Boston - American Association for Thoracic Surgery

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS11. Effect of Partial Thrombosis on Distal Aorta After Repair of AcuteDeBakey Type I Aortic DissectionSuk-Won Song, 1 Byung-Chul Chang, 2*† Bum-Koo Cho, 2*∞ Kyung-Jong Yoo 21. Yondong Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea;2. Severance Hospital, Yonsei University College of Medicine, Seoul, South KoreaInvited Discussant: Anthony L. EstreraOBJECTIVE: Patency or thrombosis of the residual aorta after repair of acuteDeBakey type I aortic dissection has been found to predict long-term outcome.However, prognostic implications of partial thrombosis of the residual aorta havenot yet been elucidated. We sought to analyze the impact of partial thrombosis onsegmental growth rates, distal reprocedures, and long-term survival.METHODS: One hundred eighteen consecutive patients (55% male; mean age, 60years) with acute DeBakey type I aortic dissection underwent aggressive resectionof the intimal tear and open distal anastomosis (1997–2007). Hospital mortalitywas 17.8%. Survivors had serial computed tomographic scans: digitization yieldeddistal segmental dimensions.Segment-specific average rates of enlargement and factors influencing fastergrowth were analyzed. Distal reprocedures and patient survival were examined.RESULTS: Sixty-six (61%) patients had imaging data sufficient for growth ratecalculations. The median diameters after repair were as follows: aortic arch, 3.5 cm;descending aorta, 3.6 cm; and abdominal aorta, 2.4 cm. Subsequent growth rateswere 0.34, 0.51, and 0.35 mm/y, respectively. Partial thrombosis of the residual aortapredicted greater growth in the distal aorta (p = 0.005). There were 13 distal aorticreprocedures (8 stent graft insertions, 5 reoperations) for 10 years, and reprocedures-freesurvival was 66%. Partial thrombosis (p = 0.002), or complete patency(p = 0.008) predicted greater risk of aorta-related reprocedures. Cox proportionalhazard analysis revealed eGFR lesser than 60 ml/min/1.73 m2 (p = 0.030), reintubation(p = 0.002), and partial thrombosis (p = 0.023) were independent predictors forpoor long-term outcome.* AATS Member† Graham Memorial Traveling Fellowship 1987–1988∞Graham Memorial Traveling Fellowship 1976–197788