Surgery for acute ascending aortic dissection: closed versus open distal aortic repair

One hundred twelve consecutive patients with acute ascending aorticdissection and submitted to immediate surgery were retrospectively analyzedwith regard to perioperative mortality and morbidity. The patients weredivided into two groups according to whether distal aortic repair wascarried out by the open procedure (using deep hypothermic circulatoryarrest, group A: 68 patients) or by the closed technique (withoutcirculatory arrest, group B: 44 patients). Patients' ages ranged from 24 to78 years (mean 57.4 years). No significant difference was found between thetwo groups in terms of age and sex distribution. However, the prevalence inthe extent of clinical and anatomical alterations was significantly higherin group A (hemodynamic instability, pericardial tamponade and neurologicaldeficit). The duration of hypothermic circulatory arrest for group Apatients averaged 25 min and ranged from 12 to 65 min. The overallperioperative mortality was 17% (19/112 patients); it was 20.6% (14/68) ingroup A and 11.4% (5/44) in group B; the difference was not statisticallysignificant but consistent with a clear trend. The trend towards a highermortality in group A mainly reflected the more severe and complexanatomical characteristics and could not be attributed to the circulatoryarrest per se. The period of deep hypothermic circulatory arrest in thesurvivors (25 min) was similar to that of the group with lethal outcome (32min). Among the non-lethal complications, however, group A patients morefrequently showed clinical signs consistent with cerebral injury: apartfrom the transient symptoms suggestive in reversible diffuse cerebraldamage, five patients in group A had a permanent focal neurological deficit(versus one patient in group B).