Allan M. Conway, Mostafa Sadek, Yonni Pellet, Georgia Panagopoulos, Alfio Carroccio, Konstadinos Plestis
Lenox Hill Heart & Vascular Institute of New York, New York, NY.
Posted April 2013
OBJECTIVES: Open surgical repair (OSR) for chronic Type B aortic dissections (CTBAD) has an associated morbidity and mortality. The role of thoracic endovascular aneurysm repair (TEVAR) in CTBAD has not been determined. We analyzed our contemporary experience of CTBAD undergoing OSR to identify high-risk patients that may be considered for TEVAR.
METHODS: From 1999-2010, 221 patients had repair of descending thoracic and thoracoabdominal aortic aneurysms, including 86 patients with CTBAD. We analyzed this cohort for mortality, complications, length of stay and re-interventions.
RESULTS: OSR was performed in 25 (29%) and 61 (71%) patients for descending thoracic and thoracoabdominal CTBAD, respectively. Mean age was 58.4 years (± 10.4) and mean diameter 6.2cm (±1.1, 4.1-10.0). Fifty-nine (69%) patients were male. Eight (9%) were treated for rupture. Mean duration of follow up was 5.2 years (± 2.7). Hospital mortality occurred in five (5.8%) patients. Cardiopulmonary bypass was used in 83 (97%) and deep hypothermic circulatory arrest in 36 (42%) patients. Paraplegia occurred in 2 (2.3%), stroke in 2 (2.3%), and renal failure requiring permanent hemodialysis in 2 (2.3%) patients. Average length of stay was 19.6 days (±17.8). Univariate predictor of hospital mortality included redo-operations and prolonged pump time (P<0.05). Maximum aneurysm diameter and rupture at presentation trended toward significance. Twenty (24.7%) patients of the 81 survivors died during follow-up (mean: 62.5 ±36 months). Six patients (7%) had aortic related re-operations at a mean of 3.8 years (±1.8): one for ascending and five for descending aortic aneurysms. Overall survival at 1, 5 and 7 years was 92%, 83% and 70%, respectively. Freedom from reoperation was 99%, 90% and 86%, respectively.
CONCLUSIONS: OSR of CTBAD is a durable option with low mortality. Patients requiring redo operations or anticipated prolonged pump time need further evaluation to determine whether conventional OSR or TEVAR, if feasible, is the optimal treatment option.
AUTHOR DISCLOSURES: A. Carroccio: Nothing to disclose; A. M. Conway: Nothing to disclose; G. Panagopoulos: Nothing to disclose; Y. Pellet: Nothing to disclose; K. Plestis: Nothing to disclose; M. Sadek: Nothing to disclose.