Long-term outcomes of primary surgical repair for communicating DeBakey IIIb chronic dissecting aortic aneurysm

Abstract

ObjectiveThis study aimed to evaluate the long-term outcomes of surgical strategies for communicating DeBakey IIIb chronic dissecting aortic aneurysm, considering the optimal primary surgical repair to prevent aortic events. MethodsFrom 2002 to 2021, 101 patients with communicating DeBakey IIIb chronic dissecting aortic aneurysm who underwent surgical repair were categorized based on the primary surgical repair: 1-stage repair of thoracoabdominal aortic aneurysm (TAAAR) (n = 22) or staged repair, such as descending thoracic aneurysm repair (DTAR) (n = 43) or total arch replacement with elephant trunk implantation (TARET) (n = 25), and thoracic endovascular aortic repair (TEVAR) (n = 11). Early and late postoperative outcomes were compared among the groups. ResultsEarly outcomes for TAAAR, DTAR, TARET, and TEVAR were associated with the incidence of stroke (9.1% vs 0% vs 4.0% vs 9.1%, respectively), spinal cord injury (13.6% vs 4.7% vs 8.0% vs 0%, respectively), and in-hospital mortality (9.1% vs 2.3% vs 0% vs 9.1%, respectively). During follow-up, the 10-year overall survival and 7-year aortic event-free rates for TAAAR, DTAR, TARET, and TEVAR were 61.8%, 71.6%, 21.5%, and 26.5% and 93.8%, 84.3%, 74.4%, and 51.4%, respectively. TAAAR had significantly higher overall survival (P = .05) and aortic event-free rates (P = .03) than TEVAR. TARET (hazard ratio, 2.27; P < .01) and TEVAR (hazard ratio, 3.40; P < .01) were independently associated with the incidence of aortic events during follow-up. ConclusionsConsidering the optimal primary surgical repair based on long-term outcomes, TEVAR was not a durable treatment option. Patient-specific TAAAR or DTAR should be considered rather than defaulting to minimally invasive primary repairs for all patients with communicating DeBakey IIIb chronic dissecting aortic aneurysm.