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The Annals of Thoracic Surgery, Vol 57, 820-824, Copyright © 1994 by The Society of Thoracic Surgeons
MA Ergin, RA Phillips, JD Galla, SL Lansman, DS Mendelson, CS Quintana and RB Griepp
Fifty-eight patients underwent repair of acute type A dissection between
1986 and 1992. Follow-up aortogram, computed tomographic scan with
contrast, magnetic resonance imaging scan, or a combination of these tests
was available in 38 patients with preoperatively patent distal false
lumens. All distal anastomoses were constructed with the open technique
during a period of circulatory arrest. There were 25 suture and 13
intraluminal graft anastomoses. Patency of the distal false lumen was found
in 47.3%. Use of the intraluminal graft for the distal anastomosis
decreased patency, although not significantly (4/13, 30% versus 14/25, 56%;
p = 0.14). The direction of flow into the false lumen was antegrade in 11
of 24 (45.8%) of sutured anastomoses and 0 of 9 intraluminal graft
anastomoses (p < 0.01). Actuarial survival at 5 years for patients with
closed distal false lumen was 95% +/- 4.8% versus 76% +/- 15% for patients
with patency of the distal false lumen (p = not significant). Event-free
survival at 5 years for both groups was 84% +/- 8.3% (closed false lumen)
and 63% +/- 13.5% (patency of distal false lumen; p = not significant).
This experience indicates that in the treatment of acute type A
dissections, operative strategy and anastomotic technique play a role in
reducing the incidence of patency and related complications of the distal
false lumen.
ARTICLES
Significance of distal false lumen after type A dissection repair
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY 10029.
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J. I. Fann, J. A. Smith, D. C. Miller, R. S. Mitchell, K. A. Moore, G. Grunkemeier, E. B. Stinson, P. E. Oyer, B. A. Reitz, and N. E. Shumway Surgical Management of Aortic Dissection During a 30-Year Period Circulation, November 1, 1995; 92(9): 113 - 121. [Abstract] [Full Text]
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