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Impact of Supraaortic Intimal Tears on Aortic Diameter Changes After Nontotal Arch Replacement

 Woon Heo  ;  Suk-Won Song  ;  Tae-Hoon Kim  ;  Sun-Hee Lim  ;  Kyung-Jong Yoo  ;  Bum-Koo Cho  ;  Hye Sun Lee 
 ANNALS OF THORACIC SURGERY, Vol.110(1) : 20-26, 2020-07 
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Issue Date
Adult ; Aged ; Aneurysm, Dissecting / surgery ; Anthropometry ; Aorta, Abdominal / diagnostic imaging ; Aorta, Abdominal / pathology* ; Aorta, Thoracic / diagnostic imaging ; Aorta, Thoracic / pathology* ; Aortic Aneurysm, Thoracic / surgery* ; Aortography ; Blood Vessel Prosthesis Implantation / methods ; Computed Tomography Angiography ; Emergencies ; Female ; Humans ; Male ; Middle Aged ; Recurrence ; Reoperation ; Retrospective Studies ; Tunica Intima / injuries*
Background: This 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. Methods: Between 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. Results: The 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. Conclusions: We 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.
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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
Heo, Woon(허운)
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