Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection

Objective

The fate of the dissected distal aorta after surgery for acute type A aortic dissection has not been fully understood. We assessed the influence of a residual patent false lumen on long-term outcomes.

Methods

Two hundred eighteen patients underwent emergency surgery for DeBakey type I or IIIb retrograde acute type A aortic dissection (1997–2006). Aortic arch replacement was performed in selected patients whose entry site was in or extended into the aortic arch. In-hospital mortality was 7.3% (16/218), and 193 survivors (mean age 62 years) underwent enhanced computed tomography within 1 month after the operation. These patients were divided into two groups according to the status of the false lumen, whether patent (n = 124) or thrombosed (n = 69). In each group, segment-specific aortic growth rate, distal reoperation, and late survival were examined.

Results

Growth rate was determined in 139 (72.0%) patients who underwent serial computed tomography. Average growth rate in the patent group was greater than that in the thrombosed group (aortic arch [1.1 vs −0.41 mm per year; P = .005], proximal descending aorta [1.9 vs −0.71 mm per year; P <.001], and distal descending aorta [1.3 vs −0.70 mm per year; P = .002]). However, growth was slow (<1 mmper year) in about 50% of patients in the patent group. There was no significant difference in distal reoperation or late survival between the two groups.

Conclusions

The patent false lumen influences postoperative aortic enlargement. However, with careful follow-up, a favorable prognosis is expected even for patients with a residual patent false lumen.

Abbreviations and Acronyms: AAAD, acute type A aortic dissection, COPD, chronic obstructive pulmonary disease, CT, computed tomography

CTSNet classification: 26