Acute type B aortic dissection: Does aortic arch involvement affect management and outcomes? Insights from the international registry of acute aortic dissection (IRAD)

Article; Proceedings Paper

关键词: SURGICAL THERAPY;    DIAGNOSIS;    ANEURYSMS;    TEAR;   

DOI  :  10.1161/CIRCULATIONAHA.106.681510

来源: SCIE

【 摘 要 】

Background - Stanford Type B acute aortic dissection (TB-AAD) spares the ascending aorta and is optimally managed with medical therapy in the absence of complications. However, the treatment of TB-AAD with aortic arch involvement (AAI) remains an unresolved issue. Methods and Results - We examined 498 patients with TB-AAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. Kaplan-Meier mortality curves were constructed and multivariate regression models were performed to identify independent predictors of AAI and to evaluate whether AAI was an independent predictor of follow-up mortality. We found that 371 (74.5%) patients with TB-AAD did not have AAI versus 127 (25.5%) with AAI. Independent predictors of AAI were a history of previous aortic surgery (OR 3.4; 95% CI, 1.6 to 7.6; P = 0.002), absence of back pain (OR 1.6; 95% CI, 1.1 to 2.5; P = 0.05), and any pulse deficit (1.9; 95% CI, 1.1 to 3.3, P = 0.03). Mortality for patients without AAI was 9.4% +/- 4.3% and 21.0% +/- 6.9% at 1 and 3 years versus 9.2% +/- 7.7% and 19.9% +/- 11.1% with AAI, respectively (mean follow-up overall, 2.3 years, log rank P = 0.82). AAI was not an independent predictor of long-term mortality. Conclusions - Patients with TB-AAD and aortic arch involvement do not differ with regards to mortality at 3 years. Whether or not AAI involvement impacts other measures of morbidity such as freedom from operation or endovascular intervention deserves further study.

【 授权许可】

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