Effect of false lumen partial thrombosis on repaired acute type A aortic dissection.

Abstract

Studies on the partial thrombosis of a false lumen after repairing a type A acute aortic dissection (TAAAD) have reported conflicting results. We investigated the effects of a partially thrombosed false lumen on the segmental growth rates, distal aortic reoperations, and long-term survival. The postoperative computed tomography scans of 67 patients were retrospectively reviewed. A false lumen was independently defined at 3 segments of the descending thoracic aorta (DTA) on the last follow-up computed tomography scan: the proximal segment near the aortic arch, the distal segment near the diaphragm, and the middle segment. The segmental aortic growth rate of completely thrombosed, completely patent, and partially thrombosed false lumens was -0.10±0.31, 0.09±0.22, and 0.35±0.60 mm/mo at the proximal DTA (P=.001), -0.04±0.18, 0.12±0.19, and 0.28±0.28 mm/mo at the middle DTA (P<.001), and -0.02±0.13, 0.07±0.07, and 0.16±0.14 mm/mo at the distal DTA (P<.001), respectively. The corresponding freedom from reoperation rates for the proximal DTA at 10 years were 100%, 88%, and 62% (P=.013). The overall 10-year survival rate was 89% and was not significantly different among the study groups. Partial thrombosis at each segment of a residual false lumen after TAAAD repair correlated with a faster regional aortic growth rate and predicted a greater reoperation rate but did not affect long-term overall survival.