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Original Articles: Cardiovascular

Outcomes and Survival in Surgical Treatment of Descending Thoracic Aorta With Acute Dissection

Cardiovascular Surgery Service, The Texas Heart Institute at St. Luke’s Episcopal Hospital, Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

Accepted for publication November 2, 2007.

^_* Address correspondence to Dr Coselli, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX 77030 (Email: jcoselli{at}bcm.edu).

Presented at the Fifty-third Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 8–11, 2006.

Background: Thoracic aortic replacement for acute DeBakey type III aortic dissection is associated with significant morbidity and mortality. We report the outcomes of 76 consecutive patients who underwent surgical repair of the descending thoracic aorta or the thoracoabdominal aorta for acute dissection.

Methods: During a 16-year period (1989 to 2004), we identified 76 patients who underwent surgery for acute type III aortic dissection. The average patient age was 64.1 ± 12.3 years (range, 36 to 84), and 55 patients (72.4%) were male. Surgical adjuncts included hypothermic circulatory arrest (8 patients), left heart bypass (15 patients), and cerebrospinal fluid drainage (5 patients). The mean aortic clamp time was 38.4 ± 17.3 minutes. Rupture was present in 17 patients (22.4%).

Results: There was 1 intraoperative death. Operative mortality was 22.4% (17 patients), including 11 patients (14.5%) who died within 30 days of operation. Five patients (6.6%) had paraplegia, and 15 patients (19.7%) required hemodialysis, 7 temporarily. Cardiac complications occurred in 33 patients (43.4%), 2 patients (2.6%) were returned to the operating room for bleeding, and 10 patients (13.6%) required tracheostomy. The mean hospital stay was 26.0 ± 29.7 days. Rupture was not associated with increased risk of postoperative complications or operative mortality.

Conclusions: In selected patients with emergent indications, operative intervention with open replacement of the descending thoracic aorta or thoracoabdominal aorta for acute dissection repair can be carried out with respectable mortality, morbidity, and survival rates.

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