Clinical outcomes and fate of the distal aorta following 1-stage repair of extensive chronic thoracic aortic dissection.

OBJECTIVE: To analyze clinical outcomes and distal segmental aortic growth and aortic reoperation rates following 1-stage open repair of extensive chronic aortic dissection that included resection and graft replacement of the aneurysmal descending thoracic aorta.

METHODS: Among 68 patients undergoing extensive 1-stage repair of chronic aortic dissection that included the ascending aorta, arch, and varying lengths of the descending thoracic aorta, 66 were hospital survivors (early mortality 2.9%). Fifty-one of these patients (77%) had serial imaging studies suitable for calculation of growth rates of the remaining thoracic and upper abdominal aorta. The mean duration of follow-up was 5.8 years and extended to 13.7 years.

RESULTS: The overall growth rate of the distal aorta for the entire cohort was 0.10 mm/year. For 28 patients followed for >5 years, the growth rate was 0.03 mm/year. Three patients required reoperation on the contiguous thoracic or abdominal aorta for aneurysmal degeneration 8 months, 34 months, and 6.2 years postoperatively. Actuarial freedom from reoperation for aneurysmal growth of the distal aorta at 5 and 10 years was 96.3% and 93.3%, respectively. Actuarial freedom from any aortic reoperation at 5 years and 10 years was 88.6% and 82.7%, respectively. Actuarial survival at 5, 7, and 10 years was 78.2%, 71.2%, and 57.3%, respectively.

CONCLUSIONS: Our extended experience with the 1-stage procedure confirms its safety and feasibility for treatment of extensive chronic thoracic aortic dissection. It is associated with a low incidence of reoperation on the contiguous aorta for aneurysmal degeneration. It represents a viable alternative to 2-stage and hybrid procedures that are also used to treat this condition.