Long-term outcomes after recurrent acute thoracic aortic dissection: Insights from the International Registry of Aortic Dissection.

Autor:	Ogami T; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa., Arnaoutakis GJ; Division of Cardiovascular and Thoracic Surgery, Institute for Cardiovascular Health, The University of Texas at Austin, Austin, Tex., Isselbacher EM; Cardiology Department, Thoracic Aortic Center, Massachusetts General Hospital, Boston, Mass., Geuzebroek GSC; Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Coselli JS; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex., De Vincentiis C; Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato, Italy., Kaiser CA; Cardiothoracic Surgery, Saint Thomas Heart, Nashville, Tenn., Hutchison S; Department of Cardiac Sciences, University of Calgary Medical Centre, Calgary, Alberta, Canada., Li QG; Cardiac Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China., Brinster DR; Department of Cardiac Surgery, Northwell Health, New York, NY., Leshnower BG; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga., Serna-Gallegos D; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa., Pai CW; Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich., Taylor BS; Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md., Patel HJ; Department of Cardiac Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich., Eagle KA; Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich., Sultan I; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: sultani@upmc.edu.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2024 Apr 28. Date of Electronic Publication: 2024 Apr 28.
DOI:	10.1016/j.jtcvs.2024.03.029
Abstrakt:	Objective: With an aging population and advancements in imaging, recurrence of thoracic aortic dissection is becoming more common. Methods: All patients enrolled in the International Registry of Aortic Dissection from 1996 to 2023 with type A and type B acute aortic dissection were identified. Among them, initial dissection and recurrent dissection were discerned. The study period was categorized into 3 eras: historic era, 1996 to 2005; middle era, 2006 to 2015; most recent era, 2016 to 2023. Propensity score matching was applied between initial dissection and recurrent dissection. Outcome of interests included long-term survival and cumulative incidence of major aortic events defined by the composite of reintervention, aortic rupture, and new dissection. Results: The proportion of recurrent dissection increased from 5.9% in the historic era to 8.0% in the most recent era in the entire dissection cohort. In patients with type A dissection, propensity score matching between initial dissection and recurrent dissection yielded 326 matched pairs. Kaplan-Meier curves showed similar long-term survival between the 2 groups. However, the cumulative incidence of major aortic events was significantly higher in the recurrent dissection group (40.3% ± 6.2% vs 17.8% ± 5.1% at 4 years in the initial dissection group, P = .02). For type B dissection, 316 matched pairs were observed after propensity score matching. Long-term survival and the incidence of major aortic events were equivalent between the 2 groups. Conclusions: The case volume of recurrent dissection or the ability to detect recurrent dissection has increased over time. Acute type A recurrent dissection was associated with a higher risk of major aortic events than initial dissection. Further judicious follow-up may be crucial after type A recurrent dissection. Competing Interests: Conflict of Interest Statement G.J.A. receives consulting fees from Terumo Aortic. I.S. receives institutional research support from Abbott, AtriCure, Artivion, Boston Scientific, Edwards, Medtronic, and Terumo Aortic. None were related to this manuscript. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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