Residual Arch Tears and Major Adverse Events After Acute DeBakey Type I Aortic Dissection Repair

Background. Tear-oriented surgical procedure is considered a standard treatment for acute DeBakey type I aortic dissection (AIAD). However, long-term surgical outcomes, including aortic growth and rate of major adverse aortic events (MAAEs), have yet to be clarified. Methods. Of the 274 patients who underwent surgical repair for AIAD between 2009 and 2016, 105 patients with both predischarge and follow-up computed tomographic scans were enrolled. The surgical extent was determined by primary entry tear location. We measured aortic diameters (pulmonary artery bifurcation, maximum diameter of the descending thoracic aorta [maxDTA], and celiac axis) and compared MAAEs (aorta growth rate >= 5 mm/year or maxDTA >= 55 mm according to surgical extent). Results. Twenty-nine patients underwent total arch replacement (TAR); 76 underwent non-TAR. In the non-TAR group, patients with or without residual tears in the arch vessels were classified as having complete arch repair (non-TAR-CAR, n = 52) or incomplete arch repair (non-TAR-IAR, n = 24). Considerable differences were found in the aortic growth rate between the TAR and non-TAR groups and the non-TAR-CAR and non-TAR-IAR groups. Freedom from MAAEs at 5 years was considerably higher in the non-TAR-CAR group than in the non-TAR-IAR group (84.5% versus 31.1%). However, no differences were observed in the aortic growth rate and freedom from MAAEs between the TAR and non-TAR-CAR groups. Conclusions. Classic tear-oriented surgical procedure is insufficient for optimal long-term surgical outcomes, mainly regarding aortic dilation. CAR without residual arch vessel tears leads to favorable aortic remodeling in the residual DTA and prevents MAAEs after AIAD repair. (C) 2018 by The Society of Thoracic Surgeons.