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Predictors of Late Adverse Events in Patients with Surgically Treated Type I Aortic Dissection

Jin Kyoung Kim1, Jung Hwan Goh2, Joon Bum Kim1

  • 1Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|May 8, 2024
PubMed

Insights

Patients with residual aortic dissection after surgery face risks. Key predictors of adverse events include large aortic diameter and multiple intimal tears, requiring vigilant monitoring.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Radiology

Background:

  • Residual aortic dissection (AD) after DeBakey type I AD repair is linked to adverse outcomes.
  • Identifying predictive factors for these events is crucial for patient management.

Purpose of the Study:

  • To identify clinical and early post-operative computed tomography angiography (CTA) factors predicting adverse events in patients with type I AD post-ascending aorta replacement.

Main Methods:

  • Retrospective cohort study of 103 patients undergoing ascending aorta replacement for type I AD.
  • Evaluated intimal tear characteristics, aortic diameter, and false lumen status on post-operative CTA.
  • Used regression analyses and a decision tree model to identify risk factors for AD-related adverse events.

Main Results:

  • 23.3% of patients experienced AD-related adverse events.
  • Multivariable analysis identified connective tissue disease, maximum aortic diameter ≥ 40 mm, and multiple intimal tears as significant predictors (HRs 15.33, 4.90, 7.12 respectively).
  • High-risk patients (≥ 40 mm diameter, multiple tears) had significantly lower 3-year survival free from adverse events (41.7% vs. 90.9%).

Conclusions:

  • Early post-operative CTA findings of maximum aortic diameter ≥ 40 mm and multiple intimal tears predict higher risk of adverse events.
  • These imaging markers suggest a need for intensified monitoring and management strategies in high-risk patients.
Abstract

Keywords:
AneurysmAortic dissectionComputed tomography angiographyEndovascular aneurysm repairRe-operation

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