Long-Term Survival in Patients Presenting With Type B Acute Aortic Dissection

Tsai, Thomas T.; Fattori, Rossella; Trimarchi, Santi; Isselbacher, Eric M.; Myrmel, Truls; Evangelista, Arturo; Hutchison, Stuart J.; Sechtem, Udo; Cooper, Jeanna V.; Smith, Dean E.; Pape, Linda; Froehlich, James B.; Raghupathy, Arun; Januzzi, James L.; Eagle, Kim A.; Nienaber, Christoph

doi:10.1161/circulationaha.106.622340

Cited by 587 publications

(162 citation statements)

References 26 publications

(18 reference statements)

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“…A report from the International Registry of Acute Aortic Dissection (IRAD) identified an in‐hospital surgical mortality rate of 30% in AAD type A patients and 13% in type B 2, 3. However, long‐term outcomes for AAD patients with type B dissection are not necessarily better than those having type A. Long‐term survival of surgically treated patients with type B AAD after discharge ranges from 56% to 96% at 1 year and from 48% to 83% at 5 years 4, 5, 6, 7, 8. In contrast, for surgically treated type A patients who survive until hospital discharge, survival rates range from 52% to 96% at 1 year and from 37% to 91% at 5 years 8, 9, 10, 11, 12.…”

Section: Introductionmentioning

confidence: 99%

“…Earlier studies have identified long‐term predictors of morbidity and mortality in AAD, including old age,13, 14 female sex,15 a history of atherosclerosis,4 and impaired renal function,16 all of which may be more representative of a patient's high‐risk clinical background than the severity and nature of the AAD itself. Indeed, as of yet, there may be no effective and simple marker available for evaluating severity of AAD, predicting long‐term clinical outcomes, and optimizing surgical management.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

JAHA

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“…The robust self-repair of aortic dissections in mice has not been observed in humans, for whom mortality continues to increase with time after aortic dissection (21,22). in the treatment of humans, therapeutic interventions for aortic dissection include surgery or stents.…”

Section: A a B Bmentioning

confidence: 99%

Evolution of angiotensin II-mediated atherosclerosis in ApoE KO mice

Niedzwiecki¹

2010

Mol Med Rep

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Abstract. The dysregulation of renin-angiotensin systemsignaling is a contributing factor to the development of atherosclerosis and cardiovascular disease. We studied the progression of angiotensin ii (angii)-induced arterial wall atherosclerosis after its induction. atherosclerosis was accelerated in apoe (-/-) c57B6 mice by 4 weeks of continuous osmotic pump administration of angii (23 nmol/24 h). changes in aortae were evaluated in these mice at 4 and 16 weeks after pump installation, as well as in control mice that were not administered angii. in comparison to the non-angii controls, angii supplementation induced additional lesions in the aortic arch and its vessels 4 weeks after pump installation, indicating that angii had an effect. These observations were grossly visible and were confirmed through histological analysis. additionally, the angii-mediated injuries continued to accelerate great vessel atherosclerosis after the discontinuation of angii administration at 4 weeks. atherosclerosis in the apoe Ko mice at 16 weeks post-angii administration was increased by over 3-fold compared to the difference between lesion development in the apoe Ko mice at 4 weeks post-angii and the age-matched control apoe Ko mice. While lesion size 12 weeks after cessation of angii (16 week post-angii group) increased 249% compared to the 4 week post-angii group, differences between the rate of lesion formation in the 4 week post-angii and non-angii groups indicated a 70% increase and a linear relationship with time. aortic dissections were present at 4 weeks post-angii pump installation at high frequency compared to the unsupplemented controls, in which they were absent. unexpectedly, aortic dissections were absent at 16 weeks post-angii, indicating the presence of a healing process. The study suggests that excessive angii initiates a cascade of pathological biochemical events and plaque evolution that does not cease even after angii administration is discontinued.

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“…[3][4][5][6] Late complications such as aortic enlargement and rupture may occur during follow-up in patients who receive conservative therapy at the acute phase, thereby necessitating surgery. [7][8][9] Several studies have reported that early or late complications such as aortic rupture and organ ischemia are related to whether the false lumen has been thrombosed or remains patent. 10,11) Akutsu, et al reported that a patent false lumen is strongly associated with late aortic events and mortality.…”

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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Long-Term Survival in Patients Presenting With Type B Acute Aortic Dissection

Cited by 587 publications

References 26 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

Evolution of angiotensin II-mediated atherosclerosis in ApoE KO mice

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

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