False lumen patency as a predictor of late outcome in aortic dissection

Bernard, Yvette; Zimmermann, Hugues; Chocron, Sidney; Litzler, J. F.; Kastler, B.; Etievent, Joseph-Philippe; Méneveau, Nicolas; Schiele, François; Bassand, Jean‐Pierre

doi:10.1016/s0002-9149(01)01556-9

Cited by 309 publications

(206 citation statements)

References 22 publications

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“…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. Mean patient age was 63 years old, and 53% of patients were men.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies17, 18, 19, 21 observed that a residual patent false lumen increases risk of long‐term mortality, compared with complete thrombosis of the false lumen (n=1082; HR, 2.12; 95% CI, 1.58–2.83; P <0.001) with no significant heterogeneity (I 2 =12.6%; P =0.330). Among studies in the type A category,17, 21 the pooled HR for long‐term mortality with a residual patent false lumen was 1.71 (95% CI, 1.16–2.52; P =0.007; Figure 2) without significant heterogeneity (I 2 =0.0%; P =0.992). One study21 reported the HR and 95% CI with preoperative and postoperative residual patent false lumen for long‐term mortality.…”

Section: Resultsmentioning

confidence: 99%

“…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. Postoperative false lumen patency may be a relatively better predictor of long‐term outcomes for AAD type A patients.…”

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: 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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“…Nevertheless, a certain percentage, being potentially underreported in the literature, do have their primary entry at a more distal site, such as the descending aorta with retrograde propagation of the dissecting membrane into the proximal thoracic aorta [8].This mechanism has also been confirmed in experimental studies [9]. In patients after surgery for acute type B aortic dissection, spontaneous closure of the primary entry tear is rare [10]. Consequently, as was also the case in our study, closure of the primary entry tear warrants any kind of surgical or interventional means [11].…”

Section: Commentmentioning

confidence: 96%

What makes the difference between the natural course of a remaining type B dissection after type A repair and a primary type B aortic dissection?

Czerny¹,

Roost-Krähenbühl²,

Sodeck³

et al. 2012

Thorac cardiovasc Surg

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OBJECTIVES: To analyse the outcome and need for intervention [surgery or thoracic endovascular aortic repair (TEVAR)] in patients after surgery for remaining type B dissection after type A repair and primary type B aortic dissection. METHODS:Within a 10-year period, 247 patients with remaining type B after type A, and 112 patients with primary type B aortic dissection were analysed. We assessed the clinical outcome as well as the need for intervention (surgery or TEVAR) within the aortic arch and the thoracoabdominal aorta as well as risk factors. RESULTS:The median follow-up was 23 months (interquartile range 5-52). There was a significant difference with regard to the status of the primary entry tear between patients after surgical repair of an acute type A aortic dissection and primary acute type B aortic dissection ( patent vs. non-patent entry 35 vs. 83%, P < 0.001). The overall need for any kind of intervention (surgery or TEVAR) was 19%. Multivariate Cox regression analysis revealed a patent primary entry tear in patients after surgery for acute type A aortic dissection as an independent predictor for intervention (surgery or TEVAR) during follow-up [odds ratio (OR) 6.4; confidence interval (CI) 1.39-29.81, P = 0.017]. Multivariate Cox regression analysis did not reveal a patent primary entry tear in patients after acute type B aortic dissection as an independent predictor for intervention (surgery or TEVAR) during follow-up (OR 0.67; CI 0.27-1.69, P = 0.671). Finally, the thrombosis status of the false lumen was not an independent predictor for intervention (surgery or TEVAR) either in patients after surgery for acute type A aortic dissection (OR 3.46; CI 0.79-15.16, P = 0.100) or in patients after acute type B aortic dissection (OR 0.77; CI 0.31-1.93, P = 0.580).CONCLUSIONS: A remaining type B dissection after type A repair and a primary type B aortic dissection represent two distinct pathophysiological entities with regard to late outcome. The need for any kind of intervention in the thoracoabdominal aorta is significantly higher in primary type B aortic dissections. A remaining patent primary entry tear independently predicts the need for intervention (surgery or TEVAR) in patients after surgery for acute type A aortic dissection and, thereby, remains the main target of initial therapy. The thrombosis status of the false lumen seems to be of secondary importance.

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“…Particular vigilance is required in patients with patent false lumens of the aorta, especially those with partial thrombosis. 77,78 Such patients appear to be at significantly increased risk of short-term (within 1-3 years) expansion and rupture.…”

Section: Acute Aortic Syndromesmentioning

confidence: 99%

Acute Aortic Syndromes and Thoracic Aortic Aneurysm

Ramanath

Sundt

et al. 2009

Mayo Clinic Proceedings

195

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Acute and chronic aortic diseases have been diagnosed and studied by physicians for centuries. Both the diagnosis and treatment of aortic diseases have been steadily improving over time, largely because of increased physician awareness and improvements in diagnostic modalities. This comprehensive review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (and its variants intramural hematoma and penetrating aortic ulcers) and thoracic aortic aneurysms. Literature searches of the PubMed database were conducted using the following keywords: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies performed within the past 20 years were included in the review; however, most data are from the past 15 years. and studied by physicians for centuries. Descriptions of such pathologic conditions of the aorta as aneurysm and dissection date back as early as the 2nd century during the time of Galen, whose discoveries were largely made through studies of apes. More "recent" reports were described by Vesalius in 1557, followed by Nichols in 1732, who detailed the process of aortic dissection. In 1761, Morgagni reported detailed pathologic features of a patient with a ruptured aorta. 1 However, our true understanding of aortic pathology began with the dissertation by Shennan 2 in 1934, which included a description of penetrating atheromatous plaques of the thoracic aorta. His report was followed by the first successful management of aortic dissection by DeBakey in 1955. 1 Since then, our knowledge of the pathologic conditions of the aorta has grown considerably and continues to evolve with ongoing research into the pathophysiology of these conditions, technological advances in the modes of detection, and improved therapeutic options. Clinical databases, such as the International Registry of Acute Aortic Dissection (IRAD), the largest current registry for acute aortic syndromes, have also contributed tremendously to our knowledge of acute aortic pathology.For the practicing clinician, knowledge of aortic disease is paramount because patients with aortic conditions contribute significantly to the overall mortality from cardiovascular disease. This review discusses the pathophysiology, epidemiology, presentation, diagnosis, and therapeutic options for several forms of acute and chronic aortic pathology: aortic dissection (including its variants intramural hematoma [IMH] and penetrating atheromatous aortic ulcer) and thoracic aortic aneurysm (TAA). Literature searches were performed of the PubMed database using the following key words: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies conducted within the past 15 years, along with some data from years prior, were included in this review.

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False lumen patency as a predictor of late outcome in aortic dissection

Cited by 309 publications

References 22 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

What makes the difference between the natural course of a remaining type B dissection after type A repair and a primary type B aortic dissection?

Acute Aortic Syndromes and Thoracic Aortic Aneurysm

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