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Does Ascending Aorta and Hemiarch Replacement For Acute Debakey Type I Dissection Alter True Lumen Geometry Distally?
Daniel D. Holloway, MD, Mollie Ferris, MD, Eric Herget, MD, Werner Harmse, MD, Vamshi K. Kotha, MD, Jehangir J. Appoo, MD.
University of Calgary, Calgary, AB, Canada.
OBJECTIVES:
Persistently narrowed distal aortic true lumen (TL) post-surgery for Debakey type I aortic dissection is a risk factor for organ malperfusion. The effect of ascending aorta and hemiarch replacement on the distal aortic TL caliber has not been reported. Novel extended arch surgical techniques aim at TL expansion.
METHODS:
All patients at a single center who underwent ascending aorta and hemiarch replacement for Debakey type I aortic dissection from 2006-2014 were assessed for the study. Patients with total arch repair and patients without adequate imaging were excluded. The pre-op and first post-op CT scans of the patients were analyzed by dedicated cardiovascular imagers. Double oblique surface area measurements of the TL, false lumen, and total aortic lumen at the level of the subclavian artery, pulmonary artery bifurcation and diaphragmatic hiatus were obtained. The ratio of the true lumen to total lumen was calculated at the three locations for each patient.
RESULTS:
Inclusion criteria were met by 39 patients (29 males and 10 females) with a mean age of 53. The median interval between scans was 10 days. After surgical replacement of the ascending aorta and hemiarch repair, there was no significant difference in the area of the true lumen at the level of the subclavian, pulmonary artery, or diaphragm when compared to pre-operative values. Similarly, there was no significant difference in the true lumen to total lumen ratio at any level. There was a significant increase in the area of the false lumen at the level of the pulmonary artery and diaphragm (p < 0.05). The total area of aorta also increased at the level of the pulmonary artery and diaphragm (p < 0.05).
CONCLUSIONS:
Ascending aorta and hemi-arch replacement for Debakey type I aortic dissection does not reliably change true lumen size in the descending thoracic aorta. When dynamic malperfusion is clinically suspected and the true lumen is effaced, consideration may be given to adjunctive procedures that expand true lumen area.
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