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Surgical Outcomes of Chronic Descending Dissections: Type I Versus III DeBakey

Ivancarmine Gambardella1, Mario Gaudino1, Christopher Lau1

  • 1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.

The Annals of Thoracic Surgery
|February 14, 2017
PubMed

Insights

Open repair for descending thoracic and thoracoabdominal aortic aneurysms in chronic aortic dissection patients showed similar outcomes for DeBakey type I and type III. Long-term survival and complication rates were comparable between the two dissection types.

Area of Science:

  • Cardiovascular Surgery
  • Aortic Aneurysm Repair
  • Dissection Management

Background:

  • Evaluating open surgical repair outcomes for descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA).
  • Comparing results between DeBakey type I and type III chronic aortic dissection patients.

Purpose of the Study:

  • To assess and compare the efficacy and safety of open surgical repair for DTA and TAAA in patients with chronic aortic dissection.
  • Specifically analyze outcomes based on DeBakey classification (Type I vs. Type III).

Main Methods:

  • Retrospective review of an institutional aortic database (1997-2015).
  • Analysis of 243 patients with chronic dissection (101 Type I, 142 Type III) undergoing open DTA/TAAA repair.
  • Propensity score matching to control for preoperative risk differences.

Main Results:

  • Operative mortality was 4% for Type I and 9.2% for Type III (p=0.12).
  • Major postoperative complication rates were similar between groups.
  • Five-year survival (68.3% Type I vs. 72% Type III, p=0.80) and reoperation risk (3.5% Type I vs. 6.6% Type III, p=0.25) were comparable, confirmed in matched pairs.

Conclusions:

  • Perioperative and midterm outcomes for open TAAA/DTA repair are similar for chronic Type I and Type III dissection.
  • A trend towards higher operative mortality and reoperation risk in Type III was observed but not statistically significant.
Abstract

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