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  • Title: Residual Arch Tears and Major Adverse Events After Acute DeBakey Type I Aortic Dissection Repair.
    Author: Heo W, Song SW, Lee KH, Kim TH, Baek MY, Yoo KJ, Cho BK.
    Journal: Ann Thorac Surg; 2018 Oct; 106(4):1079-1086. PubMed ID: 29959944.
    Abstract:
    BACKGROUND: Tear-oriented surgical procedure is considered a standard treatment for acute DeBakey type I aortic dissection (AIAD). However, long-term surgical outcomes, including aortic growth and rate of major adverse aortic events (MAAEs), have yet to be clarified. METHODS: Of the 274 patients who underwent surgical repair for AIAD between 2009 and 2016, 105 patients with both predischarge and follow-up computed tomographic scans were enrolled. The surgical extent was determined by primary entry tear location. We measured aortic diameters (pulmonary artery bifurcation, maximum diameter of the descending thoracic aorta [maxDTA], and celiac axis) and compared MAAEs (aorta growth rate ≥ 5 mm/year or maxDTA ≥ 55 mm according to surgical extent). RESULTS: Twenty-nine patients underwent total arch replacement (TAR); 76 underwent non-TAR. In the non-TAR group, patients with or without residual tears in the arch vessels were classified as having complete arch repair (non-TAR-CAR, n = 52) or incomplete arch repair (non-TAR-IAR, n = 24). Considerable differences were found in the aortic growth rate between the TAR and non-TAR groups and the non-TAR-CAR and non-TAR-IAR groups. Freedom from MAAEs at 5 years was considerably higher in the non-TAR-CAR group than in the non-TAR-IAR group (84.5% versus 31.1%). However, no differences were observed in the aortic growth rate and freedom from MAAEs between the TAR and non-TAR-CAR groups. CONCLUSIONS: Classic tear-oriented surgical procedure is insufficient for optimal long-term surgical outcomes, mainly regarding aortic dilation. CAR without residual arch vessel tears leads to favorable aortic remodeling in the residual DTA and prevents MAAEs after AIAD repair.
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