Long-term effectiveness of operations for ascending aortic dissections

Joseph F. Sabik*, Bruce W. Lytle, Eugene H. Blackstone, Patrick M. McCarthy, Floyd D. Loop, Delos M. Cosgrove

*Corresponding author for this work

Research output: Contribution to journalArticle

164 Scopus citations

Abstract

Objective: To evaluate long-term effectiveness of a strategy for managing the aortic root and distal aorta according to the pathology in ascending aortic dissection. Methods: From 1978 to 1995, 208 patients underwent operations for acute (n = 135) and chronic (n = 73) ascending aortic dissection. Surgical strategies included valve resuspension with supracoronary aortic root repair and ascending aortic graft for normal sinuses and valve (n = 135), composite valve and ascending aortic graft for abnormal sinuses and valve (n = 47), and valve replacement and supracoronary ascending aortic graft for normal sinuses and abnormal valve (n = 26). Resection extended into the arch only if the intimal tear originated in or extended to the aortic arch (n = 31). Results: Hospital mortality was 14%. Cardiogenic shock (P = .002) and concomitant coronary artery bypass grafting (P = .001) were associated with increased risk; use of circulatory arrest (P = .0003) decreased risk. Survival was 87%, 68%, and 52% at 30 days, 5 years, and 10 years, respectively. Advanced age, earlier date of operation, composite graft, and arch resection were associated with decreased survival; residual distal dissected aorta was not. Reoperation was required for 5 proximal and 8 distal problems. Conclusions: In both acute and chronic ascending aortic dissections, (1) circulatory arrest is associated with low early mortality; (2) with normal sinuses and valve, supracoronary repair of the dissected aortic root and valve resuspension is effective long term; and (3) residual distal dissected aorta does not decrease late survival and has a low risk of aneurysmal change and reoperation for at least 10 years.

Original languageEnglish (US)
Pages (from-to)946-964
Number of pages19
JournalJournal of Thoracic and Cardiovascular Surgery
Volume119
Issue number5
StatePublished - Jan 1 2000

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Sabik, J. F., Lytle, B. W., Blackstone, E. H., McCarthy, P. M., Loop, F. D., & Cosgrove, D. M. (2000). Long-term effectiveness of operations for ascending aortic dissections. Journal of Thoracic and Cardiovascular Surgery, 119(5), 946-964.