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Ann Thorac Surg 1994;57:820-825
© 1994 The Society of Thoracic Surgeons

Articles

Significance of distal false lumen after type A dissection repair

M.Arisan Ergin, MD, PhD*, Robert A. Phillips, MD, Jan D. Galla, MD, PhD, Steven L. Lansman, MD, PhD, David S. Mendelson, MD, Cid S. Quintana, MD, Randall B. Griepp, MD

Departments of Cardiothoracic Surgery and Radiology, The Mount Sinai Medical Center, New York, New York, USA

* Address reprint requests to Dr Ergin, Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, One Guslave L. Levy Place, Box 1028, New York, NY 10029.

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 ( [equation], 30% versus [equation], 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.




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