Chronic dissection of the ascending aorta: surgical results during a 20-year period (previous surgery excluded)
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Published on: May 14, 2020
Frédérique Jault1, Akhtar Rama, Laurence Lievre
1Department of Cardiovascular and Thoracic Surgery, Hôpital de la Pitié Salpetrière, service du Pr Gandjbakhch, 83 boulevard de l'Hôpital, 75013 Paris, France. frederique.jault@psl.ap-hop-paris.fr
Insights
Surgical outcomes for chronic aortic dissection show that the extent of aortic dissection significantly impacts both in-hospital and long-term survival rates. Broader dissections correlate with higher mortality risks.
Area of Science:
- Cardiovascular Surgery
- Aortic Disease Research
- Surgical Outcomes Analysis
Background:
- Chronic aortic dissection involves a tear in the ascending aorta, often undiagnosed initially.
- Pre-existing conditions like aneurysms, Marfan syndrome, or annuloaortic ectasia can predispose patients.
- Exclusion criteria focused on patients without prior cardiac surgery or proximal aortic repair.
Purpose of the Study:
- To evaluate the surgical results of chronic ascending aorta dissection over a 20-year period.
- To identify risk factors influencing mortality and survival in these patients.
- To analyze the impact of dissection extent on surgical outcomes.
Main Methods:
- A cohort of 77 patients undergoing surgery for chronic ascending aorta dissection between 1981 and 2001 was studied.
- Patients presented with conditions including severe aortic regurgitation, Marfan syndrome, and annuloaortic ectasia.
- Surgical procedures varied, with aortic arch repair in 40 cases, utilizing cerebral perfusion techniques; total aortic replacement in four patients.
Main Results:
- In-hospital mortality was 10%, with dissection extent identified as the sole risk factor.
- Neurologic stroke occurred in 2.5% of patients.
- Late survival at 12 years was 42%, significantly lower for extensive dissections (33%) compared to ascending aorta only (71%).
Conclusions:
- The extent of aortic dissection is a critical determinant of both in-hospital and late mortality.
- In-hospital mortality rates remained consistent throughout the study period.
- Surgical intervention for chronic aortic dissection necessitates careful consideration of the dissection's scope.
Objective:
We study here the surgical results of chronic dissection involving the ascending aorta over the last 20 years. Patients with previous cardiac surgery, or proximal aortic repair, were excluded. The patients survived an acute dissection, undiagnosed as pauci- or asymptomatic. The aorta was normal or pathological (atheromatous aneurysm in 15 cases, Marfan's disease in 12 cases, and annuloectasic disease in 18 cases). Two patients had a bicuspid aortic valve.
Methods:
Between January 1981 and December 2001, 77 patients (mean age 48+/-15) underwent surgery for chronic dissection of the ascending aorta; 60 patients had severe aortic regurgitation, 12 had Marfan syndrome, and 18 had annuloaortic ectasia. Only the ascending aorta was dissected in 37 patients, the ascending aorta and arch in 26, and the whole aorta in 14. Coronary artery disease occurred in five patients. Statistical analysis was performed using SAS software. Different surgical procedures were used. The aortic arch was repaired in 40 cases; selective antegrade cerebral perfusion and partial circulatory arrest were used. Total aortic replacement was performed on four patients.
Results:
In-hospital mortality was 10%. The only risk factor was the extent of the dissection. The rate of neurologic stroke was 2.5%. Late survival rate was 42+/-7.5% at 12 years for all the patients; it was 71+/-10% when only the ascending aorta was dissected, 44+/-11% when the ascending aorta and arch were dissected, and 33+/-15% when the whole aorta was dissected (p = 0.0329). The extent of the dissection was the only risk factor for late mortality. Reoperation was required for one proximal and five distal problems.
Conclusion:
In chronic aortic dissection, in-hospital and late mortality were related to the extent of the dissection; in-hospital mortality remained unchanged during the operative period.
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