Original article
Cardiovascular
Outcomes and Survival in Surgical Treatment of Descending Thoracic Aorta With Acute Dissection

Presented at the Fifty-third Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 8–11, 2006.
https://doi.org/10.1016/j.athoracsur.2007.11.013Get rights and content

Background

Thoracic aortic replacement for acute DeBakey type III aortic dissection is associated with significant morbidity and mortality. We report the outcomes of 76 consecutive patients who underwent surgical repair of the descending thoracic aorta or the thoracoabdominal aorta for acute dissection.

Methods

During a 16-year period (1989 to 2004), we identified 76 patients who underwent surgery for acute type III aortic dissection. The average patient age was 64.1 ± 12.3 years (range, 36 to 84), and 55 patients (72.4%) were male. Surgical adjuncts included hypothermic circulatory arrest (8 patients), left heart bypass (15 patients), and cerebrospinal fluid drainage (5 patients). The mean aortic clamp time was 38.4 ± 17.3 minutes. Rupture was present in 17 patients (22.4%).

Results

There was 1 intraoperative death. Operative mortality was 22.4% (17 patients), including 11 patients (14.5%) who died within 30 days of operation. Five patients (6.6%) had paraplegia, and 15 patients (19.7%) required hemodialysis, 7 temporarily. Cardiac complications occurred in 33 patients (43.4%), 2 patients (2.6%) were returned to the operating room for bleeding, and 10 patients (13.6%) required tracheostomy. The mean hospital stay was 26.0 ± 29.7 days. Rupture was not associated with increased risk of postoperative complications or operative mortality.

Conclusions

In selected patients with emergent indications, operative intervention with open replacement of the descending thoracic aorta or thoracoabdominal aorta for acute dissection repair can be carried out with respectable mortality, morbidity, and survival rates.

Section snippets

Patients and Methods

Institutional Review Board protocol H-18095 for the collection of data for this study was approved and in place at the time of this study.

Results

One patient (1.3%) died intraoperatively, 11 patients (14.5%) died within 30 days, and another 6 died in-hospital beyond 30 days, resulting in an operative mortality of 17 patients (22.4%; Table 2). Two of these deaths occurred at an outside hospital after patients were transferred and the cause of death is unknown. Eight of these deaths were secondary to cardiac arrest, 6 were a result of multiple system organ failure, and 1 patient died intraoperatively during a second operation within the

Comment

This study is a descriptive measure of our experience with the surgical treatment of acute type III aortic dissection. As no comparison was made to a cohort of patients managed nonsurgically, a statement regarding the better approach to treatment would not be supported in either direction by the present study. The decision to operate on these patients is based on mortality rates for operative and nonoperative treatment described in the literature, taking into account risk stratification based

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