Long-term outcomes after entry closure and aneurysmal wall plication for type B aortic dissection

Area of Science:

• Cardiovascular Surgery
• Thoracic Aortic Aneurysms
• Minimally Invasive Techniques

Background:

• Chronic type B aortic dissection poses significant management challenges.
• Traditional treatments often involve synthetic grafts, carrying inherent risks.
• Preserving intercostal arteries is crucial for preventing spinal cord ischemia.

Purpose of the Study:

• To assess long-term outcomes of a novel surgical approach for type B chronic aortic dissection.
• To evaluate a technique involving entry closure and aneurysmal wall plication without artificial grafts.
• To determine the efficacy in preventing paraplegia and preserving vital arteries.

Main Methods:

• Retrospective review of 40 consecutive patients undergoing entry closure and wall plication (Sept 1983 - Dec 2002).
• Mean follow-up of 9.8 years, with 95% completion.
• Long-term assessment via computed tomography scans.

Main Results:

• No operative deaths; 14 late deaths, none aneurysm-related.
• Zero incidence of paraplegia or paraparesis.
• 10-year survival rate of 64%; 78% freedom from reoperation for residual dissection at 10 years.

Conclusions:

• Entry closure and aneurysmal wall plication demonstrate excellent short-term and low long-term morbidity.
• This graft-free procedure is a viable option for selected patients, potentially preventing paraplegia.
• It represents an alternative to graft replacement for chronic aortic dissection, preserving intercostal arteries.