title: Antegrade thoracic stent grafting during repair of acute Debakey type I dissection promotes distal aortic remodeling and reduces late open distal reoperation rate.
abstract: OBJECTIVE
  Previously, we showed that antegrade stent grafting of the descending thoracic aorta during DeBakey type I dissection repair improves distal aortic remodeling. We assessed midterm outcomes of this reconstructive strategy compared with standard open repair.
  
  
  METHODS
  DeBakey type I dissections (non-Marfan, nontotal arch cases only) from 2005 to 2012 were retrospectively reviewed. One hundred eighty patients underwent standard open repair (standard group), and 62 patients underwent open repair plus stenting (stented group). Open repair entailed ascending aorta plus transverse hemiarch reconstruction under circulatory arrest, with variable aortic root work. Data was prospectively maintained.
  
  
  RESULTS
  Preoperative parameters were similar. Patients in the stented group had longer circulatory arrest time and higher utility of antegrade cerebral perfusion (P < .001). In-hospital/30-day mortality (10% vs 14%; P = .51), stroke (5% vs 8%; P = .6), and paraplegia (0% vs 1%; P = 1) were similar in the stented versus standard groups. Mean follow-up was 2.7 ± 2.3 and 2.2 ± 2.1 years. Actuarial survival in stented versus standard groups at 1 and 7 years was 86% versus 81% and 76% versus 60% (P = .5). Thoracic aorta false lumen obliteration was improved in the stented group (82% vs 39%; P < .001), along with improved freedom from open distal aortic reoperation rate (98% vs 90% at 6 years, P = .1). Endovascular distal aortic reintervention rate was higher in the stented group (18% vs 3%; P = .008), with zero mortality.
  
  
  CONCLUSIONS
  Antegrade stent graft deployment during acute DeBakey type I dissection repair is safe method to promote distal aortic remodeling without increasing postoperative or midterm mortality. This technique provides increased freedom from open distal aortic reoperations compared with standard open repair.
authors: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa. Electronic address: prashanth.vallabhajosyula@uphs.upenn.edu.
authors: Prashanth
authors: P
authors: Vallabhajosyula
authors: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
authors: Wilson Y
authors: WY
authors: Szeto
authors: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
authors: Aaron
authors: A
authors: Pulsipher
authors: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
authors: Nimesh
authors: N
authors: Desai
authors: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
authors: Rohan
authors: R
authors: Menon
authors: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
authors: Patrick
authors: P
authors: Moeller
authors: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
authors: Shenara
authors: S
authors: Musthaq
authors: Mayo Clinic, Rochester, Minn.
authors: Alberto
authors: A
authors: Pochettino
authors: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
authors: Joseph E
authors: JE
authors: Bavaria
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome