Tomoaki Kudo1, Akihito Mikamo1, Hiroshi Kurazumi1, Ryo Suzuki1, Noriyasu Morikage1, Kimikazu Hamano2. 1. Division of Cardiac Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan. 2. Division of Cardiac Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan. Electronic address: kimikazu@yamaguchi-u.ac.jp.
Abstract
OBJECTIVE: Patients with Stanford type B acute aortic dissection usually receive medical treatment during the acute phase. The present study aimed to elucidate the factors predicting late aortic events in patients treated conservatively for acute type B dissections. METHODS: From March 1991 to March 2011, 117 patients were enrolled in the present study, with a mean follow-up period of 5.1 ± 4.1 years. The patients were divided into 4 groups according to their false lumen status at onset: group F, fully open (n = 26, 22.2%); group P, partially thrombosed (n = 23, 19.6%); group U, ulcer-like projections (n = 22, 18.9%); and group T, completely thrombosed (n = 46, 39.3%). RESULTS: Long-term survival did not significantly differ among the groups. The Kaplan-Meier event-free rate curve showed that aortic events occurred less frequently in group T than in the other 3 groups; the 5-year event-free rate was 65.4%, 58.8%, 36.1%, and 95.7% for groups F, P, U, and T, respectively. Cox regression analysis showed that the presence of ulcer-like projections (P = .016) and a maximum aortic diameter of ≥ 40 mm (P = .003) were predictors of late aortic events. CONCLUSIONS: When patients have a maximum aortic diameter of ≥40 mm or ulcer-like projections at onset, early surgical intervention should be considered to prevent positive remodeling of the aorta.
OBJECTIVE:Patients with Stanford type B acute aortic dissection usually receive medical treatment during the acute phase. The present study aimed to elucidate the factors predicting late aortic events in patients treated conservatively for acute type B dissections. METHODS: From March 1991 to March 2011, 117 patients were enrolled in the present study, with a mean follow-up period of 5.1 ± 4.1 years. The patients were divided into 4 groups according to their false lumen status at onset: group F, fully open (n = 26, 22.2%); group P, partially thrombosed (n = 23, 19.6%); group U, ulcer-like projections (n = 22, 18.9%); and group T, completely thrombosed (n = 46, 39.3%). RESULTS: Long-term survival did not significantly differ among the groups. The Kaplan-Meier event-free rate curve showed that aortic events occurred less frequently in group T than in the other 3 groups; the 5-year event-free rate was 65.4%, 58.8%, 36.1%, and 95.7% for groups F, P, U, and T, respectively. Cox regression analysis showed that the presence of ulcer-like projections (P = .016) and a maximum aortic diameter of ≥ 40 mm (P = .003) were predictors of late aortic events. CONCLUSIONS: When patients have a maximum aortic diameter of ≥40 mm or ulcer-like projections at onset, early surgical intervention should be considered to prevent positive remodeling of the aorta.
Authors: Rana O Afifi; Harleen K Sandhu; Samuel S Leake; Mina L Boutrous; Varsha Kumar; Ali Azizzadeh; Kristofer M Charlton-Ouw; Naveed U Saqib; Tom C Nguyen; Charles C Miller; Hazim J Safi; Anthony L Estrera Journal: Circulation Date: 2015-08-25 Impact factor: 29.690