Long-Term Results of Surgery for Stanford Type A Aortic Dissection. Risk Factors of Distal False Lumen Dilatation / 日本心臓血管外科学会雑誌

ABSTRACT

For treatment of Stanford type A aortic dissection, we have operated only on the ascending aorta out of consideration of operative invasions and complications. However, if only the ascending aorta is replaced, the residual distal false lumen and its dilatation become problematic. We examined the risks of postoperative dilatation of the distal false lumen in terms of the following three factors (1) patency of the distal false lumen, (2) Marfan's syndrome, (3) aortic medial degeneration. Between 1984 and 1993, 55 cases of acute and chronic type A aortic dissection were treated surgically at our hospital, and a total of 33 survivors were subsequently followed up. The mean follow-up period was 92 months. None of the survivors died of late aortic complications. Five patients (15%) had Marfan's syndrome. As a result, all 18 patients (55%) with a closed distal false lumen did not show late distal dilatation or late deaths. Marfan patients had a high incidence of distal dilatation of the aorta and required additional aortic operations. Aortic medial degeneration was a high risk factor for younger onset (>40 years old) of aortic dissection, patent false lumen, and late dilatation, not only for Marfan patients but for non-Marfan patients. Non-Marfan patients with onset of aortic dissection under 40 years of age, showed significantly high incidence of medial degeneration. In conclusion, patent false lumen and medial degeneration of non-Marfan patients is a high risk factor of late dilatation as well as those of Marfan patients. On the other hand, patent false lumen is not a risk factor of late dilatation for non-Marfan patients without medial degeneration. Therefore, in both Marfan and non-Marfan patients with onset under 40 years of age, concomitant aortic arch repair should be performed because the rate of reoperation is significantly high.