Surgical Repair for Acute Type A Aortic Dissection without Entry Resection

Tomonori Koga, Hideyuki Uesugi, Takashi Oshitomi, Ichiro Ideta, Kentaro Takaji, Yukihiro Katayama, Toshiharu Sassa, Hidetaka Murata, Shizuya Shintomi

Saiseikai Kumamoto Hospital, Kumamoto, Japan

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – C

Abstract

【Objective】

Basically, our surgical strategies for acute type A aortic dissection (AAAD) are primary entry resection. But if entry site is descending aorta or unknown (DeBakey IIIa retro or IIIb retro), it is difficult to resect the entry. And then, if it can’t resect the entry, is it useful to do arch replacement? We assessed whether the difference of surgical procedure (ascending aorta or hemiarch replacement and total or partial arch replacement) make some difference in outcome.

【Methods】

Between January 2001 and June 2017, 402 patients underwent surgical repair for AAAD at our hospital, and 273 patients were followable. 36 patients of them who have entry site at descending aorta or unknown were divided into two groups, A: underwent ascending aorta or hemi arch replacement(n=12) and B:underwent total or partial arch replacement(n=24). Follw-up data include survival rate, cause of death, aortic event (reoperation, recurrent dissection, and aortic rupture).

【Results】

Mean follow-up period was 26.3 months. There are no significant difference at preoperative characteristics, post-ope intubation time, ICU stay, hospital stay in both group. Two cerebral infarction(8.3%), four spinal infarction(16.7%) and two early death(bleeding)(8.3%) occurred in group B. Freedom from aortic event are A:70.4%@5year and B:82.3%@5year (p=0.532). Survival rate are A:60.6%@5year and B:71.4%@5year (p=0.813).

【Conclusions】

In this study, there are no significant difference in major adverse events between two groups. But aortic event occur a certain frequency, so we need to choose appropriate surgical procedure for each patient.