Central Repair With Antegrade TEVAR for Malperfusion Syndromes in Acute Debakey I Aortic Dissection.
BACKGROUND
In acute DeBakey I aortic dissection presenting with malperfusion syndromes, we assessed whether standard open repair with concomitant antegrade stent grafting (thoracic endovascular aneurysm repair; TEVAR) of the descending thoracic aorta (DTA) improves outcomes compared with standard repair alone.


METHODS
From 2005 to 2012, 277 patients with acute DeBakey I dissection underwent emergent operation. Of these, 104 patients (37%) presenting with end-organ malperfusion were divided into those undergoing standard distal repair entailing transverse hemiarch replacement (Standard group, n = 65) versus standard repair with concomitant DTA TEVAR during circulatory arrest (TEVAR group, n = 39). Prospectively maintained aortic dissection database was retrospectively reviewed.


RESULTS
Demographic characteristics and preoperative comorbidities were similar. Circulatory arrest (56 ± 12 versus 34 ± 14 minutes, p < 0.001) and cross-clamp (176 ± 43 versus 119 ± 80, p = 0.001) times were longer in the TEVAR group. Overall, postoperative stroke rate (5% [n = 2] versus 6% [n = 4], p = 1), paraplegia rate (5% [n = 2] versus 5% [n = 3], p = 1.0), and renal failure rate (10% [n = 4] versus 22% [n = 14], p = 0.2) were similar. In-hospital/30-day mortality rate was lower in the TEVAR group but was not significant (18% (n = 7) versus 34% [n = 22], p = 0.1). In patients presenting with malperfusion involving greater than one end-organ system, the mortality rate was significantly improved in the TEVAR group (28% [n = 6] versus 58% [n = 14], p = 0.05).


CONCLUSIONS
Standard repair with antegrade TEVAR of the DTA for acute DeBakey I aortic dissection presenting with malperfusion syndromes can be safely performed. Further, true lumen stabilization achieved through DTA TEVAR may provide a survival benefit in patients with distal multiorgan malperfusion.
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: prashanth.vallabhajosyula@uphs.upenn.edu.
Prashanth
P
Vallabhajosyula
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Jean Paul
JP
Gottret
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Rohan
R
Menon
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Ibrahim
I
Sultan
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Zara
Z
Abbas
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Mary
M
Siki
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Matthew
M
Kramer
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Aaron
A
Pulsipher
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Suveeksha
S
Naidu
Mayo Clinic, Rochester, Minnesota.
Alberto
A
Pochettino
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Kariana
K
Milewski
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Wilson Y
WY
Szeto
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Joseph E
JE
Bavaria
D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome