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The Annals of Thoracic Surgery, Vol 49, 580-584, Copyright © 1990 by The Society of Thoracic Surgeons

ARTICLES

Thoracic aortic aneurysms after acute type A aortic dissection: necessity for follow-up

M Heinemann, J Laas, M Karck and HG Borst
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Federal Republic of Germany.

Between April 1979 and May 1989, 86 patients underwent emergency operation for acute type A aortic dissection. Sixty-four (74.4%) survived. None of the survivors died of late aortic complications. Fifty-eight patients were followed 3 months to 10 years (mean follow- up, 3.2 years) postoperatively with computed tomography and digital subtraction angiography. Dilatation of the distal aorta (diameter size range, 6 to 10.5 cm) developed in 10 patients (17%). Six patients underwent replacement of the descending aorta 1 month to 21 months (mean period, 8.5 months) after aortic dissection repair. Two of them had third-stage thoracoabdominal replacement. In 2 patients, replacement of the descending aorta was scheduled; 1 died before reoperation and 1 refused the procedure. Two patients underwent aortic arch replacement; it is scheduled for another (fourth stage). There were no deaths among the patients having reoperation. The rate of indications for reoperation on the aorta downstream from the original repair 1 month to 6 years 4 months (median time, 9 months) after primary surgical intervention for acute type A aortic dissection was 24% (14 reoperations in 10 of 58 patients). This study underscores the importance of close follow-up of patients having operation for acute type A aortic dissection. Early recognition of progressive downstream aortic pathology permits effective prevention of aortic rupture and timely reoperation.


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