title: Outcomes of open repair for chronic descending thoracic aortic dissection.
abstract: BACKGROUND
  This study analyzed early and late outcomes after open repair of descending thoracic aortic aneurysms with chronic aortic dissection.
  
  
  METHODS
  We retrospectively reviewed our cases of open repair of descending thoracic aortic aneurysms with chronic dissection from 1991 to 2011. Patient comorbid conditions and operative details were analyzed to determine risks for adverse outcome. Long-term survival and aortic reinterventions were analyzed.
  
  
  RESULTS
  We repaired 519 patients with descending thoracic aortic aneurysms during the study period, and 209 (40%) had chronic dissection. Mean age was 59 years, with 74% (154 of 209) men. Previous ascending repair was performed in 41% (85 of 209), and the second-stage elephant trunk was performed in 10% (21 of 209). Adjunctive distal aortic perfusion with cerebral spinal fluid drainage was used in 90% (188 of 209) of patients, and circulatory arrest with bypass in 1% (3 of 209). The 30-day mortality was 8.6% (18 of 209). Immediate neurologic deficit occurred in 0.95% (2 of 209) and only with extent C resection. Delayed neurologic deficit occurred in 1.4% (3 of 209), 1 patient in each extent. Because 66% (2 of 3) of the patients with delayed neurologic deficit recovered function, permanent deficit occurred in 1.4% (3 of 209). Stroke occurred in 2.4% (5 of 209) and dialysis on discharge in 5% (11 of 211). The only risk factor for 30-day mortality was preoperative glomerular filtration rate of less than 60 mL/min (odds ratio, 4.2; p < 0.006). Survival at 5, 10, and 15 years was 72%, 60%, and 49%, respectively. Freedom from reoperation on the operated-on segment was 98%, 96.5%, 96.5%, and 96.5% at 5, 10, 15, and 20 years.
  
  
  CONCLUSIONS
  Open repairs of chronic descending thoracic aortic aneurysm dissections can be performed with respectable morbidity and mortality. Neurologic deficit remains low with the use of adjuncts, and early deaths are directly related to preoperative renal status. Reintervention on the involved aortic segment is low. These results allow comparisons with endovascular repair for chronic aortic dissection.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas. Electronic address: anthony.l.estrera@uth.tmc.edu.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Estrera
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Azam
authors.initials: A
authors.lastname: Jan
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Harleen
authors.initials: H
authors.lastname: Sandhu
authors.affiliation: Division of Vascular Surgery, University of Washington, Seattle, Washington.
authors.forename: Sherene
authors.initials: S
authors.lastname: Shalhub
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Mario
authors.initials: M
authors.lastname: Medina-Castro
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Tom C
authors.initials: TC
authors.lastname: Nguyen
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Ali
authors.initials: A
authors.lastname: Azizzadeh
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Kristofer
authors.initials: K
authors.lastname: Charlton-Ouw
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Miller
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Hazim J
authors.initials: HJ
authors.lastname: Safi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D055815:Young Adult