title: Antegrade stenting of the descending thoracic aorta during DeBakey type 1 acute aortic dissection repair.
abstract: Several studies have shown that after DeBakey type 1 acute aortic dissection (DB1-AAD) surgery, 70% of the surviving patients still present with a dissected distal aorta that can eventually dilate, rupture, lead to distal malperfusion or require secondary extensive interventions. In order to minimize these complications, different surgeons have advocated total thoracic aorta remodelling procedures during primary aortic repair to promote false-lumen obliteration and distal thrombosis. Such management, which includes arch replacement and antegrade stenting of the dissected descending thoracic aorta (DTA), remains controversial due to its perceived increased operative mortality. Furthermore, the desired long-term benefits remain to be confirmed. The present article aimed to evaluate results of antegrade stenting of DTA during surgery for DB1-AAD, focusing on in-hospital mortality and morbidity, and long-term survival, occurrence of distal aortic remodelling and freedom from aortic reinterventions. Early results from the identified studies suggested that hybrid repair of DB1-AAD with antegrade DTA stenting was associated with satisfactory in-hospital mortality (10.0%) and stroke (4.8%) rates, while the risk of spinal cord injury appeared to be higher (4.3%) than that reported from historical controls. Furthermore, antegrade stenting of DTA was associated with promising rates of partial/complete thrombosis of the peristent DTA false lumen (88.9%), suggesting that aortic remodelling is highly probable with this approach. Evidence on long-term results after proximal acute dissection repair is still sparse, and mostly jeopardized by limited data beyond 5 years. Further investigations with longer term follow-up and with specifically designed protocols to assess long-term clinical outcomes (late aortic mortality and freedom from distal aortic reinterventions) of total thoracic aortic remodelling procedures vs more conservative management are warranted to reach more definitive conclusions.
authors.affiliation: Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy The Collaborative Research (CORE) Group, Sydney, Australia marco.dieusanio2@unibo.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.affiliation: Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Castrovinci
authors.affiliation: The Collaborative Research (CORE) Group, Sydney, Australia.
authors.forename: David H
authors.initials: DH
authors.lastname: Tian
authors.affiliation: Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Folesani
authors.affiliation: Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Cefarelli
authors.affiliation: Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pantaleo
authors.affiliation: Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Murana
authors.affiliation: Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Berretta
authors.affiliation: The Collaborative Research (CORE) Group, Sydney, Australia Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.affiliation: Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Roberto Di
authors.initials: RD
authors.lastname: Bartolomeo
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Acute dissection; Aorta; Great vessels; Hybrid repair; Outcomes