title: The fate of the distal aorta after repair of acute type A aortic dissection.
abstract: OBJECTIVE
  The residual aorta's behavior after repair of acute type A dissection is incompletely understood. We analyzed segmental growth rates, distal reoperation, and factors influencing long-term survival.
  
  
  METHODS
  One hundred seventy-nine consecutive patients (70% male; mean age, 60 years) with acute type A dissection underwent aggressive resection of the intimal tear and open distal anastomosis (1986-2003). Hospital mortality was 13.4%. Survivors had serial computed tomographic scans: digitization yielded distal segmental dimensions. Segment-specific average rates of enlargement and factors influencing faster growth were analyzed. Distal reoperations and patient survival were examined.
  
  
  RESULTS
  Eighty-nine (57%) patients had imaging data sufficient for growth rate calculations. The median diameters after repair were as follows: aortic arch, 3.6 cm; descending aorta, 3.7 cm; and abdominal aorta, 3.2 cm. Subsequent growth rates were 0.8, 1.0, and 0.8 mm/y, respectively. Initial size of greater than 4 cm (P = .005) and initial diameter of less than 4 cm with a patent false lumen (P = .004) predicted greater growth in the descending aorta, and male sex (P = .05) significantly affected growth in the abdominal aorta. No significant factors were found for the aortic arch. There were 25 distal aortic reoperations (16 patients), and risk of reoperation was 16% at 10 years. Risk factors reducing long-term survival after repair of acute type A dissection included age (P < .0001), new neurological deficit at presentation (P = .04), absence of preoperative thrombus in the false lumen of the ascending aorta (P = .03), and a patent distal false lumen postoperatively (P = .06) but not distal reoperation.
  
  
  CONCLUSIONS
  Growth of the distal aorta after repair of acute type A dissection is typically slow and linear. Distal reoperation is uncommon, and late risk of death is approximately twice that of a healthy population.
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA. jameschalstead@yahoo.co.uk
authors.forename: James C
authors.initials: JC
authors.lastname: Halstead
authors.forename: Matthias
authors.initials: M
authors.lastname: Meier
authors.forename: Christian
authors.initials: C
authors.lastname: Etz
authors.forename: David
authors.initials: D
authors.lastname: Spielvogel
authors.forename: Carol
authors.initials: C
authors.lastname: Bodian
authors.forename: Michael
authors.initials: M
authors.lastname: Wurm
authors.forename: Rohit
authors.initials: R
authors.lastname: Shahani
authors.forename: Randall B
authors.initials: RB
authors.lastname: Griepp
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001011:Aorta / Q000254:growth & development* / Q000473:pathology; D001014:Aortic Aneurysm / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D015996:Survival Rate