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Open thoracoabdominal aortic repair for chronic type B dissection
Nicholas T Kouchoukos1, Alexander Kulik2, Catherine F Castner1
1Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St Louis, Mo.
Insights
Open repair of chronic thoracoabdominal aortic dissection using cardiopulmonary bypass and hypothermic circulatory arrest offers comparable outcomes to newer techniques. This established method remains a primary option for managing this complex aortic condition.
Area of Science:
- Cardiovascular Surgery
- Aortic Disease Management
- Thoracic and Abdominal Aorta Surgery
Background:
- Endovascular techniques challenge the role of open surgery for chronic thoracoabdominal aortic dissection.
- Evaluating the efficacy of open repair is crucial given evolving treatment modalities.
Purpose of the Study:
- To assess the outcomes of open repair for chronic thoracoabdominal aortic dissection.
- To evaluate the safety and long-term effectiveness of a single open operative technique.
Main Methods:
- Retrospective analysis of 69 patients undergoing open repair from 1986 to 2014.
- Utilized total cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA).
- Included patients with Crawford extent I, II, and III dissections; 43% had connective tissue disorders.
Main Results:
- 30-day mortality was 5.8%; operative survivors experienced low rates of stroke (3%) and spinal cord injury (6%).
- Long-term survival rates at 1, 5, and 10 years were 87%, 65%, and 40%, respectively.
- 26% of patients required reoperations, particularly those with Marfan or Loeys-Dietz syndrome.
Conclusions:
- Open thoracoabdominal aortic repair using CPB and HCA demonstrates acceptable mortality and morbidity.
- Outcomes are comparable to reported results for endovascular and hybrid repair methods.
- Open repair remains a viable primary option for chronic thoracoabdominal aortic dissection.
Objectives:
Advances in endovascular surgery have brought into question the role of open operative treatment of chronic thoracoabdominal aortic dissection. In this context, we evaluated our experience with open repair of this condition using a single operative technique.
Methods:
From January 1986 to January 2014, 69 patients with chronic thoracoabdominal aortic dissection underwent open repair using total cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA). The degree of repair was as follows: Crawford extent I, 13 patients (19%), Crawford extent II, 41 patients (59%), and Crawford extent III, 15 patients (22%). Thirty patients (43%) had Marfan or Loeys-Dietz syndrome. Fifty-three patients (77%) had previous operations on the thoracic or abdominal aorta.
Results:
The 30-day mortality rate was 5.8% (4 patients). Stroke occurred in 2 (3%) of 66 operative survivors, and spinal cord ischemic injury in 4 (6%). Temporary dialysis for new-onset renal failure was required in 4.5% of hospital survivors and tracheostomy in 10.6%. Survival after 1, 5, and 10 years was 87%, 65%, and 40%, respectively. Eighteen patients (26%) required a total of 20 subsequent operations on the thoracic or abdominal aorta of whom 15 had Marfan or Loeys-Dietz syndrome. Three of these procedures were for contiguous distal aortic disease and 10 were for patch aneurysms of the intercostal or visceral/renal arteries.
Conclusions:
Open thoracoabdominal aortic repair for chronic dissection using CPB and HCA can be accomplished with mortality and morbidity rates that are comparable with those reported for endovascular or hybrid techniques. Open repair should remain a viable and primary option for the management of this condition until the long-term effectiveness of alternative methods of treatment is clearly established.
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