A 10-year study of surgical results of descending aorta aneurysm repair following chronic aortic dissection

• Published in: Journal of vascular surgery 2020-10, Vol.72 (4), p.1288-1297
• Main Authors: Cho, Jun Woo, Choo, Suk Jung, Lee, Chul Ho, Kim, Ho Jin, Kim, Joon Bum, Jung, Sung Ho, Chung, Cheol Hyun, Shinn, Sung Ho, Lee, Jae Won
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aneurysm, Dissecting - etiology; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - complications; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Aortic dissection; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - methods; Chronic; Chronic Disease - mortality; Chronic Disease - therapy; Female; Hospital Mortality; Humans; Male; Marfan Syndrome - complications; Marfan Syndrome - mortality; Marfan Syndrome - surgery; Middle Aged; Open surgical repair; Postoperative complication; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - therapy; Retrospective Studies; Survival; Survival Rate; Treatment Outcome
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2020.01.047

Patients presenting with descending aortic aneurysms developing after aortic dissection often undergo continued aortic expansion which may require operative interventions to address the risk of aortic rupture. In light of the current advances in various treatment options, including endovascular approaches, we analyzed our experience with open surgical repair (OSR) of aneurysms of the descending aorta following aortic dissection. Patients who underwent open repair for aneurysmal changes of the descending aorta after chronic dissection were retrospectively studied. The 30-day operative mortality rate, midterm survival, and major complications were analyzed. Patients were divided into two categories; primary chronic type B aortic dissection and remnant repaired type A aortic dissection (RTAAD). There were 149 patients with enlargement of the descending thoracic aorta developing after aortic dissection. Of these, 49 patients had medical management, while the remaining 100 patients received OSR. These patients were included in the present analysis. The 30-day mortality and permanent paraplegia rates were 9% and 4%, respectively. The 1-, 3-, and 5-year survival rates were 83%, 80.9%, and 76.1%, respectively. The 1- and 5-year survival rates between the primary chronic type B aortic dissection and remnant RTAAD groups showed no significant between-group differences at 86.7% and 84.3%, and 80% and 71.3%, respectively (P = .289). The overall outcomes of other complications such as renal injury, bleeding reoperation, and extracorporeal membrane oxygenation support showed no significant between-group differences, including an insignificantly higher neurologic complication rate in the remnant RTAAD group. The survival rate in patients with Marfan syndrome was significantly higher than in the patients without Marfan syndrome (P = .033). OSR for descending aortic aneurysms developing after chronic aortic dissection showed good early and mid- to long-term outcomes, with acceptably low complication rates. OSR for descending aortic aneurysm after chronic aortic dissection associated with Marfan syndrome also showed good early and mid- to long-term outcomes.