Pursuit of the Changes of the Descending Aortic False Lumen after Surgical Repair of Acute DeBakey Type 1 Aortic Dissection

Abstract

Background: After surgical repair of acute DeBakey type 1 aortic dissection (AIAD), most survivors suffer from persistent false lumen in the descending aorta that adversely affects the long-term prognosis, and the need for secondary intervention is prompted. Objective: This study was aimed at providing control data to determine the actual benefits of more aggressive or newer approaches by investigating the changes in the descending aortic false lumen over 1-year follow-up. Patients and Methods: This retrospective study included 83 patients with AIAD ± significant aortic incompetence (AI). On emergency basis, all the patients had undergone aggressive resection of the intimal tear and replacement of the ascending aorta ± proximal or total aortic arch replacement, and aortic valve (AV) repair, replacement, valve sparing re-implantation of the AV or composite replacement of the aortic root (depending on the encountered pathology). Multi-slice CT aortography (MSCT) at 6-months and 1-year was done for segmental analysis of the distal aortic diameter at fixed levels and false lumen status evaluation. Results: The mean age was 47.18±4.87 years. Mortality was 8(9.64%) intraoperatively, 10(12.05%) operative mortality, no late mortality and the overall 1-year survival rate was 65(78.31%). The overall hospital complications rate was 17(22.67%). The descending aortic false lumen remained patent in most [56(86.15%)] survivors. There was no dilatation of the descending aorta at 6-months. At 1-year, there was statistically significant (p<0.001) dilatation of the descending aorta of >10 mm in 24(42.86%) and <10 mm in 32(57.14%) in patients with persistent false lumen. Patients <40 years expressed statistically significant (p<0.001) total resolution of the false lumen and >10 mm dilatation of the descending aorta. Multivariable logistic regression analysis showed that the significant predictive risk factors for persistence of the false lumen in the descending aorta were age <50 year (OR: 3.10 (95% CI: 0.846-19.320); p= 0.041), Bentall operation (OR: 0.35 (95% CI: 0.026-2.087); p= 0.021) and long-term anticoagulation (OR: 0.19 (95% CI: 0.025-1.289); p= 0.043), and those for thrombosis of the false lumen were age >60 years (OR: 6.13 (95% CI: 5.123-34.162); p= 0.031) and valve-sparing aortic root reconstruction (OR: 4.23 (95% CI: 1.480-14.053); p= 0.007). Conclusion: Residual intimal tear in the distal descending aorta is the major cause of continued false lumen patency. More extensive aortic replacement and avoidance of surgical reconstruction procedures needing long-term anticoagulation could diminish the prevalence of patent false lumen and its adverse sequelae.