CONSERVATIVE APPROACH TO AORTIC PSEUDOANEURYSMS POST TYPE A DISSECTION REPAIR: SAFE ALTERNATIVE?
CCC ePoster Library. Dumont É. 10/26/19; 280541; 306
Éric Dumont
Éric Dumont
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Abstract
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BACKGROUND: Acute type A aortic dissection (ATAAD) is a life-threatening condition necessitating urgent surgical intervention. Despite success of first repair, patients may need reoperation for pseudoaneurysm (PsA) at the site of repair. We sought to evaluate the safety and long-term follow-up of a conservative approach to PsA after prior type A dissection repair.

METHODS AND RESULTS: Patients who were followed for PsA after ATAAD in our institution, from 2004 to 2017, were included. Regular consultations with computed-tomography were analyzed for follow-up. Conservative approach was indicated only if PsA was asymptomatic and did not increase rapidly. Seventeen patients with PsA were managed conservatively with regular follow-up: 16 (94%) of them were located on proximal anastomosis and 1 (6%) of them on distal anastomosis. In the same period, 194 ATAAD were operated for an incidence of 1.0 [0.7-1.4] PsA per 10 repaired ATAAD per year. Mean follow-up was 4.6 [1.1-10.2] years. PsA appeared on average at 47 [6-196] days after the repair, the initial diameter average measured 22 [16-24] mm and increased to 26 [22-32] mm at late follow-up. No patient necessitated urgent surgery for rupture nor died from rupture during follow-up.

CONCLUSION: PsA is a rare but early complication following ATAAD. High-risk reoperation, mainly on aortic root, may not always be necessary for asymptomatic lesions. Conservative approach to PsA is a safe alternative in our experience and should be considered in high risk patients.
BACKGROUND: Acute type A aortic dissection (ATAAD) is a life-threatening condition necessitating urgent surgical intervention. Despite success of first repair, patients may need reoperation for pseudoaneurysm (PsA) at the site of repair. We sought to evaluate the safety and long-term follow-up of a conservative approach to PsA after prior type A dissection repair.

METHODS AND RESULTS: Patients who were followed for PsA after ATAAD in our institution, from 2004 to 2017, were included. Regular consultations with computed-tomography were analyzed for follow-up. Conservative approach was indicated only if PsA was asymptomatic and did not increase rapidly. Seventeen patients with PsA were managed conservatively with regular follow-up: 16 (94%) of them were located on proximal anastomosis and 1 (6%) of them on distal anastomosis. In the same period, 194 ATAAD were operated for an incidence of 1.0 [0.7-1.4] PsA per 10 repaired ATAAD per year. Mean follow-up was 4.6 [1.1-10.2] years. PsA appeared on average at 47 [6-196] days after the repair, the initial diameter average measured 22 [16-24] mm and increased to 26 [22-32] mm at late follow-up. No patient necessitated urgent surgery for rupture nor died from rupture during follow-up.

CONCLUSION: PsA is a rare but early complication following ATAAD. High-risk reoperation, mainly on aortic root, may not always be necessary for asymptomatic lesions. Conservative approach to PsA is a safe alternative in our experience and should be considered in high risk patients.
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