SURGICAL REPAIR OF TYPE-A AORTIC DISSECTION BY THE CIRCULATORY ARRESTGRAFT INCLUSION TECHNIQUE IN 66 PATIENTS

During an 8-year period (1984 to 1991) 66 patients (mean age 59 years, range 26 to 84 years) with type A aortic dissection (60 ascending aor ta tears, 6 arch tears; 35 acute, 31 chronic) had surgical repair by a continuous suture-graft inclusion technique. Hypothermic circulatory arrest (16-degrees-C) was used in 58 patients (35/35 acute, 23/31 chro nic; mean arrest time 26 minutes, range 10 to 55 minutes). Fifty-two p atients had hemiarch repair and 6 had total arch replacement. Aortic v alve disease necessitated treatment in 38 patients (1 valved conduit, 20 valve replacements, 17 valve repairs). Recently 11 patients had val ve repair by reconstruction of the native aortic root, by means of tec hniques similar to those used for homograft valve insertion. Operative mortality was 9% (14% acute, 3% chronic). Stroke occurred in 2 patien ts (3%) and was fatal in both. Variables suggestive of increased opera tive risk by univariate analysis were acuteness (p = 0.12), visceral i schemia (p = 0.12), and preoperative shock (p = 0.13). No variable was significant by multivariate analysis. Overall actuarial survival at 4 8 months was 77%, with 3 late deaths from a ruptured distal aneurysm. Late computed tomography or magnetic resonance imaging scan was done i n 28 patients at a mean interval of 33 months. These studies identifie d 1 patient with a pseudoaneurysm requiring reoperation and 3 patients with contained flow between the graft and the wrap. Three patients re quired late operation: 1 for pseudoaneurysm, 1 for arch dissection, an d 1 for repair of a distal aneurysm.