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Long-term outcomes after entry closure and aneurysmal wall plication for type B aortic dissection

Department of Cardiovascular Surgery, Hyogo College of Medicine, Hyogo, Japan

Received 10 September 2007; received in revised form 6 November 2007; accepted 7 November 2007.

^_* Corresponding author. Address: Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Tel.: +81 798 45 6852; fax: +81 798 45 6853. (Email: y-miyamo{at}hyo-med.ac.jp).

Objective: To examine the long-term outcomes after entry closure and aneurysmal wall plication for type B chronic dissecting aortic aneurysm. This procedure uses no artificial graft and preserves all intercostal arteries. Methods: We reviewed the records of 40 consecutive patients who underwent this procedure between September 1983 and December 2002. The mean age at operation was 60 ± 12 years (range, 38–79 years). The mean follow-up period was 9.8 ± 5.1 years (range, 4–23 years). Follow-up was completed in 38 patients (95%). The latest computed tomography scans (n = 22) were obtained 9.5 ± 5.1 years (range, 3–18 years) after surgery. Results: There were no operative deaths and 14 late deaths, none of which were related to the aneurysm. No paraplegia or paraparesis occurred. The survival rate was 92 ± 4% at 5 years and 64 ± 9% at 10 years; 24 patients are still alive. Follow-up computed tomography revealed that the mean diameter of the plicated descending aorta was 31 ± 5 mm (range, 22–39 mm) except in four patients. One of the four patients required reoperation for recurrent aneurysm of the plicated aorta 3 years postoperatively. In the remaining three patients, the plicated aorta has become enlarged; however, these patients have not yet undergone reoperation. Reoperation for residual dissecting aneurysm was performed in another three patients whose plicated aorta was normal. Freedom from reoperation for residual dissecting aneurysm was 78 ± 5% at 10 years. Conclusions: This procedure produces excellent short-term outcomes and low long-term morbidity. It could be the procedure of choice in selected patients to prevent paraplegia, although graft replacement is currently the standard treatment for chronic aortic dissecting aneurysm.

Key Words: Chronic type B aortic dissection • Long-term outcome • Entry closure • Aortic plication • Paraplegia