Combining classic surgery with descending stent grafting for acute DeBakey type I dissection.
BACKGROUND
To possibly prevent late complications after classic type A aortic dissection repair, the radical concept of ascending/arch replacement with simultaneous antegrade descending stent grafting using a hybrid prosthesis was applied and compared with conventional repair leaving the distal false lumen untreated.


METHODS
Between January 2001 and October 2007, of 71 consecutive patients with acute type A aortic dissection (AAAD), 45 had DeBakey type I dissection and underwent emergency surgery within 24 hours after onset of symptoms. These patients were separated into group 1 (n = 23) undergoing conventional surgery, and group 2 (n = 22) undergoing combined repair with antegrade stent grafting.


RESULTS
Patients were comparable for baseline characteristics, but more group 2 patients had severely compromised hemodynamics (p = 0.05) and cerebral malperfusion at arrival (p < 0.01). Intraoperative and postoperative characteristics were similar, with an overall hospital mortality of 16% (5 [22%] versus 2 [9%], group 1 versus group 2; p = 0.22). At a mean follow-up time of 48 months for group 1 versus 23 months for group 2 (p < 0.01), late mortality did not differ between groups (p = 0.38) and was mainly related to additional surgical procedures and persisting neurologic sequelae and not to the aortic pathology. Persisting distal false lumen patency was observed in 89% of group 1 versus 10% of group 2 patients (p < 0.01).


CONCLUSIONS
This hybrid approach to patients with type I acute aortic dissection is technically feasible without increasing the operative risk and offers the chance of persistent occlusion of the persistent graft distal false lumen.
Jakob
Heinz
H
Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Essen, Germany. heinz.jakob@uk-essen.de
Tsagakis
Konstantinos
K
Tossios
Paschalis
P
Massoudy
Parwis
P
Thielmann
Matthias
M
Buck
Thomas
T
Eggebrecht
Holger
H
Kamler
Markus
M
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017130:Angioplasty / Q000379:methods*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome