with a lower 10-year mortality rate compared to the Bentall procedure (30.1% vs. 45.6%, <i>p</i>-value 0.004), but no difference was observed after matching (30.0% vs. 43.9%, <i>p</i>-value 0.082). After 10 years, no differences were observed in terms of proximal aortic reoperation (3.9% vs. 4.1%, <i>p</i>-value 0.954), even after propensity score matching (2.8% vs. 1.8%, <i>p</i>-value 0.994). <b>Conclusions:</b> The David and Bentall procedures are durable treatment methods for TAAD. When feasible, it is advisable that the David procedure is performed for acute TAAD by surgeons with experience with this demanding surgical technique.https://www.mdpi.com/2308-3425/11/11/370type A aortic dissectionaortic rootDavid procedureBentall procedure |
| spellingShingle | Fausto Biancari Giorgio Mastroiacovo Mauro Rinaldi Luisa Ferrante Timo Mäkikallio Tatu Juvonen Giovanni Mariscalco Zein El-Dean Matteo Pettinari Javier Rodriguez Lega Angel G. Pinto Andrea Perrotti Francesco Onorati Konrad Wisniewski Till Demal Petr Kacer Jan Rocek Dario Di Perna Igor Vendramin Daniela Piani Eduard Quintana Robert Pruna-Guillen Joscha Buech Caroline Radner Manoj Kuduvalli Amer Harky Antonio Fiore Angelo M. Dell’Aquila Giuseppe Gatti Lenard Conradi Mark Field Arianna Galotta Daniele Fileccia Giuseppe Nanci Sven Peterss The David Versus the Bentall Procedure for Acute Type A Aortic Dissection Journal of Cardiovascular Development and Disease type A aortic dissection aortic root David procedure Bentall procedure |
| title | The David Versus the Bentall Procedure for Acute Type A Aortic Dissection |
| title_full | The David Versus the Bentall Procedure for Acute Type A Aortic Dissection |
| title_fullStr | The David Versus the Bentall Procedure for Acute Type A Aortic Dissection |
| title_full_unstemmed | The David Versus the Bentall Procedure for Acute Type A Aortic Dissection |
| title_short | The David Versus the Bentall Procedure for Acute Type A Aortic Dissection |
| title_sort | david versus the bentall procedure for acute type a aortic dissection |
| topic | type A aortic dissection aortic root David procedure Bentall procedure |
| url | https://www.mdpi.com/2308-3425/11/11/370 |
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