Effects of the patent false lumen on the long-term outcome of type B acute aortic dissection☆

Akutsu, Koichi; Nejima, Jun; Kiuchi, Kaname; Sasaki, Kenji; Ochi, Masami; Tanaka, Keiji; Takano, Teruo

doi:10.1016/j.ejcts.2004.03.026

Cited by 197 publications

(123 citation statements)

References 12 publications

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“…Subgroup analysis showed that the pooled HR for long‐term mortality with postoperative residual patent false lumen was 2.02 (95% CI, 1.13–3.61; P =0.017) with no significant heterogeneity (I 2 =29.6%; P =0.233). For studies in the type B category,18, 19, 28 the pooled HR for long‐term mortality with preoperative residual patent false lumen was 2.79 (95% CI, 1.80–4.32; P <0.001; Figure 2); no statistically significant heterogeneity was observed (I 2 =0.0%; P =0.386). Because of the small number of studies, sensitivity analysis and Egger's test were not performed.…”

Section: Resultsmentioning

confidence: 96%

“…Four studies17, 22, 26, 27 examined the association between the false lumen status and AAD outcomes in type A patients, and another 6 studies18, 19, 20, 28, 29, 30 examined associations in type B patients. One study21 included both type A (73%) and type B (27%) AAD; in subgroup analysis based on the Stanford classification, this study was placed in the type A group.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies17, 18, 28 reported that a residual patent false lumen was significantly associated with an increased risk of long‐term aortic events (n=832; HR, 5.43; 95% CI, 2.95–9.99; P <0.001) without significant heterogeneity (I 2 =0.0%; P =0.566). One study reported an HR for long‐term aortic events with residual patent false lumen in AAD type A cases of 4.11 (95% CI, 1.85–9.16; P =0.001), and 2 studies reported that a residual patent false lumen was a predictor of aortic events in type B cases (HR, 7.97; 95% CI, 3.11–20.41; P <0.001) with no significant heterogeneity (I 2 =0.0%; P =0.852).…”

Section: Resultsmentioning

confidence: 99%

“…A large prospective cohort study indicated that preoperative false lumen patency influenced outcomes over a 6.8‐year follow‐up in AAD type A, with decreased survival rates (HR, 1.70; P =0.012) and an increase in the number of distal aortic events (HR, 4.11; P =0.001), controlling for conventional risk factors 17. Another 3 small sample‐size observational studies showed an independent association between the presence of a patent false lumen and long‐term mortality and aortic events in AAD type B 18, 19, 28. However, 1 retrospective cohort study indicated that postoperative false lumen patency was independently related to 5‐year mortality for type A cases, whereas preoperative false lumen patency was not a predictor of mortality 21.…”

Section: Discussionmentioning

confidence: 99%

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False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

et al. 2016

JAHA

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BackgroundThe long‐term association between the status of the false lumen and poor patient outcomes in acute aortic dissection (AAD) remains unclear. This systematic review and meta‐analysis investigated whether the status of the false lumen was a predictor of poor long‐term survival in AAD.Methods and ResultsEleven cohort studies (2924 participants) exploring the association between the false lumen status and long‐term outcomes (>1 year) in AAD were included. All studies reported multivariate‐adjusted hazard ratios (HRs) with 95% CIs for long‐term outcomes, according to false lumen status. Pooled HRs for mortality and aortic events were computed and weighted using generic inverse‐variance and random‐effect modeling. Residual patent false lumen was an independent predictor of long‐term mortality in AAD type A (HR, 1.71; 95% CI, 1.16–2.52; P=0.007) and type B (HR, 2.79; 95% CI, 1.80–4.32; P<0.001). AAD patients with residual patent false lumen exhibited an increased risk of aortic events (HR, 5.43; 95% CI, 2.95–9.99; P<0.001). Partial false lumen thrombosis was independently associated with long‐term mortality in type B AAD (HR, 2.24; 95% CI, 1.37–3.65; P=0.001). This association was not observed in AAD type A patients (HR, 1.75; 95% CI, 0.88–3.45; P=0.211).ConclusionsThe false lumen status influences late outcomes in AAD. Residual patent false lumen is independently associated with poor long‐term survival in AAD. However, only type B AAD patients with partial false lumen thrombosis had an increased late mortality risk.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

et al. 2016

JAHA

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“…10,11) Akutsu, et al reported that a patent false lumen is strongly associated with late aortic events and mortality. 12) However there are few reports focusing on the false lumen of acute type B dissection in relation to early and late outcomes.…”

