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One-Stage Repair of Extensive Chronic Thoracic Aortic Dissection

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Aortic Dissection and Acute Aortic Syndromes

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Abstract

Objective: The goal of this chapter is to present the technique and the results associated with the 1-stage open surgical repair (via bilateral anterior thoracotomy) for patients with extensive chronic thoracic aortic dissection.

Methods: During a 21-year interval ending in December, 2015, we employed the technique described herein to treat 80 patients with chronic, extensive aortic dissection and aneurysmal enlargement of the thoracic aorta, with surgical replacement of the ascending aorta, the entire aortic arch, and varying lengths of the descending thoracic aorta.

Results: The hospital mortality rate was 2.5% (two patients). Six patients (7.5%) required reoperation for bleeding. Stroke occurred in one patient (1.2%), and spinal cord ischemic injury (paraplegia) occurred in one patient (1.2%). Renal failure requiring dialysis occurred in six patients (7.5%). Twelve patients (15%) required a tracheostomy. At 1-year, the mortality rate was 12% (eight patients). Five patients required reoperation on the contiguous thoracic or abdominal aorta 8–174 months postoperatively for progressive enlargement. Actuarial freedom from reoperation on the contiguous aorta at 10 years was 93%, and freedom from any aortic reoperation at 10 years was 84.4%.

Conclusions: Our extended experience with the 1-stage open procedure confirms its safety and durability for treatment of chronic thoracic aortic dissection with aneurysmal enlargement. The procedure is associated with low operative risk and a low incidence of reoperation on the contiguous aorta. It represents a reasonable alternative to the 2-stage, frozen elephant trunk, and hybrid procedures that are also used to treat this condition.

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Author information

Authors and Affiliations

  1. Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, Boca Raton, FL, USA

    Alexander Kulik

  2. Florida Atlantic University, Boca Raton, FL, USA

    Alexander Kulik

  3. Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC HealthCare, St. Louis, MO, USA

    Nicholas T. Kouchoukos

  4. Washington University School of Medicine, St. Louis, MO, USA

    Nicholas T. Kouchoukos

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  1. Alexander Kulik
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  2. Nicholas T. Kouchoukos
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Editor information

Editors and Affiliations

  1. Rhode Island Hospital, Brown University, Providence, RI, USA

    Frank W. Sellke

  2. Department of Surgery, Baylor College of Medicine, Houston, USA

    Joseph S. Coselli

  3. Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Thoralf M. Sundt

  4. Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Joseph E. Bavaria

  5. Thoracic Cardiothoracic Surgery, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA

    Neel R. Sodha

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Kulik, A., Kouchoukos, N.T. (2021). One-Stage Repair of Extensive Chronic Thoracic Aortic Dissection. In: Sellke, F.W., Coselli, J.S., Sundt, T.M., Bavaria, J.E., Sodha, N.R. (eds) Aortic Dissection and Acute Aortic Syndromes. Springer, Cham. https://doi.org/10.1007/978-3-030-66668-2_24

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  • DOI: https://doi.org/10.1007/978-3-030-66668-2_24

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