Twenty-Year Results of Open Surgical Suprarenal Aortic Fenestration for Acute Complicated Type B Aortic Dissection

Open surgical suprarenal aortic fenestration (OSSAF) is a technique to treat complicated type B aortic dissection (cTBAD) by resecting the intimal membrane at the level of the visceral arteries. This invasive procedure is largely abandoned since the advent of thoracic endovascular aortic repair (TEVAR), which has become the gold standard for treating cTBAD. Identifying patterns in the late history of patients who underwent OSSAF might help better understand the evolution of type B aortic dissection (TBAD). Therefore, our aim was to investigate the long-term outcome and remodeling of the aorta in late survivals of OSSAF.

All patients who underwent OSSAF due to cTBAD were enrolled from a single tertiary referral center. Demographic, anatomical, procedural, and follow-up (FU) data were collected from the hospital and the national healthcare database.

58 cases (54.5 ± 12.1 years, 46 male) of cTBAD were treated with OSSAF. Indication for repair was malperfusion in two-thirds of the cases. An in-hospital mortality of 27.3% and a clinical success rate of 63.6% were found. Estimated survival rate at 5, 10, and 20 years were 56.1%, 45.6%, and 21.0%, respectively. Reoperation estimates were 19.2%, 28.9%, and 47.2% at the same time intervals. Thoracic aortic (40.6 ± 10.6 mm) and visceral aortic (29.4 ± 5.7 mm) diameters increased significantly (56.7 ± 15.6 mm, P = 0.001 for the thoracic aorta and 32.6 ± 10.3 mm, P = 0.028 for the visceral aorta) at an average FU time of 11.9 ± 5.7 years. The diameter increment was significantly larger (P = 0.0001) at the thoracic level than in the visceral segment.

Being a highly invasive procedure, OSSAF carries a significant operative mortality but is associated to acceptable long-term outcome. Long-term observation showed adverse remodeling of the dissected aorta, with significantly less impact on the refenestrated visceral aortic segment compared to the native proximal descending aorta. The latter predominantly contributes to the high rate of reintervention.