Section: Introductionmentioning

confidence: 99%

Mid-Term Outcomes of Acute Type B Aortic Dissection in Japan Single Center

Minami

Imoto

Uchida

et al. 2013

ATCS

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Purpose: To study mid-term outcomes in patients admitted to receive treatment for acute type B aortic dissection. Methods: The study group comprised 229 patients with acute type B aortic dissection treated between January 2000 and July 2010. 128 patients had a thrombosed false lumen, and 101 had a patent false lumen. Results: In the thrombosed group, 6 had rupture, 4 had malperfusion, and 118 had no complications. There were 5 early deaths (3.9%). In the patent group, 12 had rupture, 19 had malperfusion, and 70 had no complications. There were 6 early deaths (5.9%). Overall survival rates in the thrombosed group and the patent group were 94.7 ± 2.2% and 90.2 ± 3.2% at 1 year, and 84.3 ± 4.6% and 85.9 ± 4.3% at 5 years (p = 0.892), respectively. Aorta-related event-free rates were 85.6 ± 3.4% and 48.3 ± 5.5% at 1 year, and 76.0 ± 5.1% and 35.2 ± 7.2% at 5 years (p <0.001), respectively. Conclusions: The incidences of rupture and malperfusion during the acute phase were higher in the patent group compared with the thrombosed group. At the late period, although the aorta-related event rate was higher in the patent group, the survival rate did not differ between two groups. Close follow-up and aggressive intervention strategy of the patent group may result comparable outcomes with the thrombosed group.

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Prognostic impact of oral anticoagulation therapy and atrial fibrillation in patients with type B acute aortic dissection

Ishizue,

Fukaya,

Oikawa

et al. 2024

Journal of Arrhythmia

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BackgroundThe prognostic impact of atrial fibrillation (AF) and oral anticoagulation (OAC) therapy in patients with type B acute aortic dissection (AAD) remains unclear. Therefore, we investigated the prognostic impact of AF and OAC therapy in patients with type B AAD.MethodsConsecutive patients diagnosed with AAD were included in this single‐center, retrospective study. Patients with type B AAD were selected from the study population and divided into three groups: AF(+)/OAC(+), AF(+)/OAC(−), and AF(−)/OAC(−). The primary end point was major adverse cardiovascular and cerebrovascular events (MACCE), including all‐cause death, progressive aortic events, cerebral infarction, and organ malperfusion.ResultsIn total, 139 patients diagnosed with type B AAD were analyzed. AF was observed in 27 patients (19%). Among them, 13 patients (9%) received OAC therapy for AF. MACCE occurred in 32 patients (23%) during the observation period: all‐cause death in four patients, progressive aortic events in 24 patients, cerebral infarction events in two patients, and malperfusion events in two patients. The incidence of MACCE was higher in the AF(+)/OAC(+) group than in the AF(+)/OAC(−) group (hazard ratio[HR]: 3.875; 95% confidence interval [CI]: 1.153–17.496). In contrast, there was no significant difference in the incidence of MACCE between the AF(+)/OAC(−) and AF(−)/OAC(−) groups (HR: 1.001, 95% CI: 0.509–1.802).ConclusionAmong patients with type B AAD, the use of OAC for AF was associated with a higher risk of MACCE.

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Effects of the patent false lumen on the long-term outcome of type B acute aortic dissection☆

Abstract: Patency of the false lumen is a strong independent prognostic factor for type B aortic dissection. Location of the most dilated aortic segment at the distal arch is a significant risk factor in the patients with a patent false lumen.

Cited by 197 publications

References 12 publications

False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

Mid-Term Outcomes of Acute Type B Aortic Dissection in Japan Single Center

Prognostic impact of oral anticoagulation therapy and atrial fibrillation in patients with type B acute aortic dissection

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