Fate of the residual distal and proximal aorta after acute type a dissection repair using a contemporary surgical reconstruction algorithm

Ann Thorac Surg. 2007 Dec;84(6):1955-64; discussion 1955-64. doi: 10.1016/j.athoracsur.2007.07.017.

Abstract

Background: In this study, we evaluated the long-term results of our contemporary, standardized surgical management algorithm for repair of acute type A aortic dissections. Prior reports have analyzed heterogeneous techniques and populations.

Methods: From 1993 to 2004, 221 consecutive patients underwent repair of acute type A aortic dissection at our aortic center. Hemiarch repair was performed in 97.7% (216 of 221), and total arch in 2.3% (5 of 221). Of these, 72.9% (161 of 221) underwent aortic valve resuspension, and 27.1% (60 of 221) had aortic root replacement.

Results: In-hospital mortality for a primary operation was 12.7% (28 of 221). Actuarial survival was 79.2% at 1 year, 62.8% at 5 years, and 46.3% at 10 years. Significant risk factors for decreased survival included prior stroke, cerebral malperfusion, and length of cardiopulmonary bypass. Freedom from proximal reoperation after aortic valve resuspension was 94.6% at 5 years and 76.8% at 10 years, with cardiac malperfusion as the main risk factor. Freedom from distal reoperation was 87.6% at 5 years and 76.4% at 10 years, with Marfan syndrome, age, and extent of dissection as significant risk factors for reoperation. In-hospital mortality was 18.2% (2 of 11) after proximal reoperation and 31.2% (5 of 16) after distal reoperation.

Conclusions: We report improved long-term durability of our proximal root repair, with cardiac malperfusion as a significant risk factor. Marfan disease, younger age, and DeBakey type I dissection are risk factors for distal reoperation. To further improve long-term outcome, means to prevent progression of distal aortic disease need to be developed.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Aorta / surgery*
  • Aortic Aneurysm / mortality
  • Aortic Aneurysm / surgery*
  • Aortic Dissection / mortality
  • Aortic Dissection / surgery*
  • Aortic Valve / surgery
  • Echocardiography, Transesophageal
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Reoperation