Document Detail

Long-term survival after open repair of chronic distal aortic dissection.
MedLine Citation:
PMID:  20417761     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The optimal treatment of chronic distal aortic dissection remains controversial, with endovascular stent-graft techniques challenging traditional surgery. METHODS: From January 1994 to April 2007, 104 patients (82 male, median age 60.5 years) with chronic distal aortic dissection underwent surgical repair, 0 to 21 years after initial diagnosis of acute type A or B dissection (median 2.1 years). Twenty-three (22%) patients underwent urgent-emergent surgery. Mean aortic diameter was 6.9 +/- 1.4 cm. Indications for surgery, other than aortic expansion, were pain in 6 (6%) patients, malperfusion in 6 (6%), and rupture in 11 (11%). Forty-nine (47%) had previous cardioaortic surgery (29% dissection-related), 21 (20%) had coronary artery disease, 12 (12%) had Marfan syndrome, and 4 (4%) were on chronic dialysis. Twenty-six (25%) had a thrombosed false lumen. Thirty (29%) patients required reimplantation of visceral arteries; 8.3 +/- 2.7 segmental artery pairs were sacrificed. RESULTS: Hospital mortality was 9.6% (10 patients). Paraplegia occurred in 5 (4.8%). Twenty-seven patients (26%) experienced adverse outcome (death within one year, paraplegia, stroke, or dialysis). Adverse outcome was associated with atheroma (p = 0.04, odds ratio = 4.3). Survival was 78% at 1, 68% at 5, and 59% at 10 years (average follow-up, 7.7 +/- 4.1 years). Freedom from distal aortic reoperation was 99% at 1, 93% at 5, and 83% at 10 years. After one year, patients enjoyed longevity equivalent to a normal age-sex matched population (standardized mortality ratio = 1.38, p = 0.23). By multivariate analysis, atheroma (p = 0.0005, relative risk = 9.32) and age (p = 0.0003, relative risk = 1.15/year) were risk factors for long-term survival. CONCLUSIONS: The efficacy of open repair for distal chronic dissection is highlighted by normal survival after the first year, and a low reoperation-reintervention rate.
Stefano Zoli; Christian D Etz; Fabian Roder; Christoph S Mueller; Robert M Brenner; Carol A Bodian; Gabriele Di Luozzo; Randall B Griepp
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-26     Completed Date:  2010-06-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1458-66     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA.
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MeSH Terms
Aged, 80 and over
Aneurysm, Dissecting / mortality,  surgery*
Aortic Aneurysm, Abdominal / mortality,  surgery*
Aortic Aneurysm, Thoracic / mortality,  surgery*
Blood Vessel Prosthesis Implantation / adverse effects,  methods*
Cause of Death*
Chronic Disease
Cohort Studies
Databases, Factual
Disease-Free Survival
Follow-Up Studies
Hospital Mortality / trends
Middle Aged
Multivariate Analysis
Postoperative Complications / mortality,  physiopathology
Risk Assessment
Survival Analysis
Time Factors
Treatment Outcome
Vascular Surgical Procedures / methods,  mortality

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