Surgical Outcomes of Chronic Descending Dissections: Type I Versus III DeBakey.

Overview

BACKGROUND: We evaluated the results of open operation for the treatment of descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA) in patients with DeBakey type I versus type III chronic aortic dissection. METHODS: We reviewed our institutional aortic database and compared the results of open repair in patients with type I versus type III chronic aortic dissection. Between 1997 and 2015, 726 patients underwent open DTA or TAAA repair at our institution. The indication for this procedure was chronic dissection in 243 patients (101 type I and 142 type III). Propensity matching was used to neutralize differences in preoperative risk profile. RESULTS: Operative mortality was 4% (4 of 101) in type I and 9.2% (13 of 142) in type III (p = 0.12). The incidence of major postoperative complications was similar between the two groups. Five-year Kaplan-Meyer survival was similar between the groups (68.3% for type I and 72% for type III patients, p 0.80). Five-year risk of reoperation was 3.5% in type I and 6.6% in type III (p = 0.25). These results were confirmed in 76 propensity-matched pairs. CONCLUSIONS: Perioperative and midterm results are similar for patients undergoing open TAAA/DTA repair for chronic type I and III dissection. There was a trend toward increased operative mortality and 5-year risk of reoperation in the type III group, but it did not reach statistical significance.