Key result
Total aortic arch replacement for aortic dissection had a 28.6% hospital mortality, with COPD and ascending aortic replacement being significant independent determinants of early death.
Why the study?
Does the site of primary intimal tear affect early and late survival in patients undergoing total aortic arch replacement for aortic dissection?
Observational (n=42)
Does the site of primary intimal tear affect early and late survival in patients undergoing total aortic arch replacement for aortic dissection?
The primary site of an intimal tear and concomitant non-cardiac diseases like COPD significantly affect early and late survival after total aortic arch replacement for aortic dissection.
High mortality after total arch replacement for dissection, linked to COPD and ascending replacement, warrants caution; leaves open intimal tear site effects on survival.
This study was conducted to investigate if the site of primary intimal tear involving the aortic arch and the surgical approach affect the early and late results of total aortic arch replacement. Between 1993 and November 2001, 42 patients underwent graft replacement of the total aortic arch for aortic dissection. Their mean age was 51.9 +/- 9.8 years, and 38 of them were male. All operations were performed under hypothermic circulatory arrest with retrograde cerebral perfusion. Hospital mortality was 28.6% (12 patients). There were 2 late deaths. Multivariate analysis showed that chronic obstructive pulmonary disease and ascending aortic replacement with or without valve replacement were significant independent determinants of early death. Patients with the intimal tear originating in the ascending aorta showed a tendency towards lower 7-year survival rates than those with a tear at other aortic sites or with multiple tears, while the presence of chronic obstructive pulmonary disease adversely affected early and late outcomes. We conclude that the primary site of an intimal tear that involves the aortic arch affects early and late survival, but concomitant non-cardiac diseases play an even more important role in the early outcome as they increase the complexity of the operation.
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Kırali et al. (2004) conducted an observational in Aortic arch dissection (n=42). Site of primary intimal tear vs. Tear at other aortic sites or multiple tears was evaluated on Early death (hospital mortality) and late survival. Total aortic arch replacement for aortic dissection had a 28.6% hospital mortality, with COPD and ascending aortic replacement being significant independent determinants of early death.
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