Survival and reinterventions after isolated proximal aortic repair in acute type A aortic dissection. (2nd February 2019)

• Record Type: Journal Article
• Authors: Dohle, Daniel-Sebastian; El Beyrouti, Hazem; Brendel, Lena; Pfeiffer, Philipp; El-Mehsen, Mohammed; Vahl, Christian-Friedrich
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 28:Number 6(2019)
• Page Start: 981
• Page End: 988
• Publication Date: 2019-02-02
• Subjects: Aortic dissection -- Reintervention; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivz011
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: Conventional treatment for acute type A dissection is the replacement of the ascending aorta. This study demonstrates the results of a conventional approach with isolated proximal repair combined with concomitant endovascular procedures. METHODS: Replacement of the ascending aorta with or without an open distal anastomosis was defined as isolated proximal repair and was performed in 562/588 patients between January 2004 and June 2017. A total of 68% were DeBakey type I and 32% were DeBakey type II aortic dissections. Concomitant procedures were thoracic endovascular aortic repair (3.6%); visceral, renal and iliac stents (2%); and peripheral bypasses (1.1%). Mean follow-up was 4.6 ± 3.5 years with a 98% follow-up rate. Early and long-term survival, reintervention rates and risk factors were analysed. RESULTS: Overall, the in-hospital mortality rate was 10.7%, 5.6% in DeBakey type II and 13% in DeBakey type I aortic dissection ( P = 0.008). Risk factors for in-hospital mortality were age [odds ratio (OR) 1.03], chronic obstructive lung disease (OR 3.98), coronary artery disease (OR 2.19), Penn class BC (OR 15.41) and cardiopulmonary bypass time (OR 1.01). The 5- and 10-year survival rates, including in-hospital mortality, were 71% and 54% for type I and 73% and 65% for type II aortic dissection, respectively ( P = 0.14). Freedom from reintervention after 5 and 10 years was 96% and 94% for DeBakey type II aortic dissection and 86% and 78% for type I ( P < 0.001). CONCLUSIONS: Combined with concomitant endovascular procedures, good short- and long-term results can be achieved in DeBakey type I and II aortic dissection. The reintervention rate is higher in DeBakey type I but can be managed open and endovascularly with good results.