Aortic enlargement in two weeks is associated with subsequent aortic events in patients with type B acute aortic syndrome

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 166; no. 2; pp. 410 - 418.e1
• Main Authors: Miyoshi, Yutaro, Kaji, Shuichiro, Masumoto, Akiko, Kim, Kitae, Kitai, Takeshi, Kinoshita, Makoto, Furukawa, Yutaka
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2023
• Subjects: Acute Aortic Syndrome; Aorta; Aortic Aneurysm, Thoracic - surgery; Aortic Dissection - complications; Aortic Dissection - diagnostic imaging; Aortic Dissection - surgery; Endovascular Procedures - adverse effects; follow-up studies; Humans; imaging; prognosis; Retrospective Studies; Tomography, X-Ray Computed - methods; Treatment Outcome; AD; IMH; CI; IQR; imaging; prognosis; CT; follow-up studies; TEVAR; aorta; acute aortic syndrome; SHR; B-AAS
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2021.09.014

To determine whether aortic enlargement in 2 weeks in patients with type B acute aortic syndrome is associated with aorta-related adverse events.
This retrospective, single-center study included 183 patients who were diagnosed with uncomplicated type B acute aortic syndrome (classic aortic dissection and intramural hematoma) between 2010 and 2019 and had follow-up computed tomography at second or third week. Aortic diameter was measured at admission and at predischarge follow-up. Aorta-related adverse events were defined by a composite of aortic rupture, surgical or endovascular aortic repair, redissection, severe intestinal malperfusion, and aortic enlargement.
The patients whose aortic diameter enlarged ≥2 mm but <5 mm in 2 weeks were categorized as moderate aortic enlargement group. During follow-up, 51 patients (28%) had aorta-related adverse events and 36 patients (20%) had moderate aortic enlargement. Patients with moderate aortic enlargement showed lower aorta-related event-free survival rates than those without moderate enlargement (48 ± 9% vs 90 ± 3% at 1 year, P < .001). On multivariable analysis, moderate aortic enlargement (subhazard ratio, 3.64; 95% confidence interval, 2.08-6.35; P < .001) and aortic diameter ≥40 mm at admission (subhazard ratio, 2.96; 95% confidence interval, 1.60-5.48; P < .001) were associated with aorta-related adverse events.
Moderate aortic enlargement in 2 weeks is a significant risk factor of aorta-related adverse events in patients with uncomplicated type B acute aortic syndrome. Patients with moderate aortic enlargement should be followed up carefully and may be candidates for subsequent endovascular treatment.
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