Disadvantages of local repair in acute type A aortic dissection.
BACKGROUND
In acute type A dissection of the aorta, local repair with glue-aortoplasty was compared with aortic replacement.


METHODS
Between 1992 and 1996, 106 consecutive patients (mean age, 59 years; 84 men) were operated on average 14.5 hours after onset of dissection. A local repair (gelatin-resorcine-formaldehyde/glutaraldehyde glue, Trigon AG, Monchengladbach, Germany) without graft replacement was performed in 21 patients. Graft replacement and reinforcement of aortic stumps with gelatin-resorcine-formaldehyde/glutaraldehyde glue was performed in 85 patients (supracoronary graft, 68; aortic root replacement, 17).


RESULTS
Survival was 79% after 30 days and 69% after 2 years. There was no difference in early mortality (p = 0.2240) and survival (p = 0.07649). Risk factors for early mortality were preoperative shock, neurologic disorder, duration of crossclamp, and extracorporeal circulation. The rate of reoperation on the proximal aorta was 31.6% (6 of 19) after local repair and 9% (6 of 64) after aortic replacement (p = 0.0157). Local repair was a significant predictor for reoperation (p = 0.0087), with decreased reoperation-free survival (p = 0.01164). In all reinterventions (four supracoronary grafts, including two valve replacements; two composite grafts; two arch replacements) breakdown of the aortoplasty was confirmed.


CONCLUSIONS
Local repair has satisfactory early results but an increased incidence of reoperations due to a breakdown of the glue-aortoplasty. Indications for local repair should be restricted to high-risk patients requiring a minimal emergency surgical procedure.
Niederhäuser
U
U
Clinic for Cardiovascular Surgery, University Hospital Zürich and City Hospital Triemli, Switzerland.
Kaplan
Z
Z
Künzli
A
A
Genoni
M
M
Zünd
G
G
Lachat
M L
ML
Vogt
P R
PR
Turina
M I
MI
D000208:Acute Disease; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D012086:Reoperation; D015996:Survival Rate