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The fate of the downstream aorta after total arch replacement
Yuki Ikeno1, Koki Yokawa1, Katsuhiro Yamanaka1
1Department of Cardiovascular Surgery, Kobe University, Kobe, Japan.
Insights
Total arch replacement can lead to significant increases in descending aorta diameter, especially in acute aortic dissection patients. Preoperative descending aorta diameter is a key risk factor for adverse distal aortic events after surgery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Aortic Surgery
- Aortic Aneurysm and Dissection
Background:
- Total arch replacement is a complex procedure for aortic arch pathologies.
- Understanding the long-term behavior of the descending aorta after this surgery is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the fate of the downstream aorta after total arch replacement.
- To identify risk factors for distal aortic dilation and events post-surgery.
Main Methods:
- Retrospective analysis of 623 patients undergoing total arch replacement between 1999 and 2018.
- Assessment of late outcomes including re-operation for distal dilation and distal aortic events.
- Computed tomography evaluation of aortic diameter changes over time.
Main Results:
- Descending aorta diameter significantly increased post-total arch replacement, particularly in the distal segment.
- Freedom from additional surgery for distal dilation was 80.2% at 10 years; freedom from distal aortic events was 70.5% at 10 years.
- Preoperative descending aorta diameter was a significant predictor of unfavorable distal aortic events.
Conclusions:
- The descending aorta diameter increases significantly after total arch replacement.
- Preoperative descending aorta diameter is a critical factor for predicting adverse distal aortic events.
- Acute aortic dissection patients showed positive aortic remodeling in the descending aorta.
Objectives:
The goal of this study was to evaluate the fate of the downstream aorta following total arch replacement.
Methods:
Between October 1999 and March 2018, a total of 740 patients underwent total arch replacement. After excluding connective tissue disease, previous descending or thoracoabdominal aortic surgery, patients without adequate preoperative images or operative mortality, late outcomes consisting of additional surgery for distal dilation and distal aortic events were evaluated in 623 survivors (240 aortic dissections, including 139 patients with acute dissection and 383 with a non-dissection aneurysm). The mean follow-up was 5.0 ± 4.0 years.
Results:
The mean preoperative maximum diameter of the descending aorta was 36.9 ± 8.0 mm. An elephant trunk was inserted in 232 patients, including 183 patients with aortic dissection. Freedom from additional surgery for distal dilation was 88.5% at 5 years and 80.2% at 10 years. Freedom from distal aortic events was 81.9% at 5 years and 70.5% at 10 years. Multivariable regression analysis demonstrated that the preoperative diameter of the descending aorta was a significant risk factor for unfavourable distal aortic events. Computed tomography evaluation demonstrated a significant increase in the descending aortic diameter over time (P < 0.001). Positive aortic remodelling was observed in the proximal descending (P < 0.001) to mid-descending (P < 0.001) aorta exclusively in patients with acute aortic dissection.
Conclusions:
The diameter of the descending aorta increased significantly after total arch replacement, particularly in the distal descending aorta. The preoperative descending aortic diameter portended a significant risk for unfavourable distal aortic events.
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