The DeBakey classification exactly reflects late outcome and re-intervention probability in acute aortic dissection with a slightly modified type II definition

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• 作者：Konstantinos  ; Tsagakis ; Paschalis  ; Tossios ; Markus  ; Kamler ; Jaroslav  ; Benedik ; Dorgam  ; Natour ; Holger  ; Eggebrecht ; Jarowit  ; Piotrowski ; Heinz  ; Jakob  ; ;   ; ^{heinz.jakob@uk-essen.de}
• 关键词：Aortic dissection ; DeBakey classification ; Stanford classification
• 刊名：European Journal of Cardio-Thoracic Surgery
• 出版年：2011
• 出版时间：November 2011
• 年：2011
• 卷：40
• 期：4
• 页码：1078-1084
• 全文大小：558 K

文摘

Objective: The DeBakey classification was used to discriminate the extent of acute aortic dissection (AD) and was correlated to long-term outcome and re-intervention rate. A slight modification of type II subgroup definition was applied by incorporating the aortic arch, when full resectability of the dissection process was given. Methods: Between January 2001 and March 2010, 118 patients (64 % male, mean age 59 years) underwent surgery for acute AD. As many as 74 were operated on for type I and 44 for type II AD. Complete resection of all entry sites was performed, including antegrade stent grafting for proximal descending lesions. Results: Patients were comparable with respect to demographics and preoperative hemodynamic status. They underwent isolated ascending replacement, hemiarch, or total arch replacement in 7 % , 26 % , and 67 % in type I, versus 27 % , 37 % , and 36 % in type II, respectively. Additional descending stent grafting was performed in 33/74 (45 % ) type I patients. In-hospital mortality was 14 % , 16 % (12/74) in type I versus 9 % (4/44, type II), p = 0.405. After 5 years, the estimated survival rate was 63 % in type I versus 80 % in type II, p = 0.135. In type II, no distal aortic re-intervention was required. In type I, the freedom of distal re-interventions was 82 % in patients with additional stent grafting versus 53 % in patients without, p = 0.022. Conclusions: The slightly modified DeBakey classification exactly reflects late outcome and aortic re-intervention probability. Thus, in type II patients, the aorta seems to be healed without any probability of later re-operation or re-intervention.