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Surgery for chronic type B dissection with aneurysmal degeneration.

Jeremy R Leonard1, Christopher Lau1, Erin M Iannacone1

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Open repair of thoracoabdominal aortic aneurysms (TAAA) for chronic type B dissection shows good outcomes. Elective repair offers better long-term survival than urgent intervention, especially for extent II TAAA.

Keywords:
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Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Aortic Disease

Background:

  • Open repair of descending thoracic or thoracoabdominal aortic aneurysm (TAAA) carries significant operative risk.
  • Despite advancements, mortality and morbidity remain concerns in TAAA repair.
  • Chronic type B aortic dissections present unique challenges in surgical management.

Purpose of the Study:

  • To evaluate operative results and long-term outcomes of open repair for chronic type B aortic dissections.
  • To assess the safety and efficacy of TAAA repair in this specific patient cohort.
  • To identify factors influencing outcomes in patients with chronic type B dissections.

Main Methods:

  • Retrospective review of a surgical database from May 1997 to March 2018.
  • Inclusion of consecutive patients undergoing TAAA repair for chronic type B dissection.
  • Primary endpoint: operative mortality; Secondary endpoints: major adverse events and complications.

Main Results:

  • 153 patients met inclusion criteria; 54.9% underwent elective surgery.
  • Operative mortality was 8.5% (13/153), with higher mortality in extent II TAAA.
  • 5-year survival was 87.5% for elective vs. 69.9% for urgent/emergency repair (p=0.039).

Conclusions:

  • Open repair of chronic type B dissections can achieve excellent outcomes with low mortality.
  • Careful consideration of outcomes is crucial for patients with extent II TAAA.
  • Surgical management of chronic type B dissections is feasible with acceptable risk in experienced centers.