Significance of distal false lumen after type A dissection repair.
Fifty-eight patients underwent repair of acute type A dissection between 1986 and 1992. Follow-up aortogram, computed tomographic scan with contrast, magnetic resonance imaging scan, or a combination of these tests was available in 38 patients with preoperatively patent distal false lumens. All distal anastomoses were constructed with the open technique during a period of circulatory arrest. There were 25 suture and 13 intraluminal graft anastomoses. Patency of the distal false lumen was found in 47.3%. Use of the intraluminal graft for the distal anastomosis decreased patency, although not significantly (4/13, 30% versus 14/25, 56%; p = 0.14). The direction of flow into the false lumen was antegrade in 11 of 24 (45.8%) of sutured anastomoses and 0 of 9 intraluminal graft anastomoses (p < 0.01). Actuarial survival at 5 years for patients with closed distal false lumen was 95% +/- 4.8% versus 76% +/- 15% for patients with patency of the distal false lumen (p = not significant). Event-free survival at 5 years for both groups was 84% +/- 8.3% (closed false lumen) and 63% +/- 13.5% (patency of distal false lumen; p = not significant). This experience indicates that in the treatment of acute type A dissections, operative strategy and anastomotic technique play a role in reducing the incidence of patency and related complications of the distal false lumen.
Ergin
M A
MA
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY 10029.
Phillips
R A
RA
Galla
J D
JD
Lansman
S L
SL
Mendelson
D S
DS
Quintana
C S
CS
Griepp
R B
RB
D000206:Actuarial Analysis; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods; D000784:Aortic Dissection / Q000145:classification / Q000601:surgery*; D017541:Aneurysm, False / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000145:classification / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D014654:Vascular Patency