Retrograde ascending aortic dissection: a diagnostic and therapeutic challenge

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Aortic dissection, particularly with tears in the transverse aorta, carries a high mortality rate.
• Predicting the extension pattern of aortic dissection is challenging.
• Retrograde ascending aortic dissection requires specific diagnostic and therapeutic considerations.

Purpose of the Study:

• To investigate the incidence of retrograde ascending aortic dissection.
• To identify predictive factors for operative risk in aortic dissection.
• To evaluate the diagnostic utility of Doppler-echocardiography in localizing intimal tears.

Main Methods:

• Prospective study of 61 consecutive patients with ascending aortic dissection over 36 months.
• Surgical intervention involved aortic replacement/repair under moderate hypothermia, with deep hypothermic circulatory arrest for complex cases.
• Doppler-echocardiography was used for tear localization.

Main Results:

• Intimal tears were located in the ascending aorta in 80.3% and transverse aorta in 19.7% of patients.
• In the transverse aorta tear group, 5 patients had strictly retrograde extension, and 7 had bi-directional extension.
• Overall operative mortality was 12.1%, with higher mortality (20%) for transverse aorta dissections. Age, coronary artery disease, and tear site predicted operative risk. Doppler-echocardiography sensitivity was 96.7%.

Conclusions:

• Tears in the transverse aorta are frequently associated with retrograde dissection, potentially mimicking ascending aortic dissection.
• Localization of the primary intimal tear is a diagnostic challenge but critical for management.
• Age, coronary artery disease, and intimal tear location are significant predictors of operative risk in aortic dissection.