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Published on: December 11, 2017
Long-term survival after open repair of chronic distal aortic dissection
Stefano Zoli1, Christian D Etz, Fabian Roder
1Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA. stefanozoli@gmail.com
Insights
Open repair of chronic distal aortic dissection offers normal survival after one year and a low reoperation rate, demonstrating its efficacy in managing complex aortic conditions.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Disease Management
Background:
- Optimal treatment for chronic distal aortic dissection is debated, with endovascular stent-grafts emerging as an alternative to traditional surgery.
- This study evaluates the outcomes of open surgical repair for chronic distal aortic dissection.
Purpose of the Study:
- To assess the efficacy and long-term outcomes of open surgical repair for chronic distal aortic dissection.
- To identify risk factors associated with adverse outcomes and long-term survival.
Main Methods:
- Retrospective analysis of 104 patients undergoing surgical repair for chronic distal aortic dissection between 1994 and 2007.
- Data collected included patient demographics, indications for surgery, comorbidities, operative details, and outcomes (mortality, morbidity, reoperation rates).
Main Results:
- Hospital mortality was 9.6%, with 4.8% experiencing paraplegia.
- Twenty-six percent had adverse outcomes within one year, associated with atheroma (OR=4.3).
- Ten-year survival was 59%, with freedom from reoperation at 83%; long-term survival was comparable to the general population after one year.
Conclusions:
- Open repair of chronic distal aortic dissection provides excellent long-term survival and a low reoperation rate.
- Atheroma and patient age are significant risk factors for long-term survival after surgical repair.
Background:
The optimal treatment of chronic distal aortic dissection remains controversial, with endovascular stent-graft techniques challenging traditional surgery.
Methods:
From January 1994 to April 2007, 104 patients (82 male, median age 60.5 years) with chronic distal aortic dissection underwent surgical repair, 0 to 21 years after initial diagnosis of acute type A or B dissection (median 2.1 years). Twenty-three (22%) patients underwent urgent-emergent surgery. Mean aortic diameter was 6.9 +/- 1.4 cm. Indications for surgery, other than aortic expansion, were pain in 6 (6%) patients, malperfusion in 6 (6%), and rupture in 11 (11%). Forty-nine (47%) had previous cardioaortic surgery (29% dissection-related), 21 (20%) had coronary artery disease, 12 (12%) had Marfan syndrome, and 4 (4%) were on chronic dialysis. Twenty-six (25%) had a thrombosed false lumen. Thirty (29%) patients required reimplantation of visceral arteries; 8.3 +/- 2.7 segmental artery pairs were sacrificed.
Results:
Hospital mortality was 9.6% (10 patients). Paraplegia occurred in 5 (4.8%). Twenty-seven patients (26%) experienced adverse outcome (death within one year, paraplegia, stroke, or dialysis). Adverse outcome was associated with atheroma (p = 0.04, odds ratio = 4.3). Survival was 78% at 1, 68% at 5, and 59% at 10 years (average follow-up, 7.7 +/- 4.1 years). Freedom from distal aortic reoperation was 99% at 1, 93% at 5, and 83% at 10 years. After one year, patients enjoyed longevity equivalent to a normal age-sex matched population (standardized mortality ratio = 1.38, p = 0.23). By multivariate analysis, atheroma (p = 0.0005, relative risk = 9.32) and age (p = 0.0003, relative risk = 1.15/year) were risk factors for long-term survival.
Conclusions:
The efficacy of open repair for distal chronic dissection is highlighted by normal survival after the first year, and a low reoperation-reintervention rate.
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