Disadvantages of local repair in acute type A aortic dissection

Background. In acute type A dissection of the aorta, local repair with glue -aortoplasty was compared with aortic replacement. Methods. Between 1992 and 1996, 106 consecutive patients (mean age, 59 year s; 84 men) were operated on average 14.5 hours after onset of dissection. A local repair (gelatin-resorcine-formaldehyde/glutaraldehyde glue, Trigon A G, Monchengladbach, Germany) without graft replacement was performed in 21 patients. Graft replacement and reinforcement of aortic stumps with gelatin -resorcine-formaldehyde/glutaraldehyde glue was performed in 85 patients (s upracoronary graft, 68; aortic root replacement, 17). Results. Survival was 79% after 30 days and 69% after 2 years. There was no difference in early mortality (p = 0.2240) and survival (p = 0.07649). Ris k factors for early mortality were preoperative shock, neurologic disorder, duration of crossclamp, and extracorporeal circulation. The rate of reoper ation on the proximal aorta was 31.6% (6 of 19) after local repair and 9% ( 6 of 64) after aortic replacement (p = 0.0157). Local repair was a signific ant predictor for reoperation (p = 0.0087), with decreased reoperation-h ee survival (p = 0.01164). In all reinterventions (four supracoronary grafts, including two valve replacements; two composite grafts; two arch replaceme nts) breakdown of the aortoplasty was confirmed. Conclusion. Local repair has satisfactory early results but an increased in cidence of reoperations due to a breakdown of the glue-aortoplasty. Indicat ions for local repair should be restricted to high-risk patients requiring a minimal emergency surgical procedure. (C) 1998 by The Society of Thoracic Surgeons.