Antegrade thoracic stent grafting during repair of acute Debakey type I dissection promotes distal aortic remodeling and reduces late open distal reoperation rate

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• 作者：Prashanth Vallabhajosyula ; Wilson Y. Szeto ; Aaron Pulsipher ; Nimesh Desai ; Rohan Menon ; Patrick Moeller ; Shenara Musthaq ; Alberto Pochettino ; Joseph E. Bavaria
• 关键词：26 ; 26.1 ; 26.1.2
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：March, 2014
• 年：2014
• 卷：147
• 期：3
• 页码：942-950
• 全文大小：357 K

文摘

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Objective

Previously, we showed that antegrade stent grafting of the descending thoracic aorta during DeBakey type I dissection repair improves distal aortic remodeling. We assessed midterm outcomes of this reconstructive strategy compared with standard open repair.

Methods

DeBakey type I dissections (non-Marfan, nontotal arch cases only) from 2005 to 2012 were retrospectively reviewed. One hundred eighty patients underwent standard open repair (standard group), and 62 patients underwent open repair plus stenting (stented group). Open repair entailed ascending aorta plus transverse hemiarch reconstruction under circulatory arrest, with variable aortic root work. Data was prospectively maintained.

Results

Preoperative parameters were similar. Patients in the stented group had longer circulatory arrest time and higher utility of antegrade cerebral perfusion (P聽<聽.001). In-hospital/30-day mortality (10% vs 14%; P聽=聽.51), stroke (5% vs 8%; P聽=聽.6), and paraplegia (0% vs 1%; P聽=聽1) were similar in the stented versus standard groups. Mean follow-up was 2.7 卤 2.3 and 2.2 卤 2.1 years. Actuarial survival in stented versus standard groups at 1 and 7 years was 86% versus 81% and 76% versus 60% (P聽=聽.5). Thoracic aorta false lumen obliteration was improved in the stented group (82% vs 39%; P聽<聽.001), along with improved freedom from open distal aortic reoperation rate (98% vs 90% at 6 years, P聽=聽.1). Endovascular distal aortic reintervention rate was higher in the stented group (18% vs 3%; P聽=聽.008), with zero mortality.

Conclusions

Antegrade stent graft deployment during acute DeBakey type I dissection repair is safe method to promote distal aortic remodeling without increasing postoperative or midterm mortality. This technique provides increased freedom from open distal aortic reoperations compared with standard open repair.