Prognosis of patients undergoing emergency surgery for type A acute aortic dissection without exclusion of the intimal tear

Abstract

Objectives: To investigate the prognosis after emergency surgery for acute type A aortic dissection with an unknown entry site and to identify the predictors of postoperative aortic dilatation.Methods: The subjects were 102 patients undergoing emergency surgery for acute type A dissection from July 2005 to October 2010. They were divided into group I (n ¼ 45) undergoing aortic surgery without tear resection and group II (n ¼ 57) undergoing resection that included the intimal tear.Results: The postoperative hospital mortality was similar, 13.3% (n ¼ 6) in group I and 12.3% (n ¼ 7) in group II. Of the 102 patients, 69 underwent follow-up computed tomography scanning after discharge, and the aortic diameter was significantly increased in group I compared with that in group II (P ¼ .035). Dilatation of the descending aorta occurred in 21 patients (30.4%). Multivariate logistic regression analysis revealed that a patent false lumen (P ¼ .027) and nonexclusion of the entry site (P ¼ .012) were independent risk factors for aortic dilatation. No difference was found in the freedom from aorta-related clinical events at 4 years, with a rate of 81.9% in group I and 74.4% in group II. Also, no difference was found in the 4-year actuarial survival rate between groups I and II (86.4% and 78.5%, respectively). Conclusions:The prognosis of patients without exclusion of the entry site was acceptable. Careful follow-up is needed for patients with a patent false lumen or nonexcluded entry because of the risk of aortic dilatation.

Preoperative evaluation value of aortic arch lesions by multidetector computed tomography angiography in type A aortic dissection

“…[26,27] For patients with intimal tears located in the aortic arch, although the treatment is still controversial, we still recommend that total arch replacement can result in better long-term prognosis. [28,29] …”

DIAGNOSTIC IMAGING Assessment of intimal tears in thoracic aortic dissection using ECG-gated dual-source computed tomography

“…In most patients, the primary intimal tear is present within the ascending aorta, so ascending aorta or proximal arch replacement is sufficient. When the tear is located in the aortic arch, total or partial arch replacement should be performed to achieve tear excision [6]. If the intimal tear is not resected, the risk of residual aorta enlargement is present [6].…”

“…When the tear is located in the aortic arch, total or partial arch replacement should be performed to achieve tear excision [6]. If the intimal tear is not resected, the risk of residual aorta enlargement is present [6]. Aortic dissections with persistent false lumens carry high risk of aneurysm formation [7].…”

Endovascular repair of residual intimal tear or distal new entry after frozen elephant trunk for type A aortic dissection

“…After surgical aortic repair, a residual entry tear may lead to a patent false lumen in the downstream aorta, which will significantly affect longterm prognosis with decreased survival and increased distal aortic events (3)(4)(5). Reports on such patients in large series with longer follow-ups are scarce, especially regarding management of distal new entry tear (4,6).…”