Influence of Radiologically Evident Residual Intimal Tear on Expansion of Descending Aorta Following Surgery for Acute Type I Aortic Dissection.
- Author:
Yun Seok KIM
1
;
Jeong Heon KIM
;
Joon Bum KIM
;
Dong Hyun YANG
;
Joon Won KANG
;
Su Kyung HWANG
;
Suk Jung CHOO
;
Cheol Hyun CHUNG
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea. jbkim1975@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Aortic dissection;
Aneurysm;
Surgery;
Risk analysis
- MeSH:
Aneurysm;
Aorta;
Aorta, Thoracic*;
Aortic Aneurysm;
Dilatation;
Follow-Up Studies;
Humans;
Logistic Models;
Multivariate Analysis
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2014;47(1):6-12
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Although a residual intimal tear may contribute to the dilatation of the descending aorta following surgical repair of acute type I aortic dissection (AD), its causal relationship has not been elucidated by clinical data due to the limited resolution of imaging modalities. METHODS: This study enrolled 41 patients (age, 55.2+/-11.9 years) who were evaluated with dual-source computed tomography (CT) imaging of the whole aorta in the setting of the surgical repair of acute type I AD. Logistic regression models were used to determine the predictors of a composite of the aortic aneurysm formation (diameter >55 mm) and rapid aortic expansion (>5 mm/yr). RESULTS: On initial CT, a distal re-entry tear was identified in 9 patients. Two patients failed to achieve proximal tear exclusion by the surgery. Serial follow-up CT evaluations (median, 24.6 months; range, 6.0 to 67.2 months) revealed that 14 patients showed rapid expansion of the descending aorta or aortic aneurysm formation. A multivariate analysis revealed that the residual intimal tear (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.02 to 19.31) and the patent false lumen in the early postoperative setting (OR, 4.64; 95% CI, 0.99 to 43.61) were predictive of the composite endpoint. CONCLUSION: The presence of a residual intimal tear following surgery for acute type I AD adversely influenced the expansion of the descending aorta.
