Morphologic prognostic factor for thoracoabdominal aortic dilation after acute type A dissection repair

TL;DR

This study found that the location of the true lumen in the abdominal aorta after acute type A aortic dissection surgery is a key predictor of later aortic dilation.

Contribution

The study identifies true lumen location as a novel morphologic prognostic factor for post-surgical aortic dilation.

Findings

Patients with a ventral true lumen location had significantly higher thoraco-abdominal aortic dilation (90.9% vs 51.9%).

Ventral true lumen location was an independent prognostic factor for aortic dilation (odds ratio 6.01).

Abstract

Risk factors for late-term aortic dilation after acute type A aortic dissection repair have not been well examined. The goal of this study was to determine the relationship between the abdominal aortic true lumen location and thoraco-abdominal aortic dilation after surgical repair for acute type A aortic dissection.

Patients who were preoperatively diagnosed with acute type A aortic dissection between April 2014 and July 2022 were included in this study. We evaluated the renal artery-level dissected aortic morphology and classified the study population into 2 groups: the ventral (those with the true lumen located on the ventral side) and the dorsal (other patients not assigned to the ventral group) groups, based on the location of the true lumen. Aortic dilation was defined as thoraco-abdominal aortic expansion ≥5 mm on 1-year postoperative computed tomography images.

We examined 49 surgical patients who were assigned to the ventral (n = 22) and dorsal (n = 27) groups. The number of patients with ≥5 mm thoraco-abdominal aortic dilation after the operation was significantly higher in the ventral group than in the dorsal group (90.9% vs 51.9%, P = 0.009). The multivariable logistic regression analysis showed that the ventral type was an independent prognostic factor for thoraco-abdominal aortic dilation after the operation (odds ratio, 6.01; 95% confidence interval, 1.56–23.77; P = 0.009).

The location of the true lumen of the abdominal aorta in acute type A aortic dissection may be a prognostic factor for thoraco-abdominal aortic dilation after surgical repair.

Over the past few decades, surgical outcomes of acute type A aortic dissection (ATAAD) have improved [1].

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