Early and late outcomes of repaired acute DeBakey type I aortic dissection after graft replacement.
OBJECTIVE
The present study aimed to determine the impact of the extent of graft replacement on early and late outcomes in acute DeBakey type I aortic dissection.


METHODS
Between October 1999 and July 2014, 197 consecutive patients were surgically treated for acute DeBakey type I aortic dissection. The extent of graft replacement (hemiarch, partial, or total arch replacement) was mainly determined by the location of the primary entry. Early and late results were compared in patients after total arch replacement (n = 88) and combined hemiarch and partial arch replacement: non-total arch replacement (n = 109).


RESULTS
The in-hospital mortality rates of the total arch replacement and non-total arch replacement groups were 10.2% and 14.7%, respectively (P = .47). Multivariate analysis revealed preoperative cardiopulmonary resuscitation and visceral organ malperfusion as significant risk factors for in-hospital mortality, but not total arch replacement. During a mean follow-up period of 60 ± 48 months, the 5-year survivals in the total arch replacement and non-total arch replacement groups were 88.6% ± 4.2% and 83.8% ± 4.4%, respectively (P = .54). Rates of distal aortic events (defined as freedom from surgery for distal aorta dilation or distal arch diameter expanding to 50 mm) at 5 years were significantly better in the total arch replacement group than in the non-total arch replacement group (94.9% ± 3.5% vs 83.6% ± 4.9%, P = .01).


CONCLUSIONS
The operative mortality of patients with acute DeBakey type I aortic dissection treated by total arch replacement was acceptable with good long-term survival after both total arch replacement and non-total arch replacement. The frequency of distal aortic events might be reduced in patients after total arch replacement compared with non-total arch replacement.
Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Atsushi
A
Omura
Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Shunsuke
S
Miyahara
Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Katsuhiro
K
Yamanaka
Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Toshihito
T
Sakamoto
Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Masamichi
M
Matsumori
Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Kenji
K
Okada
Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: yokita@med.Kobe-u.ac.jp.
Yutaka
Y
Okita
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
aortic dissection; long term result; total arch replacement