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Original Articles: Cardiovascular

Fate of the Residual Distal and Proximal Aorta After Acute Type A Dissection Repair Using a Contemporary Surgical Reconstruction Algorithm

^a Division of Cardiothoracic Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
^b Cardiovascular Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania

Accepted for publication July 9, 2007.

^_* Address correspondence to Dr Pochettino, Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104-4283 (Email: alberto.pochettino{at}uphs.upenn.edu).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: In this study, we evaluated the long-term results of our contemporary, standardized surgical management algorithm for repair of acute type A aortic dissections. Prior reports have analyzed heterogeneous techniques and populations.

Methods: From 1993 to 2004, 221 consecutive patients underwent repair of acute type A aortic dissection at our aortic center. Hemiarch repair was performed in 97.7% (216 of 221), and total arch in 2.3% (5 of 221). Of these, 72.9% (161 of 221) underwent aortic valve resuspension, and 27.1% (60 of 221) had aortic root replacement.

Results: In-hospital mortality for a primary operation was 12.7% (28 of 221). Actuarial survival was 79.2% at 1 year, 62.8% at 5 years, and 46.3% at 10 years. Significant risk factors for decreased survival included prior stroke, cerebral malperfusion, and length of cardiopulmonary bypass. Freedom from proximal reoperation after aortic valve resuspension was 94.6% at 5 years and 76.8% at 10 years, with cardiac malperfusion as the main risk factor. Freedom from distal reoperation was 87.6% at 5 years and 76.4% at 10 years, with Marfan syndrome, age, and extent of dissection as significant risk factors for reoperation. In-hospital mortality was 18.2% (2 of 11) after proximal reoperation and 31.2% (5 of 16) after distal reoperation.

Conclusions: We report improved long-term durability of our proximal root repair, with cardiac malperfusion as a significant risk factor. Marfan disease, younger age, and DeBakey type I dissection are risk factors for distal reoperation. To further improve long-term outcome, means to prevent progression of distal aortic disease need to be developed.

This article has been cited by other articles:

				T. M. Sundt III, T. A. Orszulak, D. J. Cook, and H. V. Schaff Improving Results of Open Arch Replacement Ann. Thorac. Surg., September 1, 2008; 86(3): 787 - 796. [Abstract] [Full Text] [PDF]

				W. Y. Szeto Invited commentary. Ann. Thorac. Surg., July 1, 2008; 86(1): 101 - 102. [Full Text] [PDF]