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Published on: July 23, 2009
Open repair of chronic complicated type B aortic dissection using the open distal technique
Anthony L Estrera1, Harleen Sandhu1, Rana O Afifi1
1Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Houston Medical School, Memorial Hermann Hospital, Houston, Texas, USA.
Insights
Open repair of chronic type B aortic dissection offers acceptable early and late outcomes. Adjuncts like distal perfusion and CSF drainage minimize neurologic risks, with low reintervention rates for descending thoracic aortic aneurysms.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease Management
Background:
- Chronic type B aortic dissection presents complex therapeutic challenges.
- Open repair remains a viable option for descending thoracic aortic aneurysms (DTAA) with chronic dissection.
Purpose of the Study:
- To evaluate early and late outcomes of open repair for chronic type B aortic dissection.
- To identify risk factors for adverse outcomes in these patients.
- To describe the "distal first approach" technique.
Main Methods:
- Retrospective review of 240 open DTAA repairs with chronic dissection (1991-2013).
- Analysis of long-term survival and reintervention rates.
- Evaluation of patient comorbidities and use of adjuncts like distal aortic perfusion and cerebrospinal fluid drainage.
Main Results:
- Mean patient age was 59 years, with 74% males.
- Early mortality was 8.3%; permanent neurologic deficit was 1.3%.
- Long-term survival at 5, 10, 15, and 20 years was 72%, 60%, 45%, and 39%, respectively. Freedom from reoperation was high (94% at 20 years).
Conclusions:
- Open repair of chronic descending thoracic dissections is associated with acceptable morbidity and mortality.
- Adjuncts significantly reduce the risk of neurologic deficit.
- Low reintervention rates suggest durable results, providing a benchmark for endovascular comparisons.
Aim:
The present study aimed to analyze early and late outcomes after open repair of chronic type B aortic dissection.
Methods:
We retrospectively reviewed our cases of open descending thoracic aortic aneurysm (DTAA) with chronic dissection from 1991-2013. Long-term survival and aortic reinterventions were analyzed and patient comorbidities were evaluated in order to determine the risk of adverse outcomes. Furthermore, the technique for "distal first approach" is described.
Results:
Between 1991 and 2013, 240 (40%) descending thoracic aortic repairs with associated chronic dissection were performed. Mean age is 59 years and 178 (74%) are men. The majority of patients (218, 91%) underwent repair using the adjunct of distal aortic perfusion with cerebral spinal fluid drainage. Early mortality was 8.3% (20/240). Permanent neurologic deficit occurred in 1.3% (3/240). Stroke occurred in 2.9% (7/240), and dialysis on discharge in 6% (12/240). 5-, 10-, 15-, and 20-year survival was 72%, 60%, 45%, and 39%, respectively. Freedom from reoperation on the operated segment was 97%, 94%, 94% and 94% at 5, 10, 15 and 20 years.
Conclusions:
Open repairs of chronic descending thoracic dissections can be performed with respectable morbidity and mortality. Risk of neurologic deficit remains low with use of adjuncts, and risk of reintervention on the involved aortic segment is also low. These results allow comparison with endovascular repair for chronic aortic dissection.
