Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection

Kimura, Naoyuki; Itoh, Satoshi; Yasuda, Kôichi; Adachi, Koichi; Matsumoto, Harunobu; Yamaguchi, Atsushi; Adachi, Hideo

doi:10.1016/j.jtcvs.2014.08.008

Cited by 101 publications

(98 citation statements)

References 29 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.…”

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%

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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%

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

et al. 2016

JAHA

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“…Surgery for ATAAD was as reported previously 25, 26, 27. Briefly, aortic repair was performed via median sternotomy.…”

Section: Methodsmentioning

confidence: 99%

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

Itagaki

Kimura

Mieno

et al. 2018

JAHA

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BackgroundClinical characteristics and treatment outcomes of acute type A aortic dissection with D‐dimer elevation have not been clarified.Methods and ResultsD‐dimer was measured preoperatively within 24 hours of symptom onset in 262 patients with acute type A aortic dissection. The median (and interquartile range) admission D‐dimer concentration in our total patient group was 26.7 (8.3–85.9) μg/mL. Median (interquartile range) D‐dimer concentrations were 5.0 (2.6–18.0) μg/mL for complete false lumen thrombosis (n=33), 60.9 (19.4–160.4) μg/mL for partial thrombosis (n=81), 26.5 (10.0–70.6) μg/mL for a patent false lumen (n=131), and 8.7 (3.2–26.9) μg/mL for ulcerlike projection (n=17) (P<0.01). With a D‐dimer concentration of ≤8.3 μg/mL representing the lower quartile, we then investigated predictors of a low D‐dimer level. Multivariate analysis showed dissection limited to the ascending aorta (P<0.01; odds ratio, 9.81) or descending aorta (P<0.01; odds ratio, 7.68), a completely thrombosed false lumen (P<0.01; odds ratio, 4.02), and absence of brain ischemia (P=0.013; odds ratio, 4.74) to be predictors of the lower D‐dimer concentration. Compared with patients with a low D‐dimer concentration (≤8.3 μg/mL, n=66), patients with a D‐dimer concentration >8.3 μg/mL (n=196) had a reduced preoperative platelet count and increased operation time and transfusion volume. In‐hospital mortality was elevated in this group (1.5% versus 11.2%; P=0.031), although 7‐year survival did not differ for hospital survivors (lower versus higher, 93.1% versus 79.1%; P=0.21).ConclusionsD‐dimer concentrations are strongly influenced by the extent of dissection and false lumen status. Operative risks are increased in patients with a relatively high D‐dimer concentration.

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“…A distal intimal tear after initial surgery for TAAD was a proven risk factor for patent false lumen and dilation of the descending aorta (4). Kimura and colleagues reported that a patent false lumen significantly decreased survival and increased the incidence of distal aortic events (2). Obviating the residual or new tears in the descending aorta allows for false lumen thrombosis and obliteration, which would promote distal aortic remodeling and improve long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…However, following the FET repair, late complications requiring reoperations may still occur (1,2). These are often related to residual intimal…”

Section: Introductionmentioning

confidence: 99%

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

Pan

et al. 2017

J. Thorac. Dis.

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Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection

Abstract: False lumen patency influences the late outcomes of acute type A aortic dissection repair. Outcomes of distal reoperation were acceptable; thus, careful follow-up and timely reoperation may improve the late outcomes.

Cited by 101 publications

References 29 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

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

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

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