Pursuit of the Changes of the Descending Aortic False Lumen after Surgical Repair of Acute DeBakey Type 1 Aortic Dissection

Background: After surgical repair of acute DeBakey type 1 aortic dissection (AIAD), most survivors suffer from persistent false lumen in the descending aorta that adversely affects the long-term prognosis, and the need for secondary intervention is prompted. Objective: This study was aimed at providing control data to determine the actual benefits of more aggressive or newer approaches by investigating the changes in the descending aortic false lumen over 1-year follow-up. Patients and Methods: This retrospective study included 83 patients with AIAD ± significant aortic incompetence (AI). On emergency basis, all the patients had undergone aggressive resection of the intimal tear and replacement of the ascending aorta ± proximal or total aortic arch replacement, and aortic valve (AV) repair, replacement, valve sparing re-implantation of the AV or composite replacement of the aortic root (depending on the encountered pathology).Multi-slice CT aortography (MSCT) at 6-months and 1-year was done for segmental analysis of the distal aortic diameter at fixed levels and false lumen status evaluation. Results: The mean age was 47.18±4.87 years. Mortality was 8(9.64%) intraoperatively, 10(12.05%) operative mortality, no late mortality and the overall 1-year survival rate was 65(78.31%). The overall hospital complications rate was 17(22.67%). The descending aortic false lumen remained patent in most [56(86.15%)] survivors. There was no dilatation of the descending aorta at 6-months. At 1-year, there was statistically significant (p < 0.001) dilatation of the descending aorta of >10 mm in 24(42.86%) and 10 mm dilatation of the descending aorta. Multivariable logistic regression analysis showed that the significant predictive risk factors for persistence of the false lumen in the descending aorta were age p < /em>= 0.041), Bentall operation (OR: 0.35 (95% CI: 0.026-2.087); p < /em>= 0.021) and long-term anticoagulation (OR: 0.19 (95% CI: 0.025-1.289); p < /em>= 0.043), and those for thrombosis of the false lumen were age >60 years (OR: 6.13 (95% CI: 5.123-34.162); p < /em>= 0.031) and valve-sparing aortic root reconstruction (OR: 4.23 (95% CI: 1.480-14.053); p < /em>= 0.007). Conclusion: Residual intimal tear in the distal descending aorta is the major cause of continued false lumen patency. More extensive aortic replacement and avoidance of surgical reconstruction procedures needing long-term anticoagulation could diminish the prevalence of patent false lumen and its adverse sequelae.