Distal aortic reintervention after surgery for acute DeBakey type I or II aortic dissection: open versus endovascular repair.
Publication/Presentation Date
8-1-2015
Abstract
OBJECTIVES: Aortic dissection DeBakey type I and II may require distal reinterventions after initial proximal repair. We evaluated outcomes following open versus endovascular approaches to distal aortic pathologies after surgery for acute dissection.
METHODS: One hundred and forty-one consecutive patients underwent 152 distal reinterventions after previous type I or II dissection repair [63 (first quartile, 55; third quartile, 72) years old; initially 86% DeBakey type I; 54% hemiarch, 39% isolated ascending, 7% total arch replacement] at two tertiary centres in the USA and Europe over the last 14 years. Among them, 56 and 85 required reintervention for the aortic arch and the descending aorta, respectively. The median follow-up was 2.1 (first quartile, 0.8; third quartile, 5.8) years (439 patient-years).
RESULTS: The median time between acute aortic dissection repair and descending aortic reintervention was longer in the open group (2.7 (first quartile, 0.8; third quartile, 6.7) vs 0.6 (first quartile, 0.1; third quartile, 3.5) years, P < 0.01). There was one irreversible spinal ischaemia in the open and one stroke in the endovascular group. Two patients in the open and none in the endovascular group required re-exploration for bleeding. Two open and 4 endovascular patients required more than 1 distal reintervention (6 vs 8%, P = 1). Descending aortic open-repair patients experienced higher in-hospital mortality (23 vs 0%, P < 0.01) and lower survival at 1 and 5 years (74 ± 8% vs 96 ± 3%, 65 ± 9% vs 92 ± 5%, P < 0.01, respectively).
CONCLUSIONS: Endovascular intervention for descending aortic pathologies after DeBakey type I or II dissection surgical repair is associated with lower in-hospital mortality and better survival, and does not raise the likelihood of later reinterventions at the mid-term follow-up.
Volume
48
Issue
2
First Page
258
Last Page
263
ISSN
1873-734X
Published In/Presented At
Rylski, B., Beyersdorf, F., Desai, N. D., Euringer, W., Siepe, M., Kari, F. A., Vallabhajosyula, P., Szeto, W. Y., Milewski, R. K., & Bavaria, J. E. (2015). Distal aortic reintervention after surgery for acute DeBakey type I or II aortic dissection: open versus endovascular repair. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 48(2), 258–263. https://doi.org/10.1093/ejcts/ezu488
Disciplines
Medicine and Health Sciences
PubMedID
25527171
Department(s)
Department of Surgery
Document Type
Article