Approximately 10% of acute type A aortic dissections become chronic due to lack of symptoms or non-diagnosis. Clinical course, surgical strategy and outcomes differ. This study aims to analyze early outcomes of surgical treatment for chronic type A aortic dissection.
Materials and Methods: Forty-one patients operated for chronic type A aortic dissection between 2001 and 2014, were included in this study and the data were analyzed retrospectively. Mean age 55.9±13 years and 68% were male. The common risk factors for aortic dissection were hypertension (65%) and coronary artery disease (22%). Thirteen patients (31%) were previously operated for aortic or other cardiac procedure. Surgical incision was median sternotomy in most of patients (95%).
Results: The common procedures were tube graft replacement (20 patients), valved-conduit graft replacement for aortic root (15 patients) and total arch replacement (6 patients). Deep hypothermic circulatory arrest was used in 34 patients and additional antegrad cerebral perfusion in 7 patients, as brain protection strategy. The mean duration of cardiopulmonary bypass, myocardial ischemia time and cerebral ischemia were 210.1±67, 116.3±43 and 27.6±9 min, respectively. The common complications were re-exploration for bleeding in 3 patients, need for prolonged ventilator support in 5 patients. Mean intensive care unit and hospital stay was found 4.1±5 days and 9.8±8 days, respectively. Permanent stroke was observed in one patient because of multiple embolisms. Mortality was observed in one patient (%2) due to embolic stroke.
Conclusion: A low mortality rate can be achieved with appropriate strategy in the surgical treatment of chronic type A aortic dissection. Stroke seems to be the common cause of mortality.