{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T07:03:21Z","timestamp":1775113401232,"version":"3.50.1"},"reference-count":33,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2022,7,21]],"date-time":"2022-07-21T00:00:00Z","timestamp":1658361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(1) Background: We sought to analyze and compare the outcomes in terms of early and late mortality and freedom from a redo operation in patients undergoing surgical treatment for a type A acute aortic dissection in relation to the initial surgical treatment strategy, i.e., proximal or distal extension of the aortic segment resection, compared with isolated resection of the supracoronary ascending aorta. (2) Methods: This is a retrospective study in which we included 269 patients who underwent operations for a type A acute aortic dissection in the Department of Cardiac Surgery of Tor Vergata University from May 2006 to May 2016. The patients were grouped according to the extent of the performed surgical treatment: isolated replacement of the supracoronary ascending aorta (NE, no extension), replacement of the aortic root (PE, proximal extension), replacement of the aortic arch (DE, distal extension), and both (BE, bilateral extension). The analyzed variables were in-hospital mortality, postoperative complications (incidence of neurological damage, renal failure and need for prolonged intubation), late mortality and need for a redo operation. (3) Results: Unilateral cerebral perfusion was performed in 49.3% of the patients, and bilateral perfusion\u2014in 50.6%. The overall in-hospital mortality was 31.97%. In the multivariate analysis, advanced age, cardiopulmonary bypass time and preoperative orotracheal intubation were independent predictors of in-hospital mortality. In the population of patients who survived the surgery, the probability of survival at 92 months was 70 \u00b1 5%, the probability of freedom from a redo operation was 71.5 \u00b1 5%, the probability of freedom from the combined end-point death and a redo operation was 50 \u00b1 5%. The re-intervention rate in the general population was 16.9%. The overall probability of freedom from re-intervention was higher in patients undergoing aortic root replacement, although not reaching a level of statistical significance. Patients who underwent aortic arch treatment showed reduced survival. (4) Conclusions: In the treatment of type A acute aortic dissection, all the surgical strategies adopted were associated with satisfactory long-term survival. In the group of patients in which the aortic root had not been replaced, we observed reduced event-free survival.<\/jats:p>","DOI":"10.3390\/ijerph19148878","type":"journal-article","created":{"date-parts":[[2022,7,21]],"date-time":"2022-07-21T22:38:50Z","timestamp":1658443130000},"page":"8878","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Initial Surgical Strategy for the Treatment of Type A Acute Aortic Dissection: Does Proximal or Distal Extension of the Aortic Resection Influence the Outcomes?"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3328-134X","authenticated-orcid":false,"given":"Carlo","family":"Bassano","sequence":"first","affiliation":[{"name":"Cardiac Surgery Unit, Department of Surgery, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Pugliese","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Sant\u2019Anna Hospital, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Mve Mvondo","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Sant\u2019Anna Hospital, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6488-1965","authenticated-orcid":false,"given":"Calogera","family":"Pisano","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Surgery, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4005-3110","authenticated-orcid":false,"given":"Paolo","family":"Nardi","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Surgery, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dario","family":"Buioni","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Surgery, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Bertoldo","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Surgery, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattia","family":"Scognamiglio","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Surgery, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro C.","family":"Salvati","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Surgery, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Altieri","sequence":"additional","affiliation":[{"name":"Cardiology Unit of the Cardiac Surgery Division, Tor Vergata University Polyclinic, Viale Oxford 81, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Ruvolo","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Surgery, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.jtcvs.2009.11.014","article-title":"Role of age in acute type A aortic dissection outcome: Report from the International Registry of Acute Aortic Dissection (IRAD)","volume":"140","author":"Trimarchi","year":"2010","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_2","first-page":"I350","article-title":"International Registry of Acute Aortic Dissection. Long-term survival in patients presenting with type A acute aortic 48 dissection: Insights from the international registry of acute aortic dissection","volume":"114","author":"Tsai","year":"2006","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"275","DOI":"10.21037\/acs.2016.05.05","article-title":"Evolution of surgical therapy for Stanford acute type A aortic dissection","volume":"5","author":"Chiu","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.acvd.2010.11.009","article-title":"Fate of the distal aorta after surgical repair of acute DeBakey type I aortic dissection: A review","volume":"104","author":"Kirsch","year":"2011","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.jvs.2016.03.427","article-title":"Improving mortality trends for hospitalization of aortic dissection in the National Inpatient Sample","volume":"64","author":"Zimmerman","year":"2016","journal-title":"J. Vasc. Surg."},{"key":"ref_6","first-page":"580","article-title":"Surgery for type A aortic dissection: Long-term results and risk factor analysis","volume":"8","author":"Nardi","year":"2007","journal-title":"G. Ital. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1016\/j.athoracsur.2007.07.017","article-title":"Fate of the Residual Distal and Proximal Aorta After Acute Type A Dissection Repair Using a Contemporary Surgical Reconstruction Algorithm","volume":"84","author":"Geirsson","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.athoracsur.2009.11.054","article-title":"Fate of false lume after combined surgical and endovascular repair treating Stanford Type A aortic dissection","volume":"89","author":"Gorlitzer","year":"2010","journal-title":"Ann. Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.21037\/jtd.2018.03.67","article-title":"Cold crystalloid versus warm blood cardioplegia in patients undergoing aortic valve replacement","volume":"10","author":"Nardi","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1016\/j.jtcvs.2013.12.022","article-title":"The impact of unilateral versus bilateral antero-grade cerebral perfusion on surgical outcomes after aortic arch replacement: A propensity-matched analysis","volume":"147","author":"Zierer","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1093\/ejcts\/ezv356","article-title":"Mortality in patients with acute aortic dissection type A: Analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA)","volume":"49","author":"Conzelmann","year":"2015","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_12","first-page":"67","article-title":"Surgical \u201celephant trunk\u201d arch replacement with a branched arch prosthesis: Two alternative operative techniques","volume":"18","author":"Bassano","year":"2021","journal-title":"Pol. J. Thorac. Cardiovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1016\/j.athoracsur.2012.10.012","article-title":"Single cannulation, bilateral brain perfusion","volume":"95","author":"Bovio","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1055\/s-0032-1333135","article-title":"Bilateral Cerebral Perfusion via Right Axillary Artery Cannulation Alone in Aortic Arch Surgery","volume":"61","author":"Mvondo","year":"2013","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/S1010-7940(01)00660-1","article-title":"Mid-term follow-up of aortic root re-modelling compared to Bentall operation","volume":"19","author":"Bassano","year":"2001","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_16","first-page":"1","article-title":"The effects of DeBakey type acute aortic dissection and preoperative peripheral and cardiac malperfusion on the outcomes after surgical repair","volume":"18","author":"Nardi","year":"2021","journal-title":"Pol. J. Thorac. Cardiovasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1016\/j.jtcvs.2013.10.058","article-title":"Early and midterm outcomes of hemiarch repair combined with stented elephant trunk in the management of acute DeBakey type I aortic dissection: Comparison with total arch repair","volume":"148","author":"Shi","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/S0003-4975(01)03449-X","article-title":"Acute type A dissection: Conservative methods provide consistently low mortality","volume":"73","author":"Westaby","year":"2002","journal-title":"Ann. Thorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/S0003-4975(02)04378-3","article-title":"Hacker. Is Extended Aortic Replacement in Acute Type A Dissection Justifiable?","volume":"75","author":"Urbanski","year":"2003","journal-title":"Ann. Thorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.athoracsur.2015.02.041","article-title":"Total Arch Replacement Versus More Conservative Management in Type A Acute Aortic Dissection","volume":"100","author":"Berretta","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/S0022-5223(00)70136-X","article-title":"Extended total arch replacement for acute type a aortic dissection: Experience with seventy patients","volume":"119","author":"Kazui","year":"2000","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1093\/ejcts\/ezt493","article-title":"Antegrade stenting of the descending thoracic aorta during DeBakey type 1 acute aortic dissection repair","volume":"45","author":"Castrovinci","year":"2014","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.ejcts.2008.09.034","article-title":"Total arch replacement with an open stent graft for acute type A aortic dissection: Fate of the false lumen","volume":"35","author":"Uchida","year":"2009","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/S0002-9149(00)01108-5","article-title":"Evolution of aortic dissection after surgical repair","volume":"86","author":"Fattori","year":"2000","journal-title":"Am. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.athoracsur.2007.03.084","article-title":"Aortic Enlargement and Late Reoperation After Repair of Acute Type a Aortic Dissection","volume":"84","author":"Zierer","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1016\/j.jtcvs.2007.07.067","article-title":"Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: A risk factor analysis for adverse outcome in 501 patients","volume":"135","author":"Khaladj","year":"2008","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/S1010-7940(98)00310-8","article-title":"Arch and descending aortic aneurysms: Influence of perfusion technique on neurological outcome1","volume":"15","author":"Westaby","year":"1999","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"346","DOI":"10.21037\/acs.2016.05.10","article-title":"IRAD expe-rience on surgical type A acute dissection patients: Results and predictors of mortality","volume":"5","author":"Berretta","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_29","first-page":"435","article-title":"Outcome after surgery for acute aortic dissection type A in patients over 70 years: Data analysis from the German Registry for Acute Aortic Dissection Type A (GERAADA)","volume":"40","author":"Rylski","year":"2011","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1016\/j.athoracsur.2014.01.045","article-title":"Surgical Outcomes of Acute Type A Aortic Dissection in Elderly Patients","volume":"97","author":"Komatsu","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Vendramin, I., Lechiancole, A., Piani, D., Sponga, S., Di Nora, C., Muser, D., Bortolotti, U., and Livi, U. (2021). An Integrated Approach for Treatment of Acute Type a Aortic Dissection. Medicina, 57.","DOI":"10.3390\/medicina57111155"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1161\/CIRCULATIONAHA.107.702720","article-title":"Aortic diameter > or = 5.5 cm is not a good predictor of type A aortic dis-section: Observations from the International Registry of Acute Aortic Dissection (IRAD)","volume":"116","author":"Pape","year":"2007","journal-title":"Circulation"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/14\/8878\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:55:56Z","timestamp":1760140556000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/14\/8878"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,21]]},"references-count":33,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["ijerph19148878"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19148878","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,21]]}}}