Legitimacy of Entry-Oriented Strategy in DeBakey I Dissection in the Era of Endovascular Therapy

Authors

  • Tamer Ghazy Department of Cardiac Surgery, Dresden Heart Centre University Hospital, Dresden, Germany
  • Utz Kappert Department of Cardiac Surgery, Dresden Heart Centre University Hospital, Dresden, Germany
  • Ralf-Thorsten Hoffmann University Center for Vascular Medicine and Institute for Diagnostic Radiology, University Hospital Carl Gustav Carus Dresden, Germany
  • Helena Hegelmann University Center for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden, Germany
  • Zuzana Fajfrova Department of Cardiac Surgery, Dresden Heart Centre University Hospital, Dresden, Germany
  • Mohamed Eraqi Department of Cardiac Surgery, Dresden Heart Centre University Hospital, Dresden, Germany
  • Klaus Matschke Department of Cardiac Surgery, Dresden Heart Centre University Hospital, Dresden, Germany
  • Norbert Weiss University Center for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden, Germany
  • Adrian Mahlmann University Center for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, Dresden, Germany

DOI:

https://doi.org/10.1532/hsf.1708

Abstract

Background: Legitimacy of entry-oriented therapy for DeBakey I aortic dissection is of eminent importance in the era of emerging ascending aorta endovascular therapy. This study aims to evaluate early, midterm, and reintervention results of entry-oriented operative strategy compared to more aggressive strategies for treatment of DeBakey type I aortic dissection with an isolated intimal tear in the ascending aorta.

Methods: This study prospectively followed 98 consecutive patients who received an operation for DeBakey type I aortic dissection with the intimal tear in the ascending aorta between 2007 and 2013 for up to 6 years. Follow-up included survival, medical therapy, CT-imaging results, and reinterventions. Patients were grouped into entry-oriented (group I) receiving an isolated replacement of the ascending aorta and/or hemiarch (65 patients); and aggressive therapy (group II) receiving a replacement of the ascending aorta and complete aortic arch (33 patients). 

Results: The in-hospital mortality was 19% and 23% respectively. The 3-year survival was 52% and 47% respectively (P = .193). Group II showed no advantage regarding persistence or progression of the dissection, thrombosis of false lumen, increase in aortic diameter, peripheral organ malperfusion (as assessed by follow-up computed tomography imaging) or freedom from reintervention. 

Conclusion: In treating DeBakey I aortic dissection with an entry tear in the ascending aorta, it might be legitimate to adopt an entry-oriented operative strategy. Further research is also needed to clearly describe the indication of extending the operative strategy in such cases.

References

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Published

2017-10-24

How to Cite

Ghazy, T., Kappert, U., Hoffmann, R.-T., Hegelmann, H., Fajfrova, Z., Eraqi, M., Matschke, K., Weiss, N., & Mahlmann, A. (2017). Legitimacy of Entry-Oriented Strategy in DeBakey I Dissection in the Era of Endovascular Therapy. The Heart Surgery Forum, 20(5), E184-E190. https://doi.org/10.1532/hsf.1708

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