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Outcomes of urgent aortic wrapping for acute type A aortic dissection

2020; Elsevier BV; Volume: 164; Issue: 5 Linguagem: Inglês

10.1016/j.jtcvs.2020.10.136

1097-685X

Vincenzo Vento, Sébastien Multon, Ramzi Ramadan, Philippe Deleuze, Dominique Fabre, Julien Guihaire, Stéphan Haulon,

Cardiac Valve Diseases and Treatments

Standard surgical repair of acute type A aortic dissection is associated with high mortality rates, especially in high-risk patients. In an attempt to improve survival in frail patients, we evaluated the outcomes after ascending aorta wrapping in a high-risk patient cohort.This single-center retrospective cohort study included all consecutive patients treated using ascending aorta wrapping for an acute type A aortic dissection from 2008 to 2019. The primary end points included 30-day mortality, survival during follow-up, and dissection-related mortality. Secondary end points included assessment of aortic remodeling after ascending aorta wrapping. Patients with an aortic anatomy suitable for adjunctive endografting of the ascending aorta were also identified.Thirty-five consecutive patients who underwent ascending aorta wrapping were included. Their median age was 77 years (range, 46-96 years). The 30-day all-cause mortality rate was 9%. Major complications occurred in 7 patients (21%), including early reinterventions in 11 (31%). Median follow-up was 36 months (range, 2.4-106.6; interquartile range, 72). The actuarial survival at 36 months was 82%. The dissection-related mortality was 11.4%. The median aortic growth of the nonwrapped descending thoracic aorta was 3.4 mm. Computed tomography scan analysis depicted that 88% of survivors were theoretical candidates for an additional endovascular procedure to exclude the primary entry tear.Aortic wrapping is associated with favorable early outcomes and a low rate of aortic events during follow-up. This therapeutic option should be considered for patients considered too fragile for standard surgical repair.