Long-Term Outcome and Prognostic Predictors of Medically Treated Acute Type B Aortic Dissections

• Published in: The Annals of thoracic surgery Vol. 78; no. 4; pp. 1268 - 1273
• Main Authors: Onitsuka, Seiji, Akashi, Hidetoshi, Tayama, Keiichiro, Okazaki, Teiji, Ishihara, Kenji, Hiromatsu, Shinichi, Aoyagi, Shigeaki
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-10-2004; Elsevier Science
• Subjects: Acute Disease; Adrenergic alpha-Antagonists - therapeutic use; Adrenergic beta-Antagonists - therapeutic use; Adult; Aged; Aged, 80 and over; Aneurysm, Dissecting - complications; Aneurysm, Dissecting - drug therapy; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Anthropometry; Antihypertensive Agents - therapeutic use; Aorta - pathology; Aortic Aneurysm - complications; Aortic Aneurysm - drug therapy; Aortic Aneurysm - mortality; Aortic Aneurysm - surgery; Aortic Rupture - etiology; Aortic Rupture - surgery; Biological and medical sciences; Blood and lymphatic vessels; Calcium Channel Blockers - therapeutic use; Cardiology. Vascular system; Comorbidity; Disease Progression; Disease-Free Survival; Diseases of the aorta; Female; Humans; Hypertension - complications; Hypertension - drug therapy; Ischemia - etiology; Leg - blood supply; Male; Medical sciences; Middle Aged; Prognosis; Risk Factors; Rupture, Spontaneous; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgery of the respiratory system; Treatment Outcome; Viscera - blood supply; 26; Prognosis; Respiratory disease; Predictor; Acute; Prediction; Cardiovascular disease; Thorax; Long term; Arterial disease; Vascular disease; Type; Treatment; Surgery; Aortic dissection; Evolution; Predictive factor; Aortic disease
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2004.02.031

The purpose of this study was to examine the long-term outcome and the prognostic predictors related to the development of complications associated with acute type B aortic dissection.
Seventy-six medically treated patients with acute type B aortic dissection were examined between 1990 and 2001. The events associated with aortic dissection included dissection-related death, rupture, visceral ischemia, lower limb ischemia, an increase in the maximum aortic diameter greater than 50 mm, and a mean enlargement rate of greater than 5 mm per year.
Among the 76 patients 10 (13%) underwent chronic phase surgery and 25 (33%) presented with an event. A statistically significant difference was observed between patients with and without events with regard to atherosclerotic factors, blood flow status in the false lumen, maximum aortic diameter upon admission, mean aortic enlargement rate, and blood pressure control during follow-up. Of these factors a patent false-lumen and a maximum aortic diameter greater than 40 mm upon admission were the most strongly associated factors with regard to the development of events. Patients with a patent false-lumen and a maximum aortic diameter greater than 40 mm upon admission were determined to exhibit significantly higher event rates than other patients.
In determining the appropriate therapeutic approach for acute type B aortic dissection, it is important to pay careful attention to the predictors of a patent false-lumen and a maximum aortic diameter greater than 40 mm at onset to improve the long-term outcome.