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J Thorac Cardiovasc Surg 2008;136:1160-1166
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection

^a Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
^b Department of Cardiac Surgery, Kashiwa Hospital, Jikei University School of Medicine, Kashiwa, Japan

Received for publication October 27, 2007; revisions received February 10, 2008; accepted for publication May 20, 2008.

^_* Address for reprints: Naoyuki Kimura, MD, Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya, Saitama 330-0834, Japan. (Email: masashi{at}omiya.jichi.ac.jp).

Objective: The fate of the dissected distal aorta after surgery for acute type A aortic dissection has not been fully understood. We assessed the influence of a residual patent false lumen on long-term outcomes.

Methods: Two hundred eighteen patients underwent emergency surgery for DeBakey type I or IIIb retrograde acute type A aortic dissection (1997–2006). Aortic arch replacement was performed in selected patients whose entry site was in or extended into the aortic arch. In-hospital mortality was 7.3% (16/218), and 193 survivors (mean age 62 years) underwent enhanced computed tomography within 1 month after the operation. These patients were divided into two groups according to the status of the false lumen, whether patent (n = 124) or thrombosed (n = 69). In each group, segment-specific aortic growth rate, distal reoperation, and late survival were examined.

Results: Growth rate was determined in 139 (72.0%) patients who underwent serial computed tomography. Average growth rate in the patent group was greater than that in the thrombosed group (aortic arch [1.1 vs –0.41 mm per year; P = .005], proximal descending aorta [1.9 vs –0.71 mm per year; P <.001], and distal descending aorta [1.3 vs –0.70 mm per year; P = .002]). However, growth was slow (<1 mmper year) in about 50% of patients in the patent group. There was no significant difference in distal reoperation or late survival between the two groups.

Conclusions: The patent false lumen influences postoperative aortic enlargement. However, with careful follow-up, a favorable prognosis is expected even for patients with a residual patent false lumen.

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