Comparative outcomes of surgical treatment of patients with De Bakey type I versus De Bakey type II acute aortic dissection

The OBJECTIVE was to compare the immediate and long-term results of surgical treatment of patients with De Bakey type I versus De Bakey type II acute aortic dissection.

METHODS AND MATERIALS. We analyzed the immediate and long-term (5 years) results of surgical treatment of 136 patients with acute aortic dissection, operated on at the Samara Regional Clinical Cardiology Dispensary named after V. P. Poliakov from 2014 to 2022. Patients were divided into two groups: 1 (116 patients) – De Bakey type 1 dissection, 2 (20 patients) – De Bakey type 2 dissection.

RESULTS. Hospital mortality was significantly higher in group 1 (24.1 % and 5 % in groups 1 and 2, respectively, p–0.05). Independent risk factors for hospital mortality in patients with acute aortic dissection were: De Bakey type I dissection, body mass index>30.2 kg/m2, arterial hypertension, critical preoperative condition, acute renal failure, history of aortic surgery, duration of artificial circulation and circulatory arrest. The five-year survival rate of patients discharged from the hospital did not differ significantly (88 % and 74 % in groups 1 and 2, respectively, p-0.26). Five-year freedom from reoperations in group 1 – 89 %, in group 2 – 100 %, p = 0.3. Negative remodeling of the descending aorta in the long-term period occurred in 73 % of group 1; in group 2, remodeling of the descending aorta was positive or stable (p < 0.001).

CONCLUSIONS. De Bakey type 1 aortic dissection is associated with a higher risk of hospital mortality in patients after surgical treatment, compared with patients with De Bakey type 2 aortic dissection. Five-year survival rate, as well as freedom from reoperation on the aorta in patients discharged from the hospital, does not depend on the type of dissection.

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