Long-term outcomes after entry closure and aneurysmal wall plication for type B aortic dissection☆

Abstract

Objective: To examine the long-term outcomes after entry closure and aneurysmal wall plication for type B chronic dissecting aortic aneurysm. This procedure uses no artificial graft and preserves all intercostal arteries. Methods: We reviewed the records of 40 consecutive patients who underwent this procedure between September 1983 and December 2002. The mean age at operation was 60 AE 12 years (range, 38-79 years). The mean follow-up period was 9.8 AE 5.1 years (range, 4-23 years). Follow-up was completed in 38 patients (95%). The latest computed tomography scans (n = 22) were obtained 9.5 AE 5.1 years (range, 3-18 years) after surgery. Results: There were no operative deaths and 14 late deaths, none of which were related to the aneurysm. No paraplegia or paraparesis occurred. The survival rate was 92 AE 4% at 5 years and 64 AE 9% at 10 years; 24 patients are still alive. Follow-up computed tomography revealed that the mean diameter of the plicated descending aorta was 31 AE 5 mm (range, 22-39 mm) except in four patients. One of the four patients required reoperation for recurrent aneurysm of the plicated aorta 3 years postoperatively. In the remaining three patients, the plicated aorta has become enlarged; however, these patients have not yet undergone reoperation. Reoperation for residual dissecting aneurysm was performed in another three patients whose plicated aorta was normal. Freedom from reoperation for residual dissecting aneurysm was 78 AE 5% at 10 years. Conclusions: This procedure produces excellent short-term outcomes and low long-term morbidity. It could be the procedure of choice in selected patients to prevent paraplegia, although graft replacement is currently the standard treatment for chronic aortic dissecting aneurysm. #

Open surgical repair for chronic type B aortic dissection: A systematic review

“…Another study indicated that TEVAR was only a 'complication-specific' indication (28). The remaining six studies from the endovascular era did not provide any evidence that they also perform endovascular repairs (29)(30)(31)(32)34,36), while another did not state indication for OSR (2).…”

“…Nine studies did not specify indications for surgery (2,16,17,24,25,29,32,33,36). In series from institutions that also reportedly performed TEVAR, indications for open repair included extensive involvement of the aorta (33,35) or connective tissue disease (35).…”

“…Individual patient survival data of 458 patients was reconstructed from the Kaplan-Meier survival curves of 7 studies (26,(28)(29)(30)(31)33,35). Analysis of this data using Kaplan-Meier methods demonstrate 1-, 2-, 3-, 5-, and 10-year survival of 82.1%, 77.1%, 74.1%, 66.3%, 50.8%, respectively (Figure 1).…”

“…Chronicity was not defined in 10 studies (2,24,26,27,(29)(30)(31)(32)34,36). All but two studies used the Stanford classification for aortic dissections (14,24,27).…”

“…After excluding records based on abstract, 225 full-text articles were assessed according to the inclusion and exclusion criteria. Nineteen relevant studies were included in the present review (2,(14)(15)(16)(17)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36).…”