title: Open and closed distal anastomosis for acute type A aortic dissection repair.
abstract: The current consensus favours an open distal anastomosis for aortic dissection repair. A small number of experiences have compared early and long-term outcomes between closed and open distal anastomosis in the setting of acute aortic dissection.
  
  
  
  We reviewed our experience in 204 patients who underwent repair of spontaneous acute type A aortic dissection between January 2000 and December 2013. Open distal repair was performed in 109 patients, whereas 95 patients received a closed anastomosis. The clinical presentation, anatomical characteristics of aortic dissection, surgical techniques and the outcomes were analysed in the overall population and in the subgroup of patients (n = 100; open = 39, closed = 61) with Type 1 DeBakey dissection and a proximal intimal tear. Twenty-six preoperative and operative variables were studied to determine their impact on hospital mortality and postoperative neurological deficits. Imaging follow-up was available in 83 patients.
  
  
  
  A more extensive involvement of the aortic arch characterized the open repair group. No differences in terms of mortality, morbidity and survival rates were observed between the two groups of patients. Open repair with cerebral perfusion was associated with a better neurological outcome. Patients who underwent an open distal anastomosis showed a significant higher rate of complete thrombosis of the false lumen.
  
  
  
  An open repair does not increase the risk of early mortality and positively affect the evolution of the false lumen in distal unresected aortic segments. The use of cerebral perfusion reduces the risk of perioperative neurological injury.
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK pg.malvindi@hotmail.com.
authors.forename: Pietro G
authors.initials: PG
authors.lastname: Malvindi
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Amit
authors.initials: A
authors.lastname: Modi
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Szabolcs
authors.initials: S
authors.lastname: Miskolczi
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Markku
authors.initials: M
authors.lastname: Kaarne
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Theodore
authors.initials: T
authors.lastname: Velissaris
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Clifford
authors.initials: C
authors.lastname: Barlow
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Ohri
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Tsang
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Livesey
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Aorta/aortic; Aortic dissection; Aortic operation