Long Term Results After Repair of Type A Acute Aortic Dissection According to False Lumen Patency.

Background. Late survival and freedom from retreatmenton the descending aorta was evaluated after ascendingaortic repair for type A acute aortic dissection(TAAAD).Methods. Between March 1992 and January 2006, 189TAAAD patients (mean age, 52 11; range, 17 to 83years) were included; of these, 58 had a patent falselumen, and 49 had Marfan syndrome. The descendingaorta was evaluated postoperatively with computed tomography(CT). Late outcomes were assessed by Coxregression analysis and actuarial survival and freedomfrom retreatment by the Kaplan-Meier method. Meanfollow-up was 88 44 months.Results. There were 38 (20%) late deaths. At 10 years,survival was 89.8% 2.1% for patients with an occludedfalse lumen and 59.8% 3.5% for patients with a patentfalse lumen (p 0.001), and freedom from retreatment onthe descending aorta was 94.2% 3.1% for an occludedfalse lumen and 63.7% 2.6% for a patent false lumen(p < 0.0001). Descending aortic rupture (p 0.002) and apatent false lumen (p 0.001) were predictors for latedeath. Patent false lumen (p 0.0001), Marfan syndrome(p 0.03), and descending aortic diameter 4.5 cm or larger(p 0.002) were predictors for retreatment.Conclusions. A patent false lumen was a predictor forlate death and retreatment on the descending aorta.Marfan syndrome and aortic size exceeding 4.5 cmwere predictors for late retreatment. These patientsrequire very close follow-up and a plan for retreatmenton the descending aorta to prevent sudden rupture andlate death.