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30. The Fate of the Distal Aorta after Repair of Acute Type A Dissection
James C Halstead, Matthias Meier, David Spielvogel, Carol Bodian, Michael Wurm, Rohit Shahani, Randall B Griepp; New York, NY
Objective:
The history of the residual aorta following repair of acute type A dissection is incompletely understood. We analyzed segmental growth rates, distal reoperation, and other factors influencing long-term survival.
Methods:
179 consecutive patients (70% male; mean age 60) who underwent repair of acute type A dissection from 1984 to 2003--with aggressive resection of the intimal tear and open distal anastomosis-- were studied prospectively. Hospital mortality was 13.4%. Survivors underwent annual computed tomographic (CT) scans, which were digitized to obtain segmental dimensions in the distal aorta. Individual growth rates and segment-specific average rates of enlargement were determined, and factors influencing growth analyzed. Distal reoperations and patient survival were also examined.
Results:
The mean segmental diameters following repair were: aortic arch 3.64 cm, descending aorta 3.73, and abdominal aorta 3.25; their subsequent growth rates were 0.85, 1.24, and 1.02 mm/yr respectively. No factors significantly influencing growth in the aortic arch were found, but initial size >4cm (p=0.01) and a patent false lumen (p=0.02) predicted greater growth in the descending aorta, and male gender (p=0.005) significantly affected growth in the abdominal aorta. There were 25 distal aortic reoperations: 10 arch, 5 descending, 4 thoracoabdominal, and 6 abdominal. The figure shows the outlook, with respect to the distal aorta, for survivors in terms of death, distal reoperation-free survival, and distal reoperation. Risk factors reducing long-term survival after repair of acute type A dissection included age (p<0.0001), new neurological deficit at presentation (p=0.01), and absence of any preoperative thrombus in the false lumen (p=0.008), but not distal reoperation.
Conclusions:
Growth of the distal aorta following repair of acute type A dissection is typically slow and linear, making distal reoperation uncommon.
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