• Ann. Thorac. Surg. · Jul 2020

    Comparative Study

    Impact of supra-aortic intimal tears on aortic diameter changes after non-total arch replacement.

    • Woon Heo, Suk-Won Song, Tae-Hoon Kim, Sun-Hee Lim, Kyung-Jong Yoo, Bum-Koo Cho, and Hye Sun Lee.
    • Department of Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
    • Ann. Thorac. Surg. 2020 Jul 1; 110 (1): 20-26.

    BackgroundThis study evaluated the impact of the intimal tear location on aortic dilation and reintervention after nontotal arch replacement (non-TAR) for acute type I aortic dissection.MethodsBetween 2009 and 2017, 92 patients who underwent non-TAR for acute type I aortic dissection were enrolled. Intimal tears were analyzed at the supraaortic (SA) segment; segment 1, proximal descending thoracic aorta (DTA); segment 2, distal DTA; and segment 3, abdominal aorta. Aortic diameter was measured at the pulmonary artery bifurcation, celiac axis, maximal abdominal aorta, and maximal thoracoabdominal aorta using serial follow-up computed tomographic scans. The Fisher exact or χ2 test, independent t or Mann-Whitney U test, and log-rank test were used in the statistical analyses.ResultsThe significant factors for increasing aortic diameter were the first location of intimal tear in the SA segment and segments 1 and 2. In the adjusted analysis, the first location of intimal tear in the SA segment and segment 1 was statistically significant. In the additional adjusted analysis, a segment 1 tear without SA tear was the only significant factor for increasing aortic diameter. The 5-year freedom from reintervention rate was significantly higher in patients with no intimal tear than in those with a segment 1 intimal tear with/without SA tear.ConclusionsWe confirmed that SA and proximal DTA intimal tears are associated with subsequent aortic dilation and reintervention. These proximal aortic intimal tears might warrant aggressive surgical treatment at the initial operation or close postoperative follow-up.Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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