Abstract
BackgroundThis study aimed to analyze the mortality and morbidity of patients undergoing open aortic arch reconstruction for acute type A aortic dissection.MethodsBetween September 2005 and January 2012, 267 consecutive patients underwent open aortic arch reconstruction for acute type A aortic dissection at our center. The mean age was 51.2 ± 10.0 years, and 200 patients were male. Sixty-three and 184 patients underwent hemiarch replacement and total arch replacement, respectively, whereas the remaining 20 patients underwent single- or triple-branched stent graft implantation. Long-term mortality was estimated by Kaplan–Meier method.ResultsThe in-hospital and operative mortality rates within 30 days were 11.2 % and 8.2 %, respectively. The cardiopulmonary bypass, myocardial ischemic, and antegrade cerebral perfusion times were 150.2 ± 43.3, 71.9 ± 33.2, and 33.6 ± 14.4 min, respectively. The overall in-hospital and intensive care unit durations and mean ventilation time were 23.9 ± 18.4 and 9.5 ± 12.7 days and 122.7 ± 183.4 h, respectively. We observed new postoperative permanent neurological dysfunction in 29 patients and temporary neurological dysfunction in 17 patients. The mean follow-up duration was 52.4 ± 27.9 months; 76.4 % of patients completed follow-up and 143 remained alive. Overall long-term survival was 82.2 % at 5 years.ConclusionsThe open aortic arch reconstruction technique for acute type A dissection carries a relatively high in-hospital mortality risk, although the late results are encouraging. Patients with an advanced age or impaired renal function may opt for endovascular or modified single- or triple-branched stent graft implantation therapy.
Highlights
This study aimed to analyze the mortality and morbidity of patients undergoing open aortic arch reconstruction for acute type A aortic dissection
Acute Type A aortic dissection involving the aortic arch remains a catastrophic condition for patients, with high mortality and morbidity rates [1, 2]
We retrospectively investigated our experiences and reported the surgical mortality and morbidity rates and follow-up results of patients who underwent open aortic arch reconstruction for acute type A aortic dissection
Summary
This study aimed to analyze the mortality and morbidity of patients undergoing open aortic arch reconstruction for acute type A aortic dissection. Advancements in thoracic endovascular aortic repair such as branched endografts or hybrid-debranching endovascular aortic repair have extended the option of endoluminal therapy into the realm of the aortic arch, open aortic arch reconstruction currently remains an irreplaceable surgical technique. This technique remains a surgical challenge because of the long operation time, bleeding complications, and high morbidity and mortality resulting from multiple organ failure. We retrospectively investigated our experiences and reported the surgical mortality and morbidity rates and follow-up results of patients who underwent open aortic arch reconstruction for acute type A aortic dissection
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