Predictors of patent false lumen of the aortic arch after hemiarch replacement

Hemiarch replacement for acute type A aortic dissection is less invasive than total arch replacement but involves increased risk of late aortic arch dilation because of patent false lumen of the aortic arch. If we can predict this risk, it may be a valuable prognostic indicator for selecting surgical procedures for acute type A aortic dissection.

We reviewed our surgical experience to predict patent false lumen. From January 2009 to November 2014, we performed 108 hemiarch replacement procedures for acute type A aortic dissection that had patent false lumen of the ascending aortic arch. We identified 56 patients who had preoperative and postoperative contrast-enhanced computed tomography. Patients' preoperative characteristics, preoperative and postoperative contrast-enhanced computed tomography findings, intraoperative findings and postoperative course were investigated.

Of the 56 patients, 32 (57.1 %) were men and their mean age at surgery was 63.7 ± 11.8 years. Overall in-hospital mortality rate was 7.1 % (4 patients). According to postoperative imaging findings, 56 patients were classified into two groups: group A (39 patients), with patent false lumen, and group B (17 patients), with thrombosed false lumen. Logistic regression analysis revealed that brachiocephalic artery dissection and no tear resection contributed to postoperative patent false lumen of the aortic arch more strongly than did other factors.

Brachiocephalic artery dissection and no tear resection are potential predictors of patent false lumen of the aortic arch after hemiarch replacement.