title: Surgical strategy for retrograde type A aortic dissection based on long-term outcomes.
abstract: BACKGROUND
  The optimal management of a retrograde type A aortic dissection (RAAD) is controversial, and few reports have discussed the long-term outcomes of surgical strategies. To determine the most appropriate strategy, we studied the early and late outcomes of RAAD cases.
  
  
  METHODS
  From 1998 to 2014, 44 patients with RAAD (mean age of 63 ± 11 years) underwent surgical repair. Ascending aortic replacement (AAR) was performed in 21 patients and ascending and total arch replacement (TAR) was performed in 23 patients. Eight of the patients who received TAR underwent complete resection of the primary tear in the distal arch or descending aorta (TAR-R[+]), whereas the remaining 15 patients received elephant trunk implantation as an alternative procedure for tear resection (TAR-R[-]). The early and late outcomes (mean follow-up, 86.5 months) were evaluated.
  
  
  RESULTS
  Hospital mortality occurred in 4 of the 44 (9.1%) patients, with no mortalities among the patients undergoing TAR-R[-]. There was a tendency toward a higher incidence of late aorta-related events in the AAR group, with a significantly higher patency rate of the false lumen in the proximal site of the residual aorta compared with the TAR group (p = 0.009). Furthermore, the 5-year rate of freedom from aortic growth greater than 50 mm was significantly lower after AAR than after TAR (p = 0.04). A multivariate analysis indicated that the initial ascending aortic diameter (odds ratio [OR], 1.5; p = 0.02) and AAR (OR, 29.1; p = 0.01) were independent predictors of late aortic expansion.
  
  
  CONCLUSIONS
  The surgical outcomes were acceptable in both the AAR and TAR groups. The long-term outcomes potentially support the aggressive adoption of TAR in relatively younger patients with significant ascending aortic enlargement at presentation.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saga University Hospital, Saga, Japan. Electronic address: keijikamohara@hotmail.com.
authors.forename: Keiji
authors.initials: K
authors.lastname: Kamohara
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saga University Hospital, Saga, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Furukawa
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saga University Hospital, Saga, Japan.
authors.forename: Shugo
authors.initials: S
authors.lastname: Koga
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saga University Hospital, Saga, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Yunoki
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saga University Hospital, Saga, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Morokuma
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saga University Hospital, Saga, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Noguchi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saga University Hospital, Saga, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Takase
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saga University Hospital, Saga, Japan.
authors.forename: Atsuhisa
authors.initials: A
authors.lastname: Tanaka
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saga University Hospital, Saga, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Morita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome