AIM: The present study aimed to analyze early and late outcomes after open repair of chronic type B aortic dissection. METHODS: We retrospectively reviewed our cases of open descending thoracic aortic aneurysm (DTAA) with chronic dissection from 1991-2013. Long-term survival and aortic reinterventions were analyzed and patient comorbidities were evaluated in order to determine the risk of adverse outcomes. Furthermore, the technique for "distal first approach" is described. RESULTS: Between 1991 and 2013, 240 (40%) descending thoracic aortic repairs with associated chronic dissection were performed. Mean age is 59 years and 178 (74%) are men. The majority of patients (218, 91%) underwent repair using the adjunct of distal aortic perfusion with cerebral spinal fluid drainage. Early mortality was 8.3% (20/240). Permanent neurologic deficit occurred in 1.3% (3/240). Stroke occurred in 2.9% (7/240), and dialysis on discharge in 6% (12/240). 5-, 10-, 15-, and 20-year survival was 72%, 60%, 45%, and 39%, respectively. Freedom from reoperation on the operated segment was 97%, 94%, 94% and 94% at 5, 10, 15 and 20 years. CONCLUSIONS: Open repairs of chronic descending thoracic dissections can be performed with respectable morbidity and mortality. Risk of neurologic deficit remains low with use of adjuncts, and risk of reintervention on the involved aortic segment is also low. These results allow comparison with endovascular repair for chronic aortic dissection.
AIM: The present study aimed to analyze early and late outcomes after open repair of chronic type B aortic dissection. METHODS: We retrospectively reviewed our cases of open descending thoracic aortic aneurysm (DTAA) with chronic dissection from 1991-2013. Long-term survival and aortic reinterventions were analyzed and patient comorbidities were evaluated in order to determine the risk of adverse outcomes. Furthermore, the technique for "distal first approach" is described. RESULTS: Between 1991 and 2013, 240 (40%) descending thoracic aortic repairs with associated chronic dissection were performed. Mean age is 59 years and 178 (74%) are men. The majority of patients (218, 91%) underwent repair using the adjunct of distal aortic perfusion with cerebral spinal fluid drainage. Early mortality was 8.3% (20/240). Permanent neurologic deficit occurred in 1.3% (3/240). Stroke occurred in 2.9% (7/240), and dialysis on discharge in 6% (12/240). 5-, 10-, 15-, and 20-year survival was 72%, 60%, 45%, and 39%, respectively. Freedom from reoperation on the operated segment was 97%, 94%, 94% and 94% at 5, 10, 15 and 20 years. CONCLUSIONS: Open repairs of chronic descending thoracic dissections can be performed with respectable morbidity and mortality. Risk of neurologic deficit remains low with use of adjuncts, and risk of reintervention on the involved aortic segment is also low. These results allow comparison with endovascular repair for chronic aortic dissection.
Entities:
Keywords:
Chronic type B aortic dissection; distal first approach; open repair
Authors: Anthony L Estrera; Roy Sheinbaum; Charles C Miller; Ryan Harrison; Hazim J Safi Journal: J Thorac Cardiovasc Surg Date: 2010-12 Impact factor: 5.209
Authors: Christoph A Nienaber; Stephan Kische; Hervé Rousseau; Holger Eggebrecht; Tim C Rehders; Guenther Kundt; Aenne Glass; Dierk Scheinert; Martin Czerny; Tilo Kleinfeldt; Burkhart Zipfel; Louis Labrousse; Rossella Fattori; Hüseyin Ince Journal: Circ Cardiovasc Interv Date: 2013-08-06 Impact factor: 6.546
Authors: M E DeBakey; A C Beall; D A Cooley; E S Crawford; G C Morris; H E Garrett; J F Howell Journal: Surg Clin North Am Date: 1966-08 Impact factor: 2.741
Authors: Woong Chol Kang; Roy K Greenberg; Tara M Mastracci; Matthew J Eagleton; Adrian V Hernandez; Akshat C Pujara; Eric E Roselli Journal: J Thorac Cardiovasc Surg Date: 2011-05-05 Impact factor: 5.209
Authors: Stefano Zoli; Christian D Etz; Fabian Roder; Christoph S Mueller; Robert M Brenner; Carol A Bodian; Gabriele Di Luozzo; Randall B Griepp Journal: Ann Thorac Surg Date: 2010-05 Impact factor: 4.330
Authors: Michal Nozdrzykowski; Christian D Etz; Maximilian Luehr; Jens Garbade; Martin Misfeld; Michael A Borger; Friedrich-Wilhelm Mohr Journal: Eur J Cardiothorac Surg Date: 2013-06-12 Impact factor: 4.191
Authors: Salvatore T Scali; Robert J Feezor; Catherine K Chang; David H Stone; Philip J Hess; Tomas D Martin; Thomas S Huber; Adam W Beck Journal: J Vasc Surg Date: 2013-04-03 Impact factor: 4.268
Authors: Lars G Svensson; Nicholas T Kouchoukos; D Craig Miller; Joseph E Bavaria; Joseph S Coselli; Michael A Curi; Holger Eggebrecht; John A Elefteriades; Raimund Erbel; Thomas G Gleason; Bruce W Lytle; R Scott Mitchell; Christoph A Nienaber; Eric E Roselli; Hazim J Safi; Richard J Shemin; Gregorio A Sicard; Thoralf M Sundt; Wilson Y Szeto; Grayson H Wheatley Journal: Ann Thorac Surg Date: 2008-01 Impact factor: 4.330
Authors: Foeke Nauta; Hector de Beaufort; Firas F Mussa; Carlo De Vincentiis; Atsushi Omura; Hitoshi Matsuda; Santi Trimarchi Journal: Ann Cardiothorac Surg Date: 2019-09