Long-Term Results After Repair of Type A Acute Aortic Dissection According to False Lumen Patency

Background. Late survival and freedom from retreatment on the descending aorta was evaluated after ascending aortic repair for type A acute aortic dissection (TAAAD). Methods. Between March 1992 and January 2006, 189 TAAAD patients (mean age, 52 +/- 11; range, 17 to 83 years) were included; of these, 58 had a patent false lumen, and 49 had Marfan syndrome. The descending aorta was evaluated postoperatively with computed tomography (CT). Late outcomes were assessed by Cox regression analysis and actuarial survival and freedom from retreatment by the Kaplan-Meier method. Mean follow-up was 88 +/- 44 months. Results. There were 38 (20%) late deaths. At 10 years, survival was 89.8% +/- 2.1% for patients with an occluded false lumen and 59.8% +/- 3.5% for patients with a patent false lumen (p = 0.001), and freedom from retreatment on the descending aorta was 94.2% +/- 3.1% for an occluded false lumen and 63.7% +/- 2.6% for a patent false lumen (p < 0.0001). Descending aortic rupture (p = 0.002) and a patent false lumen (p = 0.001) were predictors for late death. Patent false lumen (p = 0.0001), Marfan syndrome (p = 0.03), and descending aortic diameter 4.5 cm or larger (p = 0.002) were predictors for retreatment. Conclusions. A patent false lumen was a predictor for late death and retreatment on the descending aorta. Marfan syndrome and aortic size exceeding 4.5 cm were predictors for late retreatment. These patients require very close follow-up and a plan for retreatment on the descending aorta to prevent sudden rupture and late death. (Ann Thorac Surg 2009; 88: 1244 -50) (C) 2009 by The Society of Thoracic Surgeons