Predictors of Late Adverse Events in Patients with Surgically Treated Type I Aortic Dissection.

Autor: Kim JK; Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea., Goh JH; University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea., Kim JB; Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea., Song JK; Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea., Yang DH; Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea., Kang JW; Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea., Kim SO; Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea., Koo HJ; Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea. Electronic address: radkoo@amc.seoul.kr.
Jazyk: angličtina
Zdroj: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2024 Oct; Vol. 68 (4), pp. 444-453. Date of Electronic Publication: 2024 May 06.
DOI: 10.1016/j.ejvs.2024.05.004
Abstrakt: Objective: Residual aortic dissection (AD) following DeBakey type I AD repair is associated with a high rate of adverse events that need additional intervention or surgery. This study aimed to identify clinical and early post-operative computed tomography angiography (CTA) imaging factors associated with adverse events in patients with type I AD after ascending aorta replacement.
Methods: This single centre, retrospective cohort study included consecutive patients with type I AD who underwent ascending aorta replacement from January 2011 to December 2017 and post-operative CTA within three months. The primary outcome was AD related adverse events, defined as AD related death and re-operation due to aortic aneurysm or impending rupture. The location and size of the primary intimal tears, aortic diameter, and false lumen status were evaluated. Regression analyses were performed to identify factors associated with AD related adverse events. A decision tree model was used to classify patients as high or low risk.
Results: Of 103 participants (55.43 ± 13.94 years; 49.5% male), 24 (23.3%) experienced AD related adverse events. In multivariable Cox regression analysis, connective tissue disease (hazard ratio [HR] 15.33; p < .001), maximum aortic diameter ≥ 40 mm (HR 4.90; p < .001), and multiple (three or more) intimal tears (HR 7.12; p < .001) were associated with AD related adverse events. The three year cumulative survival free from AD related events was lower in the high risk group with aortic diameter ≥ 40 mm and multiple intimal tears (41.7% vs. 90.9%; p < .001).
Conclusion: Early post-operative CTA findings indicating a maximum aortic diameter ≥ 40 mm and multiple intimal tears may predict a higher risk of adverse events. These findings suggest the need for careful monitoring and more vigilant management approaches in these cases.
(Copyright © 2024 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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