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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 46-59, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
ES Crawford, JW Kirklin, DC Naftel, LG Svensson, JS Coselli and HJ Safi
Thirty-day and 1-, 5-, 10-, and 20-year overall survivorships among 82
patients undergoing replacement of the ascending aorta with or without the
arch for acute aortic dissection between 1968 and May 1989 were 79%, 66%,
56%, 46%, and 30%, respectively. The multivariably determined risk factors
for death were the inclusion of the arch in the replacement, the year of
the operation, the predissection New York Heart Association functional
class, diabetes, and concomitant coronary artery bypass grafting. The
current 30-day survivorship predicted by the multivariable equation when
the operation involves only the ascending aorta is 97%, and the 10- and
20-year predicted survivorships are 61% and 39%, respectively. When the
current era the replacement involves the arch as well as the ascending
aorta, the predicted 30-day survivorship is 84%, and the 10- and 20-year
ones are 48% and 31%. In 1990 sixteen additional patients (one hospital
death) underwent ascending aortic replacement, and six (no hospital deaths)
ascending aorta and arch replacement. The predictions for 1990 from the
multivariable equation were similar to these actual experiences (Ps for
differences were 0.6 and 0.4). Seventy percent of surviving patients with
DeBakey type I dissection were free of a second aortic operation for
aneurysmal dilation of the distal false channel, but this occurred in none
of nine patients in whom an intimal tear in the transverse arch was
included in the resection.
ARTICLES
Surgery for acute dissection of ascending aorta. Should the arch be included?
Baylor College of Medicine, Houston, Tex.
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