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DOI: 10.1055/s-0035-1544454
Long-term Results after Open Aortic Arch Surgery for Aneurysms and Type A Aortic Dissections - Comparable Outcomes Beyond the Perioperative Period
Background: Type A aortic dissection is a life threatening disease associated with high mortality, if untreated. With recent improvements in cannulation- and cerebral protection strategies, surgery can be performed safely with acceptable operative mortality and neurologic outcomes. However, operative mortality is still higher than in patients with aneurysms and long-term survival may be reduced due to complications by the remaining dissection in the descending aorta. The objective of this study is to compare the long-term outcome after open aortic arch replacement for type A aortic dissection and aneurysm.
Methods: Between March 2000 and March 2013 204 consecutive patients received hemi-arch (n = 142) and complete arch (n = 62) replacement at our institution. 106 patients suffered from type A aortic dissection and 98 from aortic aneurysm. Cerebral perfusion strategy included unilateral (54.2%), bilateral (34.2%) and retrograde (11.6%) perfusion. Mean follow-up was 4.4 ± 3.6 years (range 0 - 13.5) and was complete in 99.5%.
Results: 30-day mortality was 3.1% for patients with aortic aneurysm compared with 29.2% for type A aortic dissection (p < 0.001). Total 10-year survival for patients with aneurysms was 64.3% and 55.5% after dissection (p = 0.005). Excluding 30d mortality analysis showed a 10-year survival of 67.4% and 74.7%, respectively (p = 0.793). In multivariate cox regression analysis the only predictor for long-term mortality was a high logistic EuroScore II.
Conclusion: Once patients survived the perioperative period, long-term survival of patients with aortic dissection undergoing aortic arch surgery is not inferior compared with patients with aortic aneurysm.