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Long-term outcomes after entry closure and aneurysmal wall plication for type B aortic dissection
Yuji Miyamoto1, Toshihiro Ohata, Masataka Mitsuno
1Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. y-miyamo@hyo-med.ac.jp
Insights
This study evaluated a graft-free surgical technique for chronic aortic dissection, showing excellent short-term results and low long-term morbidity, with no paraplegia. The procedure offers a promising alternative for selected patients, preserving intercostal arteries.
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.
Objective:
To examine the long-term outcomes after entry closure and aneurysmal wall plication for type B chronic dissecting aortic aneurysm. This procedure uses no artificial graft and preserves all intercostal arteries.
Methods:
We reviewed the records of 40 consecutive patients who underwent this procedure between September 1983 and December 2002. The mean age at operation was 60+/-12 years (range, 38-79 years). The mean follow-up period was 9.8+/-5.1 years (range, 4-23 years). Follow-up was completed in 38 patients (95%). The latest computed tomography scans (n=22) were obtained 9.5+/-5.1 years (range, 3-18 years) after surgery.
Results:
There were no operative deaths and 14 late deaths, none of which were related to the aneurysm. No paraplegia or paraparesis occurred. The survival rate was 92+/-4% at 5 years and 64+/-9% at 10 years; 24 patients are still alive. Follow-up computed tomography revealed that the mean diameter of the plicated descending aorta was 31+/-5mm (range, 22-39 mm) except in four patients. One of the four patients required reoperation for recurrent aneurysm of the plicated aorta 3 years postoperatively. In the remaining three patients, the plicated aorta has become enlarged; however, these patients have not yet undergone reoperation. Reoperation for residual dissecting aneurysm was performed in another three patients whose plicated aorta was normal. Freedom from reoperation for residual dissecting aneurysm was 78+/-5% at 10 years.
Conclusions:
This procedure produces excellent short-term outcomes and low long-term morbidity. It could be the procedure of choice in selected patients to prevent paraplegia, although graft replacement is currently the standard treatment for chronic aortic dissecting aneurysm.
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