In DeBakey Type I Aortic Dissection, Bovine Aortic Arch Is Associated With Arch Tears and Stroke

Abstract

The study sought to evaluate if a bovine aortic arch (BAA) influences the location of the entry site in acute aortic dissection type A (AADA) and to identify the impact of BAA on postoperative outcome, especially stroke. A total of 315 patients underwent surgery due to AADA DeBakey type I (72.1% men, mean age 59.5 ± 13.4 years) between 2002 and 2015. Imaging studies and operative reports were screened for presence of BAA and location of the entry site. Patients were divided into 2 groups based on presence (BAA+) and absence (BAA-) of BAA (BAA+ n= 49, BAA- n= 264). Dissection patterns, surgical treatment, risk factors for postoperative complications, and long-term outcome were analyzed. Prevalence of BAA in patients with AADA was 15.6%. Location of the entry site was more commonly in the aortic arch in patients with BAA (BAA+ 46.8% versus BAA- 14.3%; p < 0.001). Multivariable analysis identified BAA (odds ratio [OR], 5.9; 95% confidence interval [CI], 2.89 to 12.04; p < 0.001) and preoperative competent aortic valve (OR, 2.26; 95% CI, 1.19 to 4.31; p= 0.013) as independent predictors for an arch tear. Thirty-nine patients (12.4%) suffered from stroke. Patients with BAA had higher stroke rates (BAA+ 24.5% versus BAA- 10.2%; p= 0.009). BAA emerged as one risk factor for stroke in the setting of AADA (OR, 2.69; 95% CI, 1.2 to 6.0; p= 0.016). Long-term survival was comparable for patients with BAA and patients without congenital arch anomalies. BAA is an independent predictor for the distinctive location of the entry site in the aortic arch and risk factor for stroke.