• Magnus Larsen, Kristian Bartnes, Thomas T Tsai, Kim A Eagle, Arturo Evangelista, Christoph A Nienaber, Toru Suzuki, Rossella Fattori, James B Froehlich, Stuart Hutchison, Thoralf M Sundt, James L Januzzi, Eric M Isselbacher, Daniel G Montgomery, and Truls Myrmel.
• Department of Cardiothoracic and Vascular Surgery, University Hospital North Norway, Tromsø, Norway.
• J Am Heart Assoc. 2013 Jul 1; 2 (4): e000112.

BackgroundPartial thrombosis of the false lumen has been related to aortic growth, reoperations, and death in the chronic phase of type B and repaired type A aortic dissections. The impact of preoperative false lumen thrombosis has not been studied previously. We used data from a contemporary, multinational database on aortic dissections to evaluate whether different degrees of preoperative false lumen thrombosis influenced long-term prognosis.Methods And ResultsWe examined the records of 522 patients with surgically treated acute type A aortic dissections who survived to discharge between 1996 and 2011. At the preoperative imaging, 414 (79.3%) patients had patent false lumens, 84 (16.1%) had partial thrombosis of the false lumen, and 24 (4.6%) had complete thrombosis of the false lumen. The annual median (interquartile range) aortic growth rates were 0.5 (-0.3 to 2.0) mm in the aortic arch, 2.0 (0.2 to 4.0) mm in the descending thoracic aorta, and similar regardless of the degree of false lumen thrombosis. The overall 5-year survival rate was 84.7%, and it was not influenced by false lumen thrombosis (P=0.86 by the log-rank test). Independent predictors of long-term mortality were age >70 years (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.20 to 4.56, P=0.012) and postoperative cerebrovascular accident, coma, and/or renal failure (HR, 2.62; 95% CI, 1.40 to 4.92, P=0.003).ConclusionsPatients with acute type A aortic dissection who survive to discharge have a favorable prognosis. Preoperative false lumen thrombosis does not influence long-term mortality, reintervention rates, or aortic growth.

40 keywords...

hide…