Long-term outcomes after entry closure and aneurysmal wall plication for type B aortic dissection.
OBJECTIVE
To examine the long-term outcomes after entry closure and aneurysmal wall plication for type B chronic dissecting aortic aneurysm. This procedure uses no artificial graft and preserves all intercostal arteries.


METHODS
We reviewed the records of 40 consecutive patients who underwent this procedure between September 1983 and December 2002. The mean age at operation was 60+/-12 years (range, 38-79 years). The mean follow-up period was 9.8+/-5.1 years (range, 4-23 years). Follow-up was completed in 38 patients (95%). The latest computed tomography scans (n=22) were obtained 9.5+/-5.1 years (range, 3-18 years) after surgery.


RESULTS
There were no operative deaths and 14 late deaths, none of which were related to the aneurysm. No paraplegia or paraparesis occurred. The survival rate was 92+/-4% at 5 years and 64+/-9% at 10 years; 24 patients are still alive. Follow-up computed tomography revealed that the mean diameter of the plicated descending aorta was 31+/-5mm (range, 22-39 mm) except in four patients. One of the four patients required reoperation for recurrent aneurysm of the plicated aorta 3 years postoperatively. In the remaining three patients, the plicated aorta has become enlarged; however, these patients have not yet undergone reoperation. Reoperation for residual dissecting aneurysm was performed in another three patients whose plicated aorta was normal. Freedom from reoperation for residual dissecting aneurysm was 78+/-5% at 10 years.


CONCLUSIONS
This procedure produces excellent short-term outcomes and low long-term morbidity. It could be the procedure of choice in selected patients to prevent paraplegia, although graft replacement is currently the standard treatment for chronic aortic dissecting aneurysm.
Miyamoto
Yuji
Y
Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. y-miyamo@hyo-med.ac.jp
Ohata
Toshihiro
T
Mitsuno
Masataka
M
Yamamura
Mitsuhiro
M
Tanaka
Hiroe
H
Kobayashi
Yasuhiko
Y
Ryomoto
Masaaki
M
Fukui
Shinya
S
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D002908:Chronic Disease; D004108:Dilatation, Pathologic / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D013536:Suture Techniques; D016896:Treatment Outcome; D014463:Ultrasonography; D014656:Vascular Surgical Procedures / Q000379:methods*