Background: There has been great enthusiasm for thoracic endograft repair of chronic thoracic or thoracoabdominal aortic dissection (ChAD) given the low operative morbidity and mortality. However long-term results are unknown and early reintervention is common. This study examines the early and late results of open repair of ChAD using deep hypothermia and circulatory arrest (DHCA).
Methods: From January 1995 to December 2009, 343 patients had open repair of descending thoracic or thoracoabdominal aneurysms using DHCA. Of these individuals, 93 patients had open repair of ChAD with DHCA. All patients undergoing elective procedures underwent preoperative cardiac catheterization. Lumbar drains were not placed preoperatively. Visceral or renal artery bypass was performed in 20% of patients. Supraaortic branches were bypassed in 14% of patients.
Results: Mean age was 60 ± 14 years. Men composed 77% of the cohort. Aortic replacement encompassed the descending aorta in 29% of patients, type I thoracoabdominal repair was performed in 25% of patients, type II thoracoabdominal repair was performed in 40% of patients, and arch replacement was performed in 24% of patients. Operative mortality was 2.2%, renal failure requiring dialysis was 0%, paralysis occurred in 1.1% of patients, stroke occurred in 1.1% of patients, prolonged intubation was needed in 9.7% of patients, and tracheostomy was needed in 2.2% of patients. Postoperative length of stay was 10.5 ± 7.6 days. One-, 3-, 5-, and 10-year survival rates were 93%, 90%, 79%, and 61%, respectively. Reintervention was necessary in 2.2% of patients for graft infection, in 2.2% of patients for anastomotic pseudoaneurysm, and in 4.4% of patients for growth of a distal aortic aneurysm.
Conclusions: Open repair of ChAD with DHCA has low operative morbidity and mortality. Long-term survival is very good with low rates of reintervention. Endovascular repair of ChAD does not have proven short- or long-term efficacy.
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