Changes in the distal aorta after various operations in patients with acute type A aortic dissection

• Eduard R. Charchyan
• Dmitriy V. Kuznetsov
• Deyara A. Chakal
• A. Aleksandr Zybin
• Valeriy V. Khovrin
• Ekaterina M. Sukhinina

Abstract

Objective. The aim of this study was to investigate changes in the distal aorta after surgical treatment of patients with acute type A aortic dissection in the remote postoperative period.

Patients and methods. Our prospective study included a total of 116 patients presenting with acute type A aortic dissection and operated on at the Samara Regional Clinical Cardiological Dispensary named after V.P. Polyakov (54 patients subjected to prosthetic repair of the ascending aorta either alone or in a combination with aortic hemiarch replacement – Group 1) and at the Petrovsky National Research Center of Surgery (62 patients undergoing hybrid surgery – Group 2) from 2013 to 2022. The condition of the distal aorta was studied before and in the remote period after surgery (48.7±30.1 months).

Results. In the late postoperative period, thrombosis of the false lumen most often occurred in the proximal descending aorta, observed in 21% and 67% of Group 1 and Group 2 patients, respectively (p<0.01). Negative remodeling of the descending aorta in the remote period occurred in 59% of Group 1 patients, with no negative remodeling observed in Group 2 patients (p<0.001). Group 2 patients were found to have only positive remodeling or maintain the stable condition. Risk factors for false lumen functioning in the remote postoperative period, regardless of the type of surgery, were as follows: patient age <50 years (p=0.002) for the thoracic descending aorta, the number of secondary fenestrations greater than 5 in the abdominal aorta (p=0.001), as well as extension of dissection to branches of the aortic arch for the thoracic aorta after proximal “limited” aortic reconstruction (p=0.002).

Conclusions. In patients with acute type A aortic dissection, hybrid operations more often result in thrombosis of the false lumen in the thoracic descending aorta and are not accompanied by negative remodeling. Risk factors for false lumen functioning in the thoracic aorta after surgery are as follows: patient age under 50 years, propagation of dissection to branches of the aortic arch (after proximal “limited” aortic reconstructions); in the abdominal aorta – the number of secondary fenestrations in this section >5.

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Charchyan E.R., Kuznetsov D.V.; data collection and handling – Kuznetsov D.V., Zybin A.A., Chakal D.A., Khovrin V.V., Sukhinina E.M.; statistical processing – Kuznetsov D.V.; draft manuscript preparation – Kuznetsov D.V.; manuscript revision – Charchyan E.R.

For citation: Charchyan E.R., Kuznetsov D.V., Chakal D.A., Zybin A.A., Khovrin V.V., Sukhinina E.M. Changes in the distal aorta after various operations in patients with acute type A aortic dissection. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2025; 31 (1): 100–8. DOI: https://doi.org/10.33029/1027-6661-2025-31-1-100-108

Keywords: acute type A aortic dissection; surgery for acute aortic dissection; descending aorta remodeling; aortic false lumen functioning