Joon Bum Kim1, Suk Jung Choo2, Wan Kee Kim1, Ho Jin Kim1, Sung-Ho Jung1, Cheol Hyun Chung1, Jae Won Lee1, Jae-Kwan Song1. 1. From the Deparment of Thoracic and Cardiovascular Surgery (J.B.K., S.J.C., W.K.K., H.J.K., S.-H.J., C.H.C., J.W.L.) and Division of Cardiology (J.-K.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 2. From the Deparment of Thoracic and Cardiovascular Surgery (J.B.K., S.J.C., W.K.K., H.J.K., S.-H.J., C.H.C., J.W.L.) and Division of Cardiology (J.-K.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sjchoo@amc.seoul.kr.
Abstract
BACKGROUND: Optimal management strategy of acute aortic dissection (AD) with retrograde extension from entry tear in the descending aorta into the ascending aorta remains undetermined. METHODS AND RESULTS: Of the 538 patients who were diagnosed as having acute AD from 1999 through 2011, 49 patients (37 men; 52.5±13.1 years) were identified as having entry tear in the descending aorta with retrograde extension of AD into the ascending aorta. Sixteen patients who were clinically stable with thrombosed false lumen in the ascending aorta were treated medically (MED group), whereas 33 patients underwent aortic replacement (SURG group) on an intention-to-treat basis. In the MED group, 1 patient was converted to urgent aortic surgery and 2 patients underwent endovascular stent grafting in the descending aorta during the initial hospitalization. The early (30-day or in-hospital) mortality rates were 0% and 9.1% in the MED and SURG group, respectively (P=0.54). Follow-up was complete in all patients (median, 61.4 months; Q1-Q3, 28.2-99.1 months). The 5-year 100% survival rate in the MED group was higher than that in the SURG group (81.2±7.0%; P=0.080), in the surgically treated patients with antegrade type A AD (74.5±2.8%; P=0.038), and in the patients with type B AD (75.3±3.3%; P=0.045). Aortic event-free survival at 5 years was 52.7±14.8% and 69.6±8.0% in the MED and SURG groups, respectively (P=0.98). CONCLUSIONS: Patients with acute retrograde type A AD showed a more favorable prognosis than patients with antegrade AD. In selected patients with retrograde type A AD, excellent outcomes could be achieved with initial medical management combined with timely interventions.
BACKGROUND: Optimal management strategy of acute aortic dissection (AD) with retrograde extension from entry tear in the descending aorta into the ascending aorta remains undetermined. METHODS AND RESULTS: Of the 538 patients who were diagnosed as having acute AD from 1999 through 2011, 49 patients (37 men; 52.5±13.1 years) were identified as having entry tear in the descending aorta with retrograde extension of AD into the ascending aorta. Sixteen patients who were clinically stable with thrombosed false lumen in the ascending aorta were treated medically (MED group), whereas 33 patients underwent aortic replacement (SURG group) on an intention-to-treat basis. In the MED group, 1 patient was converted to urgent aortic surgery and 2 patients underwent endovascular stent grafting in the descending aorta during the initial hospitalization. The early (30-day or in-hospital) mortality rates were 0% and 9.1% in the MED and SURG group, respectively (P=0.54). Follow-up was complete in all patients (median, 61.4 months; Q1-Q3, 28.2-99.1 months). The 5-year 100% survival rate in the MED group was higher than that in the SURG group (81.2±7.0%; P=0.080), in the surgically treated patients with antegrade type A AD (74.5±2.8%; P=0.038), and in the patients with type B AD (75.3±3.3%; P=0.045). Aortic event-free survival at 5 years was 52.7±14.8% and 69.6±8.0% in the MED and SURG groups, respectively (P=0.98). CONCLUSIONS:Patients with acute retrograde type A AD showed a more favorable prognosis than patients with antegrade AD. In selected patients with retrograde type A AD, excellent outcomes could be achieved with initial medical management combined with timely interventions.
Authors: Paul D DiMusto; Brooks L Rademacher; Jennifer L Philip; Shahab A Akhter; Christopher B Goodavish; Nilto C De Oliveira; Paul C Tang Journal: J Surg Res Date: 2017-02-27 Impact factor: 2.192
Authors: Jun Ho Lee; Yongil Cho; Yang Hyun Cho; Hyunggoo Kang; Tae Ho Lim; Hyo Jun Jang; Sun Kyun Ro; Hyuck Kim Journal: J Korean Med Sci Date: 2020-10-19 Impact factor: 2.153