Surgical outcome of subtypes of aortic arch dissection.

This study was conducted to investigate if the site of primary intimal tear involving the aortic arch and the surgical approach affect the early and late results of total aortic arch replacement. Between 1993 and November 2001, 42 patients underwent graft replacement of the total aortic arch for aortic dissection. Their mean age was 51.9 +/- 9.8 years, and 38 of them were male. All operations were performed under hypothermic circulatory arrest with retrograde cerebral perfusion. Hospital mortality was 28.6% (12 patients). There were 2 late deaths. Multivariate analysis showed that chronic obstructive pulmonary disease and ascending aortic replacement with or without valve replacement were significant independent determinants of early death. Patients with the intimal tear originating in the ascending aorta showed a tendency towards lower 7-year survival rates than those with a tear at other aortic sites or with multiple tears, while the presence of chronic obstructive pulmonary disease adversely affected early and late outcomes. We conclude that the primary site of an intimal tear that involves the aortic arch affects early and late survival, but concomitant non-cardiac diseases play an even more important role in the early outcome as they increase the complexity of the operation.

Extensive aortic surgery in Marfan syndrome: 16-year experience.

The aim of this study was to evaluate the clinical outcome of surgical treatment in patients with Marfan syndrome. Between 1985 and November 2001, 33 patients with Marfan syndrome were operated for chronic aneurysm of the aortic root with involvement of the ascending aorta in 20 patients and type A dissection in 13 patients. The patients comprised 24 males and 9 females with a mean age of 31.9 +/- 9.7 years (range, 18 to 54 years). The mean diameter of the ascending aorta was 6.6 +/- 1.6 cm and that of the aortic root was 5.4 +/- 1.2 cm. Hemodynamic instability was observed in 11 patients. The aortic arch was replaced in 7 patients. There was no hospital mortality. Late mortality was 6%, involving 2 patients who had aortic valve replacement. Actuarial freedom from death was 92.3% +/- 7.4% at 12 years and from late aortic complications was 86.4% +/- 9.4% at 13 years. Aortic aneurysm was a significant univariate adverse factor for late aortic complications. Aortic surgery can be performed in Marfan patients with low morbidity and mortality. Aggressive surgical intervention does not impair surgical outcome while it decreases reoperation risk.