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Long-term outcomes after repaired acute type A aortic dissections

^a Department of Adult Cardiac Surgery, Timone Hospital, Marseille, France
^b LERTIM, Medicine Faculty, Marseille, France

*Corresponding author: Service de Chirurgie Cardiaque Adulte, Hôpital de la Timone, 264, rue St Pierre, 13005 Marseille, France. Tél.: +33 491385717; fax: +33 491384926.

E-mail address: vlad.gariboldi{at}ap-hm.fr (V. Gariboldi).

The aim was to evaluate long-term outcomes after surgical treatment of acute type A dissection. Between 1993 and 2004, 199 consecutive patients were operated on for acute type A dissection. All survivors were included in an MRI follow-up program. Follow-up time averaged 4.45 years. Overall survival was 96%, 80% and 65% at 1, 5 and 10 years. The false lumen remained patent in 101 cases (69%). Predicitve factors for thrombosis of the false lumen were age >70 years old and valve-sparing aortic root reconstruction. Significant risk factors for patency of the distal false lumen were age <50 years old, De Bakey type III retrograde dissections, Bentall procedure and long-term anticoagulation. Freedom from reoperation was 98%, 96% and 69% at 1, 5 and 10 years. Eight patients required reoperations for dilatation of distal aorta at 4.7±2.8 years after the first operation. Reoperations consisted of combined surgical and endovascular procedures, without in-hospital or late deaths. Close MRI follow-up demonstrated that aortic false lumen remained patent in a majority of cases. Surgical reconstruction needing long-term anticoagulation must be avoided when possible to decrease patency of the false lumen. However, late reoperations are infrequent and can be treated with a low risk by using endovascular procedures.

Key Words: Aortic dissection; Magnetic resonance imaging; Reoperation

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