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KMID : 0364020140470010006
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Korean Journal of Thoracic and Cardiovascular Surgery
2014 Volume.47 No. 1 p.6 ~ p.12
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Influence of Radiologically Evident Residual Intimal Tear on Expansion of Descending Aorta Following Surgery for Acute Type I Aortic Dissection
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Kim Yun-Seok
Kim Jeong-Heon
Kim Joon-Bum
Yang Dong-Hyun
Kang Joon-Won
Hwang Su-Kyung
Choo Suk-Jung
Chung Cheol-Hyun
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Abstract
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Background : Although a residual intimal tear may contribute to the dilatation of the descending aorta following surgical repair of acute type I aortic dissection (AD), its causal relationship has not been elucidated by clinical data due to the limited resolution of imaging modalities.
Methods : This study enrolled 41 patients (age, 55.2±11.9 years) who were evaluated with dual-source computed tomography (CT) imaging of the whole aorta in the setting of the surgical repair of acute type I AD. Logistic regression models were used to determine the predictors of a composite of the aortic aneurysm formation (diameter >55 mm) and rapid aortic expansion (>5 mm/yr).
Results : On initial CT, a distal re-entry tear was identified in 9 patients. Two patients failed to achieve proximal tear exclusion by the surgery. Serial follow-up CT evaluations (median, 24.6 months; range, 6.0 to 67.2 months) revealed that 14 patients showed rapid expansion of the descending aorta or aortic aneurysm formation. A multivariate analysis revealed that the residual intimal tear (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.02 to 19.31) and the patent false lumen in the early postoperative setting (OR, 4.64; 95% CI, 0.99 to 43.61) were predictive of the composite endpoint.
Conclusion : The presence of a residual intimal tear following surgery for acute type I AD adversely influenced the expansion of the descending aorta.
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KEYWORD
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Aortic dissection, Aneurysm, Surgery, Risk analysis
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