Long-Term Survival After Open Repair of Chronic Distal Aortic Dissection

Stefano Zoli, Christian D. Etz, Fabian Roder, Christoph S. Mueller, Robert M. Brenner, Carol A. Bodian, Gabriele Di Luozzo, Randall B. Griepp

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)1458-1466
Number of pages9
JournalAnnals of Thoracic Surgery
Volume89
Issue number5
DOIs
Publication statusPublished - May 2010

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

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    Zoli, S., Etz, C. D., Roder, F., Mueller, C. S., Brenner, R. M., Bodian, C. A., Di Luozzo, G., & Griepp, R. B. (2010). Long-Term Survival After Open Repair of Chronic Distal Aortic Dissection. Annals of Thoracic Surgery, 89(5), 1458-1466. https://doi.org/10.1016/j.athoracsur.2010.02.014