Locational impact of luminal communication on aortic diameter changes and reintervention in acute type I aortic dissection.

Abstract

OBJECTIVES:

The aim of this study is to evaluate the locational impact of a luminal communication on aortic diameter changes and reintervention after surgical repair of acute type I aortic dissection.

METHODS:

Between 2009 and 2017, 304 patients underwent operation for acute type I aortic dissection. Among them, 93 patients were enrolled. The luminal communications were analysed in segment 1 (the proximal descending thoracic aorta), segment 2 (the distal descending thoracic aorta) and segment 3 (the abdominal aorta). The aortic diameter was measured at the pulmonary artery bifurcation, coeliac axis, maximal abdominal aorta and maximal thoraco-abdominal aorta using serial follow-up computed tomography scans. The linear mixed model was used, and the rate of freedom from reintervention was analysed.

RESULTS:

In the adjusted analysis, the initial diameter of the maximal abdominal aorta and the first luminal communication in segment 1 was statistically significant. However, the slope value of the maximal abdominal aorta was smaller than that of the first luminal communication in segment 1 (0.024 vs 0.198). The 3-year freedom from reintervention rate was significantly higher in patients without a luminal communication than in those with an initial luminal communication in segment 1 (96% vs 47%, log rank, P = 0.003).

CONCLUSIONS:

A luminal communication at the proximal descending thoracic aorta (segment 1) is a significant factor for an increasing aortic diameter and reintervention after surgical repair of acute type I aortic dissection.

• Authors: Woon Heo, Suk-Won Song, Shin-Young Lee, Tae-Hoon Kim, Jin-Seong Lee, Kyung-Jong Yoo, Bum-Koo Cho
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 55 Issue 6 Pg. 1037-1044 (Jun 01 2019) ISSN: 1873-734X [Electronic] Germany
• PMID: 30608538 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Topics

• Acute Disease
• Aortic Dissection (diagnosis, surgery)
• Aorta, Abdominal (diagnostic imaging)
• Aorta, Thoracic (diagnostic imaging, surgery)
• Aortic Aneurysm, Thoracic (diagnosis, surgery)
• Blood Vessel Prosthesis Implantation (methods)
• Computed Tomography Angiography (methods)
• Endovascular Procedures (methods)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prosthesis Design
• Reoperation
• Retrospective Studies