Foeke J H Nauta1, Jip L Tolenaar2, Himanshu J Patel3, Jehangir J Appoo4, Thomas T Tsai3, Nimesh D Desai5, Daniel G Montgomery3, Firas F Mussa6, Gilbert R Upchurch7, Rosella Fattori8, G Chad Hughes9, Christoph A Nienaber10, Eric M Isselbacher11, Kim A Eagle3, Santi Trimarchi12. 1. Thoracic Aortic Research Center, Policlinico San Donato Istituto di Ricovero e Cura a Carattere Scientifico, University of Milan, Italy; Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan. Electronic address: foekenauta@gmail.com. 2. Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands. 3. Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan. 4. Division of Cardiac Surgery, Libin Cardiovascular Instititue, University of Calgary, Calgary, Alberta, Canada. 5. Cardiac Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 6. Vascular Surgery, Columbia University Medical Center, New York, New York. 7. Heart and Vascular Center, University of Virginia, Charlottesville, Virginia. 8. Vascular Surgery, University Hospital S. Orsola, Bologna, Italy. 9. Division of Cardiovascular Surgery, Duke University Medical Center, Durham, North Carolina. 10. Cardiology & Aortic Centre, Royal Brompton Hospital, London, United Kingdom. 11. Thoracic Aortic Center, Massachusetts General Hospital, Boston, Massachusetts. 12. Thoracic Aortic Research Center, Policlinico San Donato Istituto di Ricovero e Cura a Carattere Scientifico, University of Milan, Italy.
Abstract
BACKGROUND: Optimal management of acute type B aortic dissection with retrograde arch extension is controversial. The effect of retrograde arch extension on operative and long-term mortality has not been studied and is not incorporated into clinical treatment pathways. METHODS: The International Registry of Acute Aortic Dissection was queried for all patients presenting with acute type B dissection and an identifiable primary intimal tear. Outcomes were stratified according to management for patients with and without retrograde arch extension. Kaplan-Meier survival curves were constructed. RESULTS: Between 1996 and 2014, 404 patients (mean age, 63.3 ± 13.9 years) were identified. Retrograde arch extension existed in 67 patients (16.5%). No difference in complicated presentation was noted (36.8% vs 31.7%, p = 0.46), as defined by limb or organ malperfusion, coma, rupture, and shock. Patients with or without retrograde arch extension received similar treatment, with medical management in 53.7% vs 56.5% (p = 0.68), endovascular treatment in 32.8% vs 31.1% (p = 0.78), open operation in 11.9% vs 9.5% (p = 0.54), or hybrid approach in 1.5% vs 3.0% (p = 0.70), respectively. The in-hospital mortality rate was similar for patients with (10.7%) and without (10.4%) retrograde arch extension (p = 0.96), and 5-year survival was also similar at 78.3% and 77.8%, respectively (p = 0.27). CONCLUSIONS: The incidence of retrograde arch dissection involves approximately 16% of patients with acute type B dissection. In the International Registry of Acute Aortic Dissection, this entity seems not to affect management strategy or early and late death.
BACKGROUND: Optimal management of acute type B aortic dissection with retrograde arch extension is controversial. The effect of retrograde arch extension on operative and long-term mortality has not been studied and is not incorporated into clinical treatment pathways. METHODS: The International Registry of Acute Aortic Dissection was queried for all patients presenting with acute type B dissection and an identifiable primary intimal tear. Outcomes were stratified according to management for patients with and without retrograde arch extension. Kaplan-Meier survival curves were constructed. RESULTS: Between 1996 and 2014, 404 patients (mean age, 63.3 ± 13.9 years) were identified. Retrograde arch extension existed in 67 patients (16.5%). No difference in complicated presentation was noted (36.8% vs 31.7%, p = 0.46), as defined by limb or organ malperfusion, coma, rupture, and shock. Patients with or without retrograde arch extension received similar treatment, with medical management in 53.7% vs 56.5% (p = 0.68), endovascular treatment in 32.8% vs 31.1% (p = 0.78), open operation in 11.9% vs 9.5% (p = 0.54), or hybrid approach in 1.5% vs 3.0% (p = 0.70), respectively. The in-hospital mortality rate was similar for patients with (10.7%) and without (10.4%) retrograde arch extension (p = 0.96), and 5-year survival was also similar at 78.3% and 77.8%, respectively (p = 0.27). CONCLUSIONS: The incidence of retrograde arch dissection involves approximately 16% of patients with acute type B dissection. In the International Registry of Acute Aortic Dissection, this entity seems not to affect management strategy or early and late death.
Authors: Foeke Nauta; Hector de Beaufort; Firas F Mussa; Carlo De Vincentiis; Atsushi Omura; Hitoshi Matsuda; Santi Trimarchi Journal: Ann Cardiothorac Surg Date: 2019-09
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