Long-term outcomes after repaired acute type A aortic dissections.
The aim was to evaluate long-term outcomes after surgical treatment of acute type A dissection. Between 1993 and 2004, 199 consecutive patients were operated on for acute type A dissection. All survivors were included in an MRI follow-up program. Follow-up time averaged 4.45 years. Overall survival was 96%, 80% and 65% at 1, 5 and 10 years. The false lumen remained patent in 101 cases (69%). Predictive factors for thrombosis of the false lumen were age >70 years old and valve-sparing aortic root reconstruction. Significant risk factors for patency of the distal false lumen were age <50 years old, De Bakey type III retrograde dissections, Bentall procedure and long-term anticoagulation. Freedom from reoperation was 98%, 96% and 69% at 1, 5 and 10 years. Eight patients required reoperations for dilatation of distal aorta at 4.7+/-2.8 years after the first operation. Reoperations consisted of combined surgical and endovascular procedures, without in-hospital or late deaths. Close MRI follow-up demonstrated that aortic false lumen remained patent in a majority of cases. Surgical reconstruction needing long-term anticoagulation must be avoided when possible to decrease patency of the false lumen. However, late reoperations are infrequent and can be treated with a low risk by using endovascular procedures.
Department of Adult Cardiac Surgery, Timone Hospital, Marseille, France. vlad.gariboldi@ap-hm.fr
Vlad
V
Gariboldi
Dominique
D
Grisoli
François
F
Kerbaul
Roch
R
Giorgi
Alberto
A
Riberi
Dominique
D
Metras
Thierry G
TG
Mesana
Frédéric
F
Collart
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome