Open thoracoabdominal aortic repair for chronic type B dissection

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 149; no. 2; pp. S125 - S129
• Main Authors: Kouchoukos, Nicholas T., MD, Kulik, Alexander, MD, MPH, Castner, Catherine F., RN, BSN
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2015
• Subjects: Adult; Aged; Aneurysm, Dissecting - diagnosis; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aortic Aneurysm, Thoracic - diagnosis; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Cardiopulmonary Bypass; Cardiothoracic Surgery; Chronic Disease; Circulatory Arrest, Deep Hypothermia Induced; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Postoperative Complications - mortality; Postoperative Complications - therapy; Reoperation; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; Young Adult; 26.1; CPB; spinal cord ischemic injury; SCII; CSF; cerebral spinal fluid; HCA; cardiopulmonary bypass; hypothermic circulatory arrest
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2014.07.064

Objectives Advances in endovascular surgery have brought into question the role of open operative treatment of chronic thoracoabdominal aortic dissection. In this context, we evaluated our experience with open repair of this condition using a single operative technique. Methods From January 1986 to January 2014, 69 patients with chronic thoracoabdominal aortic dissection underwent open repair using total cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA). The degree of repair was as follows: Crawford extent I, 13 patients (19%), Crawford extent II, 41 patients (59%), and Crawford extent III, 15 patients (22%). Thirty patients (43%) had Marfan or Loeys-Dietz syndrome. Fifty-three patients (77%) had previous operations on the thoracic or abdominal aorta. Results The 30-day mortality rate was 5.8% (4 patients). Stroke occurred in 2 (3%) of 66 operative survivors, and spinal cord ischemic injury in 4 (6%). Temporary dialysis for new-onset renal failure was required in 4.5% of hospital survivors and tracheostomy in 10.6%. Survival after 1, 5, and 10 years was 87%, 65%, and 40%, respectively. Eighteen patients (26%) required a total of 20 subsequent operations on the thoracic or abdominal aorta of whom 15 had Marfan or Loeys-Dietz syndrome. Three of these procedures were for contiguous distal aortic disease and 10 were for patch aneurysms of the intercostal or visceral/renal arteries. Conclusions Open thoracoabdominal aortic repair for chronic dissection using CPB and HCA can be accomplished with mortality and morbidity rates that are comparable with those reported for endovascular or hybrid techniques. Open repair should remain a viable and primary option for the management of this condition until the long-term effectiveness of alternative methods of treatment is clearly established.