Different techniques of distal aortic repair in acute type A dissection: impact on late aortic morphology and reoperation

Objective: To compare three different techniques of distal aortic repair in acute type A (de Bakey type I) aortic dissection and to evaluate their imp act on the Tate morphology of the aortic arch and descending aorta and on t he incidence of reoperation. Methods: From 65 patients operated on due to a n acute type A aortic dissection between 1989 and 1993, 54 long-term surviv ors underwent clinical and radiologic follow-up examination after a mean po stoperative interval of 62 +/- 16 months. The surgical techniques of distal aortic reconstruction included closed repair using Teflon felt reinforceme nt under moderate hypothermic cardiopulmonary bypass (n = 20) and open repa ir in deep hypothermic circulatory arrest using either Teflon felt reinforc ement (n = 16) or gelatin-resorcin-formaldehyde (GRF) glue (n = Is) to read apt the dissected aortic layers. In all patients, MR imaging was performed on a 1.5-T whole body imaging system for the evaluation of the morphology a nd function of the heart, aorta and supraaortic branches. Results: Overall hospital mortality following surgical repair of type A aortic dissection wa s 15.4% during this time period. The highest rate of persistent false lumen perfusion (17/20, 85%) and presence of an intimal flap in the aortic arch (13/20, 65%) was observed in patients following closed repair of acute asce nding aortic dissection, whereas the lowest rate of such findings was demon strated in patients who had undergone open distal aortic repair using biolo gical glue (false lumen perfusion 10/18, 55% and intimal flap in the arch 2 /18, 11%). Redo-surgery was significantly reduced in the open repair group using GRF glue (1/18, 5.5%) as compared with the Teflon felt repair group ( 3/16, 18%) and the closed repair group (6/20, 30%). Conclusions: In patient s with acute type A dissection, open distal aortic repair using GRF-glue fa vourably influences both (1) the severity of late morphologic alterations i n the downstream aorta and (2) the incidence of reoperation. (C) 1999 Elsev ier Science B.V. All rights reserved.