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Differential Impact of Intimal Tear Location on Aortic Dilation and Reintervention in Acute Type I Aortic Dissection After Total Arch Replacement

Authors
 Woon Heo  ;  Suk-Won Song  ;  Tae-Hoon Kim  ;  Jin-Seong Lee  ;  Kyung-Jong Yoo  ;  Bum-Koo Cho  ;  Hye Sun Lee 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.158(2) : 327-338.e2, 2019-08 
Journal Title
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 
ISSN
 0022-5223 
Issue Date
2019-08
MeSH
Aneurysm, Dissecting / diagnostic imaging ; Aneurysm, Dissecting / pathology ; Aneurysm, Dissecting / surgery* ; Aorta, Thoracic / diagnostic imaging ; Aorta, Thoracic / pathology ; Aorta, Thoracic / surgery* ; Computed Tomography Angiography ; Female ; Humans ; Male ; Middle Aged ; Reoperation / statistics & numerical data ; Retrospective Studies ; Tunica Intima / diagnostic imaging ; Tunica Intima / pathology ; Tunica Intima / surgery
Keywords
aortic dissection ; aortic operation ; imaging
Abstract
Objective: The study objective was to evaluate the differential impact of intimal tear location on aortic dilation and reintervention after total arch replacement for acute type I aortic dissection. Methods: From 2009 to 2016, 85 patients underwent total arch replacement for acute type I aortic dissection with residual dissected thoracoabdominal aorta. Forty patients (47%) underwent serial computed tomography scans that were sufficient for analysis. Among these, 14 (35%) underwent total arch replacement via the frozen elephant trunk procedure. Intimal tears were analyzed (size and number) at 3 different levels (level 1, proximal descending thoracic aorta; level 2, distal descending thoracic aorta; level 3, abdominal aorta). Aortic diameter was measured at 4 levels (pulmonary artery bifurcation, celiac axis, maximal abdominal aorta, and maximal thoracoabdominal aorta) using serial follow-up computed tomography scans. The linear mixed model for a repeated-measures random intercept and slope model was used. The rate of freedom from reintervention was analyzed. Results: In the unadjusted analysis, initial diameter of pulmonary artery bifurcation level, number of intimal tears, presence of 3- or 5-mm intimal tears, and frozen elephant trunk were not significant factors for aortic dilation or shrinking. The significant factors for aortic dilation were intimal tear location and number of visceral branches from the false lumen. The 3-year freedom from reintervention rate was significantly higher in patients with intimal tears 3 mm or greater at level 3 than in those with tears at level 1 (94.1% vs 37.5%, log-rank, P < .001). Conclusions: Intimal tear in the proximal descending thoracic aorta is the most important factor for aortic dilation and reintervention in acute type I aortic dissection after total arch replacement.
Full Text
https://www.sciencedirect.com/science/article/pii/S0022522318326540
DOI
10.1016/j.jtcvs.2018.09.110
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Tae Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-3987-0057
Song, Suk Won(송석원) ORCID logo https://orcid.org/0000-0002-9850-9707
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175867
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