Prognostic implications of descending thoracic aorta dilation after surgery for aortic dissection

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• 作者：Madelien V. Regeer^a ; ¹ ; Bryan Martina^b ; ¹ ; Michel I.M. Versteegh^b ; Arend de Weger^b ; Robert J.M. Klautz^b ; Martin J. Schalij^a ; Jeroen J. Bax^a ; Nina Ajmone Marsan^a ; Victoria Delgado^a ; ^{v.delgado@lumc.nl}
• 关键词：Aortic dilation ; Aortic dissection ; Computed tomography ; Surgery ; Prognosis
• 刊名：Journal of Cardiovascular Computed Tomography
• 出版年：2017
• 出版时间：January-February 2017
• 年：2017
• 卷：11
• 期：1
• 页码：1-7
• 全文大小：2015 K
• 卷排序：11

文摘

The present study assessed whether descending thoracic aorta growth can be measured reliably by volumetric analysis using multi-detector row computed tomography (MDCT) and whether growth influences the need for future aortic interventions in survivors of acute type A aortic dissection.MethodsA total of 51 patients (58 ± 11 years, 61% male) who underwent surgery for type A aortic dissection with ≥2 postoperative MDCT scans ≥5 months apart were included. Volumetric analysis of the descending thoracic aorta was performed with acceptable intraobserver variability. Growth of the complete, false and true lumen was estimated in ml/year and defined as slow growth (≤average growth) or fast growth (>average growth).ResultsThe complete lumen volume increased from 133 ± 8 ml to 163 ± 9 ml after 3.5 years follow-up (p < 0.001), with an average growth rate of 6.1 ml/year. The false lumen volume increased from 81 ± 7 ml to 106 ± 12 ml (p = 0.018) with an average growth rate of 2.8 ml/year. The true lumen changed only slightly from 59 ± 4 ml to 65 ± 8 ml (p = 0.205). Five-year freedom from descending thoracic aorta intervention was significantly lower in patients with above-average growth of the complete lumen (80 ± 9%) compared to slow growth (100%; p = 0.003). Similar observations were made for the false lumen (fast: 74 ± 12% vs. slow: 100%; p = 0.042).ConclusionsIncreased growth of the false lumen of the descending thoracic aorta after type A aortic dissection was associated with a higher risk of secondary interventions.