Authors: Ana G Almeida Ângelo L Nobre Ricardo A Pereira Altamiro CostaPereira Clara Tavares João Cravino Mário G Lopes
Publish Date: 2008/02/02
Volume: 24, Issue: 6, Pages: 633-640
Abstract
Background Patients operated on for type A aortic dissection remain at risk of longterm aneurysm development the main cause for late death The aim of this study was to identify early predictors for aneurysm formation at threeyears after surgery Methods A study group of 70 consecutive patients 52 ± 10 yearsold 41 male operated on for aortic dissection with replacement of the ascending segment was evaluated prospectively for threeyears In order to detect aneurysm formation the dimension of residual distal aortic segments was obtained soon after surgery and then annually for three years using cardiovascular magnetic resonance Results During followup 38 ± 26 months aneurysm was found in 25 patients 35 involving residual segments Larger initial dimension of segments higher pulse pressure lower distensibility of residual segments and the presence of a residual flap were univariately associated with aneurysm Multivariate analysis identified the initial dimension mm of the descending thoracic aorta OR 147 95CI 119–182 and pulse pressure OR 14395CI 110–186 as independent variables for aneurysm formation A risk score using pulse pressure and descending thoracic dimension was constructed Patients with ≤24 points had no late aneurysm formation while those with a score ≥45 yielded 100 of aneurysm frequency Conclusions Type A aortic dissection treated by graft interposition is associated with a high risk of aneurysm formation Early postoperative pulse pressure and the descending thoracic aortic dimension were independent variables and seem to be the main predictors for the outcome
Keywords: