Influence of Luminal Communication on Aortic Enlargement after Hemiarch Replacement for Acute Type A Aortic DissectionFunding None.
11 October 2018
27 December 2018
22 February 2019 (online)
Background Aortic enlargement after hemiarch replacement (HAR) for acute type A aortic dissection (AAAD) is a serious problem. We reviewed our experience and analyzed the risk factors for aortic enlargement.
Methods During April 2005 to December 2017, 364 patients underwent HAR for AAAD. Seventy-three patients fulfilled the inclusion criteria. We analyzed the change in aortic diameter, aortic growth rate, and major adverse aortic events (MAAEs) and their association with luminal communication of the aortic arch.
Results Anastomotic communication, supra-aortic communication (SAC), and distal aortic communication were found in 34 (46.6%), 28 (38.4%), and 20 (27.4%) patients, respectively. The aortic growth rate was high because of the presence of SAC, distal aortic communication, and the number of coexisting aortic communication. Univariate analysis showed that the presence of SAC and an initial aortic diameter > 35 mm at 20 mm distal to the left subclavian artery and at the pulmonary artery bifurcation (PAB) were risk factors for MAAEs. Multivariate analysis showed that SAC and an initial aortic diameter > 35 mm at the PAB were independent risk factors for MAAEs.
Conclusion SAC, distal aortic communication, and the number of coexisting aortic communication are significant risk factors for aortic enlargement after HAR for AAAD. SAC and an initial aortic diameter > 35 mm at the PAB are independent risk factors for MAAEs after this procedure.
- 1 Aizawa K, Kawahito K, Misawa Y. Long-term outcomes of tear-oriented ascending/hemiarch replacements for acute type A aortic dissection. Gen Thorac Cardiovasc Surg 2016; 64 (07) 403-408
- 2 Rylski B, Milewski RK, Bavaria JE. , et al. Long-term results of aggressive hemiarch replacement in 534 patients with type A aortic dissection. J Thorac Cardiovasc Surg 2014; 148 (06) 2981-2985
- 3 Rylski B, Beyersdorf F, Kari FA, Schlosser J, Blanke P, Siepe M. Acute type A aortic dissection extending beyond ascending aorta: limited or extensive distal repair. J Thorac Cardiovasc Surg 2014; 148 (03) 949-954 , discussion 954
- 4 Poon SS, Theologou T, Harrington D, Kuduvalli M, Oo A, Field M. Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis. Ann Cardiothorac Surg 2016; 5 (03) 156-173
- 5 Kimura N, Tanaka M, Kawahito K, Yamaguchi A, Ino T, Adachi H. Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg 2008; 136 (05) 1160-1166 , 1166.e1–1166.e3
- 6 Kimura N, Itoh S, Yuri K. , et al. Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg 2015; 149 (2, Suppl): S91-8.e1
- 7 Concistrè G, Casali G, Santaniello E. , et al. Reoperation after surgical correction of acute type A aortic dissection: risk factor analysis. Ann Thorac Surg 2012; 93 (02) 450-455
- 8 Rylski B, Hahn N, Beyersdorf F. , et al. Fate of the dissected aortic arch after ascending replacement in type A aortic dissection. Eur J Cardiothorac Surg 2017; 51 (06) 1127-1134
- 9 Tamura K, Chikazawa G, Hiraoka A, Totsugawa T, Sakaguchi T, Yoshitaka H. The prognostic impact of distal anastomotic new entry after acute type I aortic dissection repair. Eur J Cardiothorac Surg 2017; 52 (05) 867-873
- 10 Heo W, Song SW, Lee KH. , et al. Surgery for acute type I aortic dissection without resection of supra-aortic entry sites leads to unfavourable aortic remodelling. Eur J Cardiothorac Surg 2018; 54 (01) 34-41
- 11 Oda T, Minatoya K, Sasaki H. , et al. Adventitial inversion technique for type A aortic dissection distal anastomosis. J Thorac Cardiovasc Surg 2016; 151 (05) 1340-1345
- 12 Sabik JF, Lytle BW, Blackstone EH, McCarthy PM, Loop FD, Cosgrove DM. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg 2000; 119 (05) 946-962
- 13 Inoue Y, Matsuda H, Omura A. , et al. What is the optimal surgical strategy for Stanford type A acute aortic dissection in patients with a patent false lumen at the descending aorta?. Eur J Cardiothorac Surg 2018; 54 (05) 933-939
- 14 Watanuki H, Ogino H, Minatoya K. , et al. Is emergency total arch replacement with a modified elephant trunk technique justified for acute type A aortic dissection?. Ann Thorac Surg 2007; 84 (05) 1585-1591
- 15 Inoue Y, Matsuda H, Omura A. , et al. Long-term outcomes of total arch replacement with the non-frozen elephant trunk technique for Stanford type A acute aortic dissection. Interact Cardiovasc Thorac Surg 2018; 27 (03) 455-460
- 16 Evangelista A, Salas A, Ribera A. , et al. Long-term outcome of aortic dissection with patent false lumen: predictive role of entry tear size and location. Circulation 2012; 125 (25) 3133-3141
- 17 Tanaka H, Okada K, Kawanishi Y, Matsumori M, Okita Y. Clinical significance of anastomotic leak in ascending aortic replacement for acute aortic dissection. Interact Cardiovasc Thorac Surg 2009; 9 (02) 209-212
- 18 Unosawa S, Hata M, Niino T, Shimura K, Shiono M. Prognosis of patients undergoing emergency surgery for type A acute aortic dissection without exclusion of the intimal tear. J Thorac Cardiovasc Surg 2013; 146 (01) 67-71
- 19 Uchino G, Ohashi T, Iida H. , et al. Predictors of patent false lumen of the aortic arch after hemiarch replacement. Gen Thorac Cardiovasc Surg 2016; 64 (12) 722-727
- 20 Tsai TT, Evangelista A, Nienaber CA. , et al; International Registry of Acute Aortic Dissection. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med 2007; 357 (04) 349-359
- 21 Tsai M-T, Wu H-Y, Roan J-N. , et al. Effect of false lumen partial thrombosis on repaired acute type A aortic dissection. J Thorac Cardiovasc Surg 2014; 148 (05) 2140-2146.e3
- 22 Song SW, Chang BC, Cho BK. , et al. Effects of partial thrombosis on distal aorta after repair of acute DeBakey type I aortic dissection. J Thorac Cardiovasc Surg 2010; 139 (04) 841-7.e1 , discussion 847
- 23 Girish A, Padala M, Kalra K. , et al. The impact of intimal tear location and partial false lumen thrombosis in acute type B aortic dissection. Ann Thorac Surg 2016; 102 (06) 1925-1932