Twenty-Year Follow-Up of Acute Type A Dissection: The Incidence and Extent of Distal Aortic Disease using Magnetic Resonance Imaging

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Abstract
A persistent distal false lumen (PDFL) after surgical repair of type A aortic dissection is the most important factor in determining long‐term survival. It has been suggested that changes in surgical technique reduce the incidence of distal false lumen. We report the findings of a 20‐year follow‐up (mean 5.2 years) on 87 patients who have undergone surgical repair of type A aortic dissection with all survivors undergoing magnetic resonance (MR) scanning of the entire aorta. Early mortality was 27.5%, and actuarial 5‐, 10‐, and 15‐year survival was 65%, 28% and 20% respectively. Early mortality had decreased to 18% in the last 5 years. The most common cause of late death was related to distal aortic disease, accounting for 47% of all late deaths with a peak incidence at 7–10 years after surgery. The incidence of PDFL in survivors was 72%, despite the fact that 82% of all intimal tears were resected at time of operation. Incidence was not affected by extension of the repair into the aortic arch nor by the use of the open technique or Gelatin‐Resorcine‐Formal tissue glue. In patients with a distal false lumen 6% had reached a maximum aortic diameter of 6 cm in at least one plane on MR scanning and 25% had reached 5 cm. We conclude that if dissection has extended beyond the arch at time of presentation then the choice of surgical technique does not prevent the persistance of a distal false lumen. MR scanning gives ideal anatomical and functional assessment of distal aortic disease and provides the surgeon with all the necessary information to plan the timing and indications for further surgery.