Chronic Type I and Type III aortic dissections: a propensity analysis of outcomes after open distal repair. (2nd March 2018)

• Record Type: Journal Article
• Authors: Preventza, Ourania; Price, Matt D; Amarasekara, Hiruni S; Tullos, Adam; Chen, Peter; Reidy, Michael R; Pattakos, Gregory; de la Cruz, Kim I; Zhang, Qianzi; Coselli, Joseph S
• Is Part Of: European journal of cardio-thoracic surgery. Volume 54:Number 3(2018)
• Page Start: 510
• Page End: 516
• Publication Date: 2018-03-02
• Subjects: Chronic Type I or Type A aortic dissection -- Chronic Type III or Type B aortic dissection -- Outcomes -- Open repair -- Fenestrated or branched endografts for thoraco-abdominal aneurysms; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezy039
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: To compare short-term outcomes, long-term survival and reinterventions in patients requiring surgery after chronic Type I and chronic primary Type III aortic dissections. METHODS: Over an 11-year period, 466 patients underwent thoraco-abdominal aortic aneurysm repair for chronic Type III ( n = 239) and Type I ( n = 227) aortic dissections. Short-term outcomes and reinterventions were evaluated by multivariable regression analysis for the entire group; propensity matching produced 169 pairs. RESULTS: Mortality was 6% ( n = 28) in the overall cohort and 6.2% ( n = 14) and 5.9% ( n = 14) in those with chronic Type I and Type III aortic dissections, respectively. Overall stroke and persistent spinal cord deficit rates were 4.0% and 2.6%, respectively, in the Type I group and 1.3% and 3.8% in the Type III group. In the propensity-matched patients, analysis showed no neurological differences between the 2 groups, but respiratory failure was significantly more frequent in the chronic Type I group (30.2% vs 15.4%; P = 0.001). Multivariable analysis identified chronic Type I dissection as an independent risk factor for postoperative pulmonary complications (odds ratio 1.612; 95% confidence interval 1.060–2.452; P = 0.026) and an association between chronic Type I dissection and stroke (odds ratio 4.013; 95% confidence interval 1.026–15.698; P = 0.046). Six-year survival was 74.4% ± 4.1% and 74.4% ± 4.6% in the chronic Type I and Type III groups, respectively ( P = 0.87). CONCLUSIONS: Short- and long-term mortality and reintervention rates were comparable after open repair for chronic Type I and primary chronic Type III aortic dissections. Respiratory failure was more frequent in the chronic Type I aortic dissection group.