Does the technique of distal anastomosis influence clinical outcomes in acute type A aortic dissection?

The purpose of this study was to evaluate clinical outcomes of two different surgical techniques for the repair of acute type A dissection: open distal anastomosis under deep hypothermic circulatory arrest (DHCA) compared with distal aortic clamping on hypothermic cardiopulmonary bypass (ACPB). Between January 2000 and July 2008, 82 patients underwent DHCA and 42 had ACPB. Major morbidity, operative mortality and five-year actuarial survival were compared between groups. There were no significant differences in the preoperative characteristics. Operative mortality (17% in DHCA vs. 21% in ACPB, P=0.63), reoperation for bleeding (20% in DHCA vs. 34% in ACPB, P=0.16) and stroke rates (16 DHCA vs. 24% in ACPB, P=0.33) were comparable between the two groups. Actuarial five-year survival rates were 74% for DHCA vs. 73% for ACPB, P=0.99. No significant differences in operative mortality, major morbidity and actuarial five-year survival were observed between DHCA and ACPB. There are some practical technical advantages if the distal anastomosis is performed in an open manner. More studies are required to determine the fate of the false lumen between the two techniques.