Assessing the effect of endoprosthetic repair of the thoracic portion on aortic remodelling after surgical correction for DeBakey type I dissection.

OBJECTIVE: The purpose of the study was to evaluate the influence of endoprosthetic repair of the aortic thoracic portion on remodelling of the descending aorta in patients after the surgical stage of correction for DeBakey type I aortic dissection.

PATIENTS AND METHODS: The authors retrospectively analysed a group of 12 patients (9 men and 3 women) subjected to endoprosthetic repair of the aortic thoracic portion after previously performed surgical correction of the ascending aorta and its braches. The average age of the patients amounted to 48 (43-56.7) years. All patients underwent multispiral computed tomography (MSCT) first performed at admission, then immediately after implantation of the stent graft and at 6, 12 and 24 months after discharge. The Control Group consisted of nine patients with a previous history of DeBakey type I aortic dissection, who had endured only surgical correction of the ascending aorta and arch.

RESULTS: The success rate of the intervention amounted to 100%. There were no signs of ischaemia of the spinal cord, visceral organs or lower limbs. The diameter of the implanted stent grafts varied from 28 to 40 mm and the length ranged from 140 to 204 mm. Seven (58%) patients of the Study Group as early as during a year were found to have no blood flow along the false channel. The false channel remained patent in 100% of the Control Group patients. Over a two-year period of follow up, in patients after endoprosthetic repair, the diameter of the false channel did not increase. In the Control Group patients during the same period of follow up, there was a tendency towards an increase in the aortic diameter at the expense of dilatation of the false channel, with an enlargement of the false channel of the descending aorta at the level of the diaphragm from 1.8 (1.57-2.1) to 2.05 (1.7-2.31) cm (p=0.4) and at the level of the renal arteries from 1.5 (1.32-1.8) to 1.8 (1.58-1.97) cm (p=0.4). There were no lethal outcomes during follow up.

CONCLUSION: Endoprosthetic repair of the thoracic portion after surgical correction was in the remote period accompanied and followed by stabilization of the diameter of the descending aorta, as well as contributed to closure of the false channel.