Background: The approach to acute and chronic type B aortic dissection has changed significantly over the past years. In this aspect, we have reviewed our single-center experience in surgery for type B dissections and compared the current data presented by other centers.
Methods: Twenty-nine patients operated at our center for type B aortic dissection (14 acute, 15 chronic) were reviewed over the years between 1996 and 2004. All patient data in addition to immediate and late outcome following surgery were noted.
Results: The mean age in acute and chronic groups was 53 +/- 16 versus 62 +/- 12 years, respectively (p = 0.1). Hospital mortality was 4 patients. The mean period in the intensive care unit was 4.2 +/- 3.1 days. Follow-up time was 36 +/- 11 months. Median interval between the initial symptoms and surgery was 3.8 days for acute cases. No patients underwent reoperation in acute patients; whereas 3 underwent reoperation in the chronic group. False lumen patency rates in acute and chronic dissections were 16.7% versus 46% after 24 months (p< 0.05). Distal anastomoses included both true and false lumens in 83% of the chronic cases with false lumen patency. The mean reoperation-free survival was 79.35 months with standard error of 5.57 months (95% CI, 68.42 to 90.27) in all patients.
Conclusions: Open surgery in acute type B dissections yielded excellent immediate and long-term durability in our series with no false lumen patency or aortic expansion. However, incorporation of both false and true lumina into distal anastomosis in patients with chronic dissection resulted in false lumen patency with aortic expansion.