Long-term effectiveness of operations for ascending aortic dissections

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Ascending aortic dissection requires tailored surgical management based on pathology.
• Long-term effectiveness of specific aortic root and distal aorta management strategies is crucial.

Purpose of the Study:

• To evaluate the long-term effectiveness of a strategy for managing the aortic root and distal aorta in ascending aortic dissection.
• To assess outcomes based on pathological findings.

Main Methods:

• Analysis of 208 patients (acute and chronic dissection) operated between 1978-1995.
• Surgical strategies included valve resuspension, supracoronary aortic root repair, composite grafts, and valve replacement.
• Arch resection was performed only if the intimal tear involved the arch.

Main Results:

• Hospital mortality was 14%; cardiogenic shock and CABG increased risk, while circulatory arrest decreased risk.
• Long-term survival was 87% (30-day), 68% (5-year), and 52% (10-year).
• Advanced age, earlier operation date, composite grafts, and arch resection were linked to decreased survival; residual distal aorta did not impact survival.

Conclusions:

• Circulatory arrest is associated with low early mortality in ascending aortic dissections.
• Supracoronary repair and valve resuspension are effective long-term for normal sinuses and valves.
• Residual distal dissected aorta does not reduce late survival and has a low risk of complications.