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[Long-term outcome of a false lumen after surgical correction of type A acute aortic dissection]
A Dubar1, J P Beregi, F Bouchard
1Service de chirurgie cardiovasculaire B, Lille.
Insights
Long-term outcomes for acute aortic dissection surgery show that most patients develop a persistent false lumen. Management of false lumen dilatation remains challenging, with potential benefits from extending aortic arch repair.
Area of Science:
- Cardiovascular Surgery
- Vascular Imaging
- Aortic Diseases
Context:
- Acute aortic dissection requires surgical intervention, often involving the ascending aorta.
- Long-term monitoring is crucial for assessing outcomes and potential complications.
- The presence and progression of a false lumen after surgery are key concerns.
Purpose:
- To evaluate the long-term clinical outcomes of patients undergoing surgery for acute aortic dissection.
- To assess the fate of the false lumen and aortic diameter changes post-surgery.
- To identify factors influencing aortic dilatation and inform future management strategies.
Summary:
- This study followed 44 patients operated for acute aortic dissection of the ascending aorta for a mean of 64.3 months.
- A persistent false lumen was observed in 92% of patients whose dissection extended beyond the innominate artery.
- Aortic dilatation occurred in a significant proportion of patients, necessitating ongoing surveillance and management.
Impact:
- Findings highlight the high incidence of persistent false lumens and subsequent aortic dilatation after ascending aorta repair.
- The study suggests that extending initial repair to the aortic arch may mitigate false lumen progression.
- Results underscore the need for standardized management protocols for false lumen dilatation in aortic dissection patients.
Abstract:
The long-term outcome (64.3 +/- 45 months) of 44 patients operated for acute dissection of at least the ascending aorta was assessed by regular clinical examination and annual CT scan. The diameter of the aorta at different levels was measured at each CT scan for all patients. Initially, 7 patients (16%) had acute dissection limited to the ascending aorta; none had a false lumen after surgery. No signs of aneurysmal dilatation were observed during follow-up of these patients. In the 37 other cases (84%) dissection of the aorta extended beyond the innominate artery; the false lumen remained patent distal to the prosthetic tube replacing the ascending aorta in 34 patients (92%). The false lumen was partially thrombosed in 8% of patients, leading to distal emboli in 1 patient. Moderate increases (less than 15 mm) in diameter of the false lumen were observed in 32% of patients; more severe dilatation (over 20 mm) was observed in 12% of patients. The management of dilatation of the false lumen is not standard; it depends mainly on the rate of progression and the clinical consequences. It is hoped that extension of the initial repair to the aortic arch, when the intimal tear is situated in this zone, will reduce the short and long-term progression of the false lumen.