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Acute-on-Chronic Aortic Dissection: Management and Outcomes of the Unstable "Triple-Lumen" Aorta
Elizabeth L Norton1, Woodrow J Farrington1, William B Keeling1
1Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Insights
Acute aortic dissection can create a triple-lumen aorta, a complex condition often requiring urgent repair. This complication, particularly in type B dissections, presents significant risks and necessitates careful management.
Area of Science:
- Cardiovascular Surgery
- Aortic Diseases
- Vascular Imaging
Background:
- The clinical impact of acute aortic dissection on a chronically dissected distal aorta remains unclear.
- This study investigates the incidence and characteristics of triple-lumen aortic dissection.
Purpose of the Study:
- To describe the incidence and features of triple-lumen aortic dissection.
- To evaluate the impact of triple-lumen aortic dissection on patient survival.
Main Methods:
- A single-institution aortic database was queried for patients with chronic distal aortic dissection from 2010 to 2021.
- Triple-lumen aortic dissections were identified via contrast-enhanced cross-sectional imaging.
- Triple-lumen patients were matched 1:1 with double-lumen patients based on preoperative variables for outcome assessment.
Main Results:
- 2.9% of chronic distal aortic dissection patients (33/1149) had triple-lumen dissections.
- The median age was 46 years; 67% had initial type B dissection.
- 85% required urgent repair for rapid growth, large diameter (≥55 mm), malperfusion, pain, or rupture; 30-day mortality was 12%.
Conclusions:
- Triple-lumen aorta resulting from acute-on-chronic dissection should be classified as complicated type B dissection.
- These patients often present with large aneurysms and rapid false lumen expansion.
- Urgent surgical repair is frequently indicated.
Background:
The impact of acute aortic dissection of the chronically dissected distal aorta is unknown. This study sought to describe the incidence and characteristics of the triple-lumen aortic dissection and its impact on survival.
Methods:
From 2010 to 2021, a query of a single-institution aortic database identified 1149 patients with chronic distal aortic dissection. Thirty-three (2.9%) patients with at least 3 distinct lumens and 2 separate "primary" intimal tears were identified by analysis of contrast-enhanced cross-sectional imaging. Triple-lumen patients were exactly matched with a cohort of double-lumen patients on a 1:1 ratio using 5 preoperative variables, and outcomes between the groups were assessed.
Results:
The median age at time of initial dissection in patients with a triple-lumen dissection was 46 years. Initial dissection was a type A in 33% and a type B in 67% of patients. The median time from initial dissection to triple-lumen diagnosis was 4.2 years. On diagnosis of the triple-lumen aorta, 85% of patients required urgent aortic repair for rapid growth (36%), aortic diameter ≥55 mm (30%), malperfusion (6%), intractable pain (6%), and rupture/type A (6%). Thirty-day mortality after triple lumen dissection was 12%.
Conclusions:
Acute-on-chronic distal dissection resulting in a triple-lumen aorta should be classified as a "complicated" type B dissection as these patients typically have large aneurysms and a high incidence of rapid false lumen expansion requiring urgent surgical repair.
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