Thorac Cardiovasc Surg 2016; 64 - OP173
DOI: 10.1055/s-0036-1571607

Influence of DeBakey Classification on Re-intervention, Early and Late Outcomes of Patients with Acute Aortic Dissection

L. Castro 1, J. Brickwedel 1, A. Bernhardt 1, M. Coutandin 1, H. Reichenspurner 1, C. Detter 1
  • 1Universitäres Herzzentrum Hamburg, Klinik für Herzchirurgie, Hamburg, Germany

Objectives: Acute type A aortic dissection (AADA) is a life-threatening disease and its treatment is highly challenging. DeBakey (DB) classification is used for anatomic description of thoracic AADA. DB type I aortic dissection (AD) involves the ascending aorta and extends to the descending aorta. Type DB II AD is limited to the ascending aorta. We compared outcomes of patients with DB type I and type II AD with regard to early and late outcomes after initial surgical treatment.

Methods: Between January 1998 and July 2015, 285 consecutive patients (male 70.2%, mean age 61.1 ± 13.5 years) underwent surgery of the thoracic aorta due to acute DB type I and type II AD. We conducted a retrospective study and divided patients into two groups (DB I n = 225, DB II n = 60) and compared clinical characteristics, 30-day mortality, and re-intervention. Mean follow-up time was 36.8 ± 20.9 months (range 2–132 months), 260 patients (91%) were included.

Results: Procedural times (DB I 399.1 ± 138.2min, DB II 365.4 ± 120.6min, p = 0.06), cardiopulmonary bypass (CPB) times (DB I 245.6 ± 102.8min, DB II 200.7 ± 82.4min, p = 0.05) and aortic cross clamp (ACC) times (DB I 125.5 ± 70.1min, DB II 111.62 ± 46.4min, p = 0.07) showed a trend toward shorter times in the DB II group. 30-day mortality did not differ between groups (DB I n = 41 (18.2%), DB II n = 9 (15%), p = 0.56). Re-intervention on the distal aorta was required in 17 patients (7.6%) in the DB I group compared with no re-interventions in the DB II group (p = 0.03). Freedom from re-intervention after 1, 5, and 10 years follow-up was 97.4%, 94.0%, and 90% in patients with DB I AD and 100% after 10 years in patients with DB II AD, respectively (p = 0.04).

Conclusion: DB classification reflects late outcomes and need of re-intervention. DB type II AD can be treated by complete resection of the dissecting aorta thus making the probability of re-intervention less likely. Based on the presented findings a closer postoperative follow-up should be mandatory for patients with DB type I AD.