Computed Tomography Imaging Measurements as a Surrogate for Clinical Outcomes After Surgical Management of Acute Type A Aortic Dissection: A Systematic Review.

Autor: Vo TX; Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada., Rahmouni K; Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada., Visintini S; Berkman Library University of Ottawa Heart Institute Ottawa Ontario Canada., Guo MH; Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada., Ouzounian M; Division of Cardiac Surgery University of Toronto Toronto Ontario Canada., Chu MWA; Division of Cardiac Surgery Western University London Ontario Canada., Boodhwani M; Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada., Appoo JJ; Division of Cardiac Surgery University of Calgary Calgary Alberta Canada., Tucker K; Division of Medical Sciences, Nuffield Department of Primary Care Health Sciences Oxford University Oxford UK., Al-Atassi T; Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Sep 09, pp. e034496. Date of Electronic Publication: 2024 Sep 09.
DOI: 10.1161/JAHA.124.034496
Abstrakt: Background: Postoperative computed tomography imaging surveillance is an essential component of care after acute type A aortic dissection (ATAAD) repair. Prognostic imaging factors after ATAAD repair have not been systematically reviewed.
Methods and Results: We performed a systematic review to summarize postoperative computed tomography measurements including aortic diameter, cross-sectional area, volume, growth rate, and false lumen thrombosis in addition mid- to long-term clinical outcomes after ATAAD repair. Searches were conducted in Medline, Embase, and CENTRAL in October 2022. Studies were included if they reported clinical outcomes such as mortality or aortic reintervention after 1 year and included aforementioned computed tomography findings. Studies of chronic aortic dissection and studies of exclusive patient populations such as those with connective tissue diseases were excluded. Risk of bias was assessed with the Newcastle-Ottawa Scale. Searches retrieved 6999 articles. Sixty-eight studies met inclusion criteria (7885 patients). Extended repairs were associated with improved false lumen thrombosis, decreased aortic growth rate, and decreased rates of reintervention but not improved survival. Growth rates of the aorta post-ATAAD repair were highest in the descending thoracic aorta. The most frequent prognostic imaging factors reported were a patent/partially thrombosed false lumen and postoperative aortic diameter >40 to 45 mm.
Conclusions: Established measurements of positive aortic remodeling, including complete false lumen thrombosis and stabilization of postoperative aortic diameter and growth are the most studied prognostic indicators for improved clinical outcomes after ATAAD repair. Growth rate of the aorta remains significant after ATAAD repair. Future studies should prospectively evaluate and compare prognostic factors for improved surveillance and management.
Databáze: MEDLINE
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