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Ann Thorac Surg 1999;68:1586-1591
© 1999 The Society of Thoracic Surgeons

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Original Articles

Is distal anastomosis only to the true channel in chronic type B aortic dissection justified?

^a Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan

Address reprint requests to Dr Okita, Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka, Japan 565
e-mail: yokita{at}ncvc.hsp.go.jp

Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.

Background. We investigated long-term outcomes of the distal false lumen of the aorta and aortic branches after distal anastomosis of the graft only to the true lumen in chronic type B aortic dissection.

Methods. From November 1979 until June 1998, we treated 98 patients without Marfan syndrome who had chronic type B aortic dissection and underwent replacement of the descending aorta, 79 of whom had distal anastomosis to the true lumen only. The celiac artery originated from the false lumen in 11 patients, superior mesenteric artery in 5, right renal artery in 19, and left renal artery in 16.

Results. There were 12 (15.1%) early deaths. Spinal cord ischemia was detected in 5 patients. Postoperative follow-up was achieved in 67 patients, and 13 patients died. Postoperative survival at 10 years was 67.6% ± 7.1%. Eight patients had complete occlusion of the distal false lumen, 54 patients had occlusion of the false lumen down to the celiac artery, and 5 patients had a patent false lumen. Four patients required further replacement of the thoracoabdominal aorta.

Conclusions. In non-Marfan patients with chronic type B aortic dissection, the false lumen distal to the graft anastomosis was likely to be thrombosed when the graft was anastomosed to the true lumen only. Postoperative visceral circulation was not compromised, but spinal cord ischemia is a problem that remains to be solved.

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