title: Clinical outcomes and fate of the distal aorta following 1-stage repair of extensive chronic thoracic aortic dissection.
abstract: OBJECTIVE
  To analyze clinical outcomes and distal segmental aortic growth and aortic reoperation rates following 1-stage open repair of extensive chronic aortic dissection that included resection and graft replacement of the aneurysmal descending thoracic aorta.
  
  
  METHODS
  Among 68 patients undergoing extensive 1-stage repair of chronic aortic dissection that included the ascending aorta, arch, and varying lengths of the descending thoracic aorta, 66 were hospital survivors (early mortality 2.9%). Fifty-one of these patients (77%) had serial imaging studies suitable for calculation of growth rates of the remaining thoracic and upper abdominal aorta. The mean duration of follow-up was 5.8 years and extended to 13.7 years.
  
  
  RESULTS
  The overall growth rate of the distal aorta for the entire cohort was 0.10 mm/year. For 28 patients followed for >5 years, the growth rate was 0.03 mm/year. Three patients required reoperation on the contiguous thoracic or abdominal aorta for aneurysmal degeneration 8 months, 34 months, and 6.2 years postoperatively. Actuarial freedom from reoperation for aneurysmal growth of the distal aorta at 5 and 10 years was 96.3% and 93.3%, respectively. Actuarial freedom from any aortic reoperation at 5 years and 10 years was 88.6% and 82.7%, respectively. Actuarial survival at 5, 7, and 10 years was 78.2%, 71.2%, and 57.3%, respectively.
  
  
  CONCLUSIONS
  Our extended experience with the 1-stage procedure confirms its safety and feasibility for treatment of extensive chronic thoracic aortic dissection. It is associated with a low incidence of reoperation on the contiguous aorta for aneurysmal degeneration. It represents a viable alternative to 2-stage and hybrid procedures that are also used to treat this condition.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St Louis, Mo. Electronic address: ntkouch@aol.com.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Kouchoukos
authors.forename: Alexander
authors.initials: A
authors.lastname: Kulik
authors.forename: Catherine F
authors.initials: CF
authors.lastname: Castner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: 26; 26.1; 26.1.2; CABG; DTA; coronary artery bypass grafting; descending thoracic aorta