• Junichiro Takahashi, Yutaka Wakamatsu, Jun Okude, Tsuyoshi Kanaoka, Youichi Sanefuji, Toshihiro Gohda, Shigeyuki Sasaki, and Yoshiro Matsui.
• Division of Cardiovascular Surgery, Aishin Memorial Hospital, Sapporo, Japan.
• Ann Thorac Cardiovasc Surg. 2008 Oct 1;14(5):303-10.

ObjectivesTo identify the most prognostic predictor of Stanford type B aortic dissection at admission.Patients And MethodsForty-three patients with Stanford type B aortic dissection were divided into two groups: (1) those who developed dissection-related events later (EV group: n = 18), including the need for surgery (n = 12), rupture (n = 1), dissection-related death (n = 5), and aortic enlargement > or =5 mm in diameter per year (n = 15); (2) those without later events (NoEV group: n = 25). Clinical features, aortic diameters, and blood flow status were compared.ResultsThe maximum aortic diameter at admission was 41.5 +/- 1.7 mm for the EV group, which was significantly greater than the NoEV group (34.4 +/- 0.9 mm, p <0.001). A maximum aortic diameter > or =40 mm was found in 11 patients (61%) of the EV group, whereas this maximum was found in 4 (16%) of the NoEV group (p = 0.004). A patent false lumen at admission was found in all patients of the EV group and in 17 (68%) of the NoEV group (p = 0.013). Other factors were not significant. A Cox hazard analysis indicated a maximum aortic diameter > or =40 mm as a significant predictor for dissection-related events (hazard ratio 3.13, p = 0.032). The presence of a patent false lumen did not reach a statistical significance.ConclusionOur results indicated that a maximum aortic diameter > or =40 mm at admission was the most prognostic factor for developing late dissection-related events, rather than the presence of a patent false lumen.

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