Predictive factors for late aortic events after central repair of acute DeBakey I dissection.

OBJECTIVE: In acute type A aortic dissection, reports recommend total arch replacement with or without frozen elephant trunk over hemiarch replacement to avoid reoperation attributable to dilation of the residual dissected aorta. However, the residual dissected aorta can still enlarge. This study investigated the long-term factors contributing to enlargement in DeBakey type I aortic dissections. METHODS: We analyzed 126 cases of central repair for false lumen-patent DeBakey type I aortic dissection. We compared preoperative computed tomography findings and characteristics, operative findings, and long-term outcomes between 51 cases experiencing aortic events (dilation of distal aorta >5 cm, new aortic dissections, distal aortic surgery, or distal aortic rupture) and 75 without events. RESULTS: Patient characteristics and operative findings did not significantly differ between groups, with significantly more dissections involving the brachiocephalic artery or the iliac artery and cases undergoing hemiarch replacement in the event group. Univariable analyses showed that dissections involving the brachiocephalic artery, bilateral or unilateral iliac artery involvement, and hemiarch replacement were significantly associated with a greater risk of aortic events than in patients without these features. Multivariable analysis showed that dissections involving the brachiocephalic artery, unilateral iliac artery involvement, and hemiarch replacement were independent predictors of aortic events. CONCLUSIONS: Dissections involving the brachiocephalic artery or unilateral iliac artery on preoperative computed tomography were prognostic predictors of long-term aortic events. When dissection involves these vessels, large re-entry sites may form and contribute to late aortic events. Extensive aortic surgery and pre-emptive endovascular treatment may help suppress aortic events.