Contemporary outcomes in patients undergoing repair for acute DeBakey type I aortic dissection with a focus on distal aortic remodeling

P0092 

Abstract Submission 

Bjarki Leó Snorrason (1), Katrín Hólmgrímsdóttir (1), Birta Rakel Óskarsdóttir (1), Syed Usman Bin Mahmood (2), Roland Assi (2), Arnar Geirsson (3)

(1) University of Iceland, Reykjavík, Iceland, (2) Yale University School of Medicine, New Haven, CT, (3) Columbia University, New York, NY

Bjarki Leó Snorrason    -  Contact Me
University of Iceland

Katrín Hólmgrímsdóttir    -  Contact Me
University of Iceland

Birta Rakel Óskarsdóttir    -  Contact Me
University of Iceland

Syed Usman Bin Mahmood    -  Contact Me
Yale University School of Medicine

Roland Assi    -  Contact Me
Yale University School of Medicine

*Arnar Geirsson    -  Contact Me
Columbia University

Bjarki Leó Snorrason    -  Contact Me
N/A

Objective: Aortic dissection (AD) is an acute event characterized by an intimomedial tear with the formation of a false lumen inside the aortic wall. In this study, we sought to determine whether a more aggressive surgical approach for acute type I AD results in improved distal aortic remodeling.

Methods: In this study of patients who underwent surgery for acute type I AD between 2013 and 2022, we conducted retrospective chart review of health records and reviewed cross sectional scans at three distinct anatomical locations: aortic zone 3, at the pulmonary artery bifurcation, and at the aortic hiatus. Patients were stratified into hybrid and traditional repair groups. Aortic remodeling was defined by aortic growth rate, true lumen diameter (TLD), and total aortic diameter (TAD) to TLD ratio difference.

Results: Fifty eight patients were included. Nineteen patients (33%) underwent hybrid repair and 39 (67%) underwent traditional repair. Analysis revealed a significant discrepancy in descending aortic growth rate at the level of the pulmonary artery bifurcation between the hybrid group and traditional group with median aortic growth of -0.15 mm/month and +0.12 mm/month respectively (p=0.047). At aortic zone 3 TAD/TLD ratio difference was significantly different with a ratio difference of -0.42 and +0.12 in the hybrid and traditional groups, respectively (p=0.003). and at the level of the pulmonary artery bifurcation, the ratio difference was found to be -0.79 for the hybrid group and +0.13 for the traditional group (p=0.010). Additionally, significant positive changes in TLD were observed at zone 3, with the hybrid repair group showing TLD growth from 19.4 mm at baseline to 27.1 mm at follow up (p< 0.001) and the traditional group showing no significant change in size from 18 mm at baseline (p>0.9). At the pulmonary artery bifurcation, the TLD grew from 17 mm at baseline to 28 mm at follow up (p< 0.001) in the hybrid group, while the traditional group showed no change from 14 mm (p>0.9).

Conclusions: Hybrid repair has been suggested to induce favorable remodeling profile in patients with type I AD. Our study showed that an aggressive hybrid repair led to less aortic growth rate, increased true lumen size, and decreased TAD/TLD ratio difference indicating positive aortic remodeling.

Dissection