Surgical results of Stanford type B aortic dissection. Comparisons between partial and subtotal replacement of the dissected aorta.

BACKGROUND

Surgical results for Stanford type B aortic dissection were retrospectively compared between the subtotal prosthetic replacement of the thoracoabdominal dissected aorta (STR) and partial replacement of the descending aorta at the intimal tear (PR).

METHODS

Twenty-two patients (11 males and 11 females with mean age of 56.9+/-2.6 years) undergoing repair of aneurysms were analyzed. All operations were performed with the aid of femorofemoral partial cardiopulmonary bypass. Reconstruction of the critical artery for spinal cord blood supply was determined by evoked spinal cord potential (ESP) monitoring in non-urgent cases. Operative mortality and incidence of complications were compared between the PR group (Group I; n=15) and the STR group (Group II; n=7).

RESULTS

There were one operative death and one late death in Group I. No early or late deaths occurred in Group II. Postoperative paraplegia occurred in 1 patient in Group I and 2 patients in Group II. Among patients undergoing selective reconstruction of the critical intercostal arteries, paraplegia occurred in only one patient. Incidence of postoperative complications was not significantly different between Group I and Group II. Presence of rupture (p<0.001) and development of acute renal failure (p<0.05) revealed significant determinants of postoperative mortality by multivariate analysis. Operative procedure did not influence postoperative mortality or occurrence of paraplegia.

CONCLUSIONS

Operative results of STR with selective reconstruction of the critical arteries and PR for aortic dissection were comparable. Subtotal replacement of the thoracoabdominal dissected aorta is encouraged to apply for patients with diffuse, large postdissection aneurysms or those with a high risk of future enlargement of remaining false channels such as Marfan syndrome, under adequate reconstruction of the critical segmental arteries.