Contemporary Outcomes of Open Repair of Acute Complicated Type B Aortic Dissection.
Academic Article
Overview
abstract
OBJECTIVE: Open repair of acute complicated type B aortic dissection (ACTBAD), required when endovascular repair is not possible, is historically considered high-risk. We analyze our experience with this high-risk cohort compared to standard cohort. METHODS: We identified consecutive patients undergoing descending thoracic (DTA) or thoracoabdominal aortic aneurysms (TAAA) repair from 1997-2021. Patients with ACTBAD were compared to those having surgery for other reasons. Logistic regression was used to identify associations with major adverse events (MAE). Five-year survival and competing risk of reintervention were calculated. RESULTS: Of 926 patients, 75 (8.1%) had ACTBAD. Indications included rupture (25/75), malperfusion (11/75), rapid expansion (26/75), recurrent pain (12/75), large aneurysm (5/75), and uncontrolled hypertension (1/75). The incidence of MAE was similar (13.3% (10/75) vs 13.7% (117/851), p=0.99). Operative mortality was 5.3% (4/75) versus 4.8% (41/851)(p=0.99). Complications included tracheostomy (8%, 6/75), spinal cord ischemia (4%, 3/75), and new dialysis (2.7%, 2/75). Renal impairment, urgent/emergent operation, FEV1≤50%, and malperfusion were associated with MAE, but not ACTBAD (OR 0.48, 95% CI [0.20-1.16], p=0.1). At 5- and 10-years, there was no difference in survival (65.8%(95%CI 54.6-79.2) vs 71.3%(95%CI 67.9-74.9), p=0.42 and 47.3%(95%CI 34.5-64.7) vs 53.7%(95%CI 49.3-58.4), p=0.29, respectively) or 10-year reintervention (12.5%(95%CI 4.3-25.3) vs 7.1%(95%CI 4.7-10.1), p=0.17, respectively). CONCLUSIONS: In an experienced center, open repair of ACTBAD can be performed with low rates of operative mortality and morbidity. Outcomes similar to elective repair are achievable even in high-risk ACTBAD patients. In patients unsuitable for endovascular repair, transfer to a high-volume center experienced in open repair should be considered.
