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Joseph F. Sabik
Bruce W. Lytle
Eugene H. Blackstone
Patrick M. McCarthy
Floyd D. Loop
Delos M. Cosgrove
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J Thorac Cardiovasc Surg 2000;119:946-962
© 2000 The American Association for Thoracic Surgery

Surgery For Acquired Cardiovascular Disease

Long-term effectiveness of operations for ascending aortic dissections

Joseph F. Sabik, MD, Bruce W. Lytle, MD, Eugene H. Blackstone, MD, Patrick M. McCarthy, MD, Floyd D. Loop, MD, Delos M. Cosgrove, MD

From the Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.

Address for reprints: Joseph F. Sabik, MD, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195 (E-mail: sabikj{at}ccf.org ).

Objective: To evaluate long-term effectiveness of a strategy for managing the aortic root and distal aorta according to the pathology in ascending aortic dissection.
Methods: From 1978 to 1995, 208 patients underwent operations for acute (n = 135) and chronic (n = 73) ascending aortic dissection. Surgical strategies included valve resuspension with supracoronary aortic root repair and ascending aortic graft for normal sinuses and valve (n = 135), composite valve and ascending aortic graft for abnormal sinuses and valve (n = 47), and valve replacement and supracoronary ascending aortic graft for normal sinuses and abnormal valve (n = 26). Resection extended into the arch only if the intimal tear originated in or extended to the aortic arch (n = 31).
Results: Hospital mortality was 14%. Cardiogenic shock (P = .002) and concomitant coronary artery bypass grafting (P = .001) were associated with increased risk; use of circulatory arrest (P = .0003) decreased risk. Survival was 87%, 68%, and 52% at 30 days, 5 years, and 10 years, respectively. Advanced age, earlier date of operation, composite graft, and arch resection were associated with decreased survival; residual distal dissected aorta was not. Reoperation was required for 5 proximal and 8 distal problems.
Conclusions: In both acute and chronic ascending aortic dissections, (1) circulatory arrest is associated with low early mortality; (2) with normal sinuses and valve, supracoronary repair of the dissected aortic root and valve resuspension is effective long term; and (3) residual distal dissected aorta does not decrease late survival and has a low risk of aneurysmal change and reoperation for at least 10 years.




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