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Contemporary Midterm Outcomes After Primary Repair of Chronic Type A Aortic Dissection

Rodrigo Zea-Vera1, Susan Y Green2, Hiruni S Amarasekara2

  • 1Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.

The Annals of Thoracic Surgery
|December 17, 2022
PubMed

Insights

Surgical repair of chronic type A aortic dissection (TAAD) offers durable outcomes with acceptable risk. Both DeBakey type I and II TAAD showed similar survival rates after repair, indicating effective treatment strategies.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Disease Management

Background:

  • Acute type A aortic dissection (TAAD) is often fatal without prompt surgical intervention.
  • A subset of patients survive the acute phase and develop chronic TAAD, for whom optimal management remains less clear.
  • This study evaluates the contemporary outcomes of primary surgical repair for chronic TAAD.

Purpose of the Study:

  • To assess the contemporary outcomes of primary surgical repair for chronic type A aortic dissection (TAAD).
  • To compare outcomes between DeBakey type I and type II chronic TAAD.
  • To evaluate the operative risk and long-term survival following surgical repair of chronic TAAD.

Main Methods:

  • A retrospective analysis of 205 patients who underwent repair of chronic TAAD (defined as >60 days post-onset) between 1990 and 2021.
  • Patients were classified by DeBakey type (I or II) and underwent various surgical approaches, including hemiarch or total arch repair.
  • Kaplan-Meier and competing-risk analyses were used to determine time-dependent outcomes, including survival and reoperation rates.

Main Results:

  • The median interval from dissection onset to repair was 7 months, with most patients presenting with chronic symptoms.
  • Operative mortality was 7% (15 deaths), with a 3% incidence of persistent stroke and no cases of paraplegia.
  • The 5-year reoperation-free survival was 61%, with similar survival rates observed for DeBakey type I and type II dissections.

Conclusions:

  • Surgical repair of chronic type A aortic dissection (TAAD) can be performed with reasonable operative risk and yields durable results.
  • Individualized treatment approaches are effective, leading to low rates of persistent neurologic complications.
  • Despite variations in surgical techniques based on DeBakey type, early and late outcomes for chronic TAAD repair are comparable.
Abstract

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