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Article Dans Une Revue Journal of Cardiovascular Surgery Année : 2023

Aortic dissection: results of the invasive treatment in France between 2012 and 2018 according to the French national database

Résumé

BACKGROUND: To evaluate results of the invasive repair in the management of acute aortic dissection (AoD) in France. METHODS: Patients admitted to hospital with acute AoD from 2012 to 2018 were identified. Patient demographics, severity score at admission, treatment strategy and in-hospital mortality were described. For patients undergoing intervention, perioperative complications rate was reported. A secondary analysis evaluating patients’ outcome as regards of the annual caseload per center was conducted. RESULTS: Overall, 14,706 patients with acute AoD were identified (male 64%, mean age 67, median modified Elixhauser score 5). The overall incidence increased during the study period (from 3.8 in 2012 to 4.4/100,000 in 2018) associated with a North-South gradient (respectively 3.6 vs. 4.7/100,000) and a winter peak; 45.5% (N.=6697) of patients received medical treatment alone. Among those with invasive repair, 6276 (78.3%) were defined as type A AoD (TAAD), whereas type B AoD (TBAD) accounted for 1733 patients (21.7%), of whom 1632 (94%) had TEVAR and 101 (6%) had other arterial procedures; 30-day mortality was respectively 18.9% in TAAD and 9.5% for TBAD. In high-volume centers (i.e. >20 AoD/year), a lower 3-month mortality of 22.3% was noted compared to 31.4% in the low-volume centres (P<0.001); 47% of patients reported ≥1 early major complication. TEVAR exhibited less complication (P<0.001) compared to other arterial reconstructions in TBAD. CONCLUSIONS: The incidence of acute AoD increased in France over the period of the study and was associated with stable postoperative early mortality. Early postoperative mortality is significantly reduced in high-volume centers.
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hal-04477216 , version 1 (26-02-2024)

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Anais Lejot, Guillaume Ledieu, Xavier Lenne, Amelie Bruandet, Pascal Delsart, et al.. Aortic dissection: results of the invasive treatment in France between 2012 and 2018 according to the French national database. Journal of Cardiovascular Surgery, 2023, Journal of Cardiovascular Surgery, 64, ⟨10.23736/S0021-9509.23.12570-5⟩. ⟨hal-04477216⟩

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