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Korean J Thorac Cardiovasc Surg. 2014 Feb;47(1):6-12. doi: 10.5090/kjtcs.2014.47.1.6. Epub 2014 Feb 5.

Influence of radiologically evident residual intimal tear on expansion of descending aorta following surgery for acute type I aortic dissection.

Author information

1
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea.
2
Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Korea.
3
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea.

Abstract

BACKGROUND:

Although a residual intimal tear may contribute to the dilatation of the descending aorta following surgical repair of acute type I aortic dissection (AD), its causal relationship has not been elucidated by clinical data due to the limited resolution of imaging modalities.

METHODS:

This study enrolled 41 patients (age, 55.2±11.9 years) who were evaluated with dual-source computed tomography (CT) imaging of the whole aorta in the setting of the surgical repair of acute type I AD. Logistic regression models were used to determine the predictors of a composite of the aortic aneurysm formation (diameter >55 mm) and rapid aortic expansion (>5 mm/yr).

RESULTS:

On initial CT, a distal re-entry tear was identified in 9 patients. Two patients failed to achieve proximal tear exclusion by the surgery. Serial follow-up CT evaluations (median, 24.6 months; range, 6.0 to 67.2 months) revealed that 14 patients showed rapid expansion of the descending aorta or aortic aneurysm formation. A multivariate analysis revealed that the residual intimal tear (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.02 to 19.31) and the patent false lumen in the early postoperative setting (OR, 4.64; 95% CI, 0.99 to 43.61) were predictive of the composite endpoint.

CONCLUSION:

The presence of a residual intimal tear following surgery for acute type I AD adversely influenced the expansion of the descending aorta.

KEYWORDS:

Aneurysm; Aortic dissection; Risk analysis; Surgery

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