• Woon Heo, Suk-Won Song, Shin-Young Lee, Tae-Hoon Kim, Jin-Seong Lee, Kyung-Jong Yoo, and Bum-Koo Cho.
• Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
• Eur J Cardiothorac Surg. 2019 Jun 1; 55 (6): 1037-1044.

ObjectivesThe aim of this study is to evaluate the locational impact of a luminal communication on aortic diameter changes and reintervention after surgical repair of acute type I aortic dissection.MethodsBetween 2009 and 2017, 304 patients underwent operation for acute type I aortic dissection. Among them, 93 patients were enrolled. The luminal communications were analysed in segment 1 (the proximal descending thoracic aorta), segment 2 (the distal descending thoracic aorta) and segment 3 (the abdominal aorta). The aortic diameter was measured at the pulmonary artery bifurcation, coeliac axis, maximal abdominal aorta and maximal thoraco-abdominal aorta using serial follow-up computed tomography scans. The linear mixed model was used, and the rate of freedom from reintervention was analysed.ResultsIn the adjusted analysis, the initial diameter of the maximal abdominal aorta and the first luminal communication in segment 1 was statistically significant. However, the slope value of the maximal abdominal aorta was smaller than that of the first luminal communication in segment 1 (0.024 vs 0.198). The 3-year freedom from reintervention rate was significantly higher in patients without a luminal communication than in those with an initial luminal communication in segment 1 (96% vs 47%, log rank, P = 0.003).ConclusionsA luminal communication at the proximal descending thoracic aorta (segment 1) is a significant factor for an increasing aortic diameter and reintervention after surgical repair of acute type I aortic dissection.© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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