Open and closed distal anastomosis for acute type A aortic dissection repair: early and long-term outcomes from a contemporary series of 204 patients

204 patients underwent repair of spontaneous acute type A aortic dissection between January 2000 and December 2013. Open and distal anastomosis strategies were equally used by all the first operators throughout the study period. Univariate comparisons of preoperative, operative and postoperative variables were performed between the two groups. Twenty-six variables were entered into a regression model to determine the impact on mortality and the occurrence of postoperative neurologic complications. The subgroup of patients with type 1 de Bakey and an intimal tear in the proximal aorta was studied with a similar analysis design. Mean FU was of 67 +/- 46 months. CT scan FU was available in 83 patients among survivors. Patients in the open repair group were more likely to present and intimal tear located into the aortic arch and a dissection flap extending distally to the descending aorta. There were no differences in terms of mortality, morbidity and length of stay between the two groups of patients. Open repair with cerebral perfusion was associated with a lower rate of postoperative neurologic complications; DHCA alone was an independent risk factor for the occurrence of postoperative neurologic deficits. Patients who underwent an open distal anastomosis showed a significant higher rate of complete thrombosis of the false lumen (p = 0.036)