Open thoracoabdominal aortic repair for chronic type B dissection.

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.