Thoracic aortic aneurysms after acute type A aortic dissection: necessity for follow-up.
Between April 1979 and May 1989, 86 patients underwent emergency operation for acute type A aortic dissection. Sixty-four (74.4%) survived. None of the survivors died of late aortic complications. Fifty-eight patients were followed 3 months to 10 years (mean follow-up, 3.2 years) postoperatively with computed tomography and digital subtraction angiography. Dilatation of the distal aorta (diameter size range, 6 to 10.5 cm) developed in 10 patients (17%). Six patients underwent replacement of the descending aorta 1 month to 21 months (mean period, 8.5 months) after aortic dissection repair. Two of them had third-stage thoracoabdominal replacement. In 2 patients, replacement of the descending aorta was scheduled; 1 died before reoperation and 1 refused the procedure. Two patients underwent aortic arch replacement; it is scheduled for another (fourth stage). There were no deaths among the patients having reoperation. The rate of indications for reoperation on the aorta downstream from the original repair 1 month to 6 years 4 months (median time, 9 months) after primary surgical intervention for acute type A aortic dissection was 24% (14 reoperations in 10 of 58 patients). This study underscores the importance of close follow-up of patients having operation for acute type A aortic dissection. Early recognition of progressive downstream aortic pathology permits effective prevention of aortic rupture and timely reoperation.
Heinemann
M
M
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Federal Republic of Germany.
Laas
J
J
Karck
M
M
Borst
H G
HG
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000473:pathology / Q000601:surgery; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery; D001014:Aortic Aneurysm / Q000473:pathology / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation; D015996:Survival Rate