COMPLICATED ACUTE TYPE B DISSECTION AND THORACOABDOMINAL DISSECTING ANEURYSM: LONG-TERM RESULTS OF SURGICAL AORTIC CONSERVATIVE TREATMENT.

OBJECTIVES:
Aortic fenestration and aortic tailoring represent surgical techniques proposed for treating ischemic complications of acute type B dissection and thoracic and thoraco-abdominal dissecting aneurysms. The purpose of this study is to evaluate the long-term results of these aortic conservative surgical treatments.
METHODS:
We retrospectively analyzed in-hospital surgical and long-term results of 26 patients, treated over 18 years. Among these, showing a normal sized aorta, 11 were acutely managed with a suprarenal surgical fenestration (Group 1A), while 8 had an infrarenal approach (Group 1B). 7 patients were operated on for subacute or chronic expanding dissecting aneurysms and were included in Group 2.
RESULTS:
In Group 1, surgical mortality was 26.3 % (5/19 pts); 27.8 % in Group 1A (3/11), related to myocardial infarction and mesenteric infarction, and 25% in Group 1B (2/8), due to heart failure and stroke. In Group 2, no in-hospital deaths were observed. Mean follow-up, completed for all patients, was 9.7 yrs (range 3-18 yrs). In group 1A and 1B, actuarial survival rate at 5, 10 and 15 yrs was 70%, 70% and 60%, and 75%, 71% and 57%, respectively. In group 2 it was 100% and 85% at 7 and 15 years. In group 1, mortality occurred in 3 patients on 14 (21.4%), and was related to cancer, myocardial infarction and a ruptured thoracic aneurysm in a segment not previously treated. In Group 2, one patient of 7 (14.3%) died 8 years after operation secondary to a stroke. No significant dilatations of the tailored aortic segments were noted in both groups.
CONCLUSIONS:
Aortic fenestration and thoracic and thoraco-abdominal aortic tailoring represent an effective option for treating acute ischemic and chronic expanding post-dissection type B aortic complications. In this series, long-term results provide evidence that the aorta surgically managed, both in descending and abdominal segments, do not dilate over time.