The changes of aortic diameter after aortic repair with aortic tailoring technique for chronic type B aortic dissection.

OBJECTIVES

Aortic repair with aortic tailoring of the false lumen can preserve the true lumen and intercostal arteries naturally. It is a useful surgical strategy to prevent paraplegia. However, aortic remodelling of tailored segments in a late phase after surgery is another concern. This study investigates the destiny of aortic remodelling of tailored aorta.

METHODS

From June 2004 to April 2013, 21 consecutive patients underwent aortic tailoring operation for chronic type B aortic dissecting aneurysm. The mean age at operation was 60 ± 10 years (range, 43-77). The tailored aortic segments were followed by serial CT scanning with the mean follow-up period of 46 ± 32 months (range, 2-103).

RESULTS

There were no operative deaths but paraplegia in 1, stroke in 1 and reversible renal failure in 2 patients. There were two late deaths: one due to pneumonia and the other due to aneurysmal rupture of the abdominal aorta. Eighteen patients revealed a completely thrombosed false lumen and no expansion of the tailored aorta, with it remaining less than 40 mm in diameter during follow-up. However, 3 cases were associated with a patent false lumen and 2 cases revealed aortic events. The aortic event-free rate at 5 years was 95 ± 5.1% in all patients and 66 ± 27% in patients in the patent false lumen group.

CONCLUSIONS

Aortic tailoring is a useful surgical technique for chronic type B aortic dissection. Paraplegia and ischaemia of other visceral organs could less likely occur. Patients with a completely thrombosed false lumen revealed no aortic events; however, a patent false lumen was associated with a high risk of aortic events.