Outcome of surgical treatment in patients with acute type B aortic dissection.
BACKGROUND
Surgery for acute type B aortic dissection is associated with significant mortality and morbidity. The purpose of this study was to assess the clinical outcome of surgical management of complicated acute type B aortic dissection.


METHODS
During the last 5 years, 112 patients were admitted for acute type B aortic dissection. Of these patients, 24 consecutive patients were enrolled who underwent surgical management during the acute or subacute stage. The mean age was 66.7 +/- 9.1 years; 8 patients were female. Indications for surgery were rupture in 10 patients, impending rupture in 7, and malperfusion in 7. Fifteen patients were transferred from another hospital. The overall clinical outcome including morbidity, aorta-related events, and death were retrospectively assessed.


RESULTS
The mean duration from the time of onset to surgery was 7.1 +/- 9.0 days. Graft replacement of the aorta included the total aortic arch with cerebral perfusion in 6 patients, and replacement of the distal aortic arch or descending aorta with left heart bypass in 12. The remaining 6 patients underwent peripheral bypass for ischemia. Significant complications occurred in 7 patients (24.8%). The operative mortality rate was 8.3% (2 of 24); 5.6% (1 of 18) with central operation and 16.7% (1 of 6) with peripheral operation. The 5-year survival rate was 82.6 +/- 7.9% and freedom from aorta-related events at 1 and 5 years were 95.2% +/- 4.7% and 68.0% +/- 16.6%, respectively.


CONCLUSIONS
Surgical management of patients with complicated acute type B dissection has an acceptable perioperative risk and survival. This study suggests earlier surgery with left heart bypass may be beneficial for appropriate patients.
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan. tshimokawa-circ@umin.ac.jp
Tomoki
T
Shimokawa
Kazutaka
K
Horiuchi
Naomi
N
Ozawa
Kenu
K
Fumimoto
Susumu
S
Manabe
Tetsuya
T
Tobaru
Shuichiro
S
Takanashi
D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome