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Gaudry M, Porto A, Guivier-Curien C, et al. Results of a prospective follow-up study after type A aortic dissection repair: a high rate of distal aneurysmal evolution and reinterventions. Eur J Cardiothorac Surg. 2021;61(1):152-159doi: 10.1093/ejcts/ezab317.
Gaudry, M., Porto, A., Guivier-Curien, C., Blanchard, A., Bal, L., Resseguier, N., Omnes, V., De Masi, M., Ejargue, M., Jacquier, A., Gariboldi, V., Deplano, V., & Piquet, P. (2021). Results of a prospective follow-up study after type A aortic dissection repair: a high rate of distal aneurysmal evolution and reinterventions. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 61(1), 152-159. https://doi.org/10.1093/ejcts/ezab317
Gaudry, Marine, et al. "Results of a prospective follow-up study after type A aortic dissection repair: a high rate of distal aneurysmal evolution and reinterventions." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery vol. 61,1 (2021): 152-159. doi: https://doi.org/10.1093/ejcts/ezab317
Gaudry M, Porto A, Guivier-Curien C, Blanchard A, Bal L, Resseguier N, Omnes V, De Masi M, Ejargue M, Jacquier A, Gariboldi V, Deplano V, Piquet P. Results of a prospective follow-up study after type A aortic dissection repair: a high rate of distal aneurysmal evolution and reinterventions. Eur J Cardiothorac Surg. 2021 Dec 27;61(1):152-159. doi: 10.1093/ejcts/ezab317. PMID: 34355742.
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Eur J Cardiothorac Surg. 2021 Dec 27;61(1):152-159. doi: 10.1093/ejcts/ezab317.

Results of a prospective follow-up study after type A aortic dissection repair: a high rate of distal aneurysmal evolution and reinterventions.

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

Marine Gaudry, Alizée Porto, Carine Guivier-Curien, Arnaud Blanchard, Laurence Bal, Noemie Resseguier, Virgile Omnes, Mariangela De Masi, Meghann Ejargue, Alexis Jacquier, Vlad Gariboldi, Valérie Deplano, Philippe Piquet

Affiliations

  1. Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France.
  2. Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France.
  3. Aix-Marseille Université, CNRS, Ecole Centrale Marseille, IRPHE UMR 7342, Marseille, France.
  4. Department of Epidemiology and Public Health Cost, APHM, Marseille, France.
  5. Department of Radiology, APHM, Timone Hospital, Marseille, France.

PMID: 34355742 DOI: 10.1093/ejcts/ezab317

Abstract

OBJECTIVES: We investigated the anatomical evolution of residual aortic dissection after type A repair and factors associated with poor prognosis at a high-volume aortic centre.

METHODS: Between 2017 and 2019, all type A aortic dissections were included for prospective follow-up. Patients without follow-up computed tomography (CT) scan available for radiological analysis and patients without residual aortic dissection were excluded from this study. The primary end point was a composite end point defined as dissection-related events including aneurysmal evolution (increased diameter > 5 mm/year), aortic reintervention for malperfusion syndrome, aortic diameter >55 mm, rapid aortic growth >10 mm/year or aortic rupture and death. The secondary end points were risk factors for dissection-related events and reintervention analysis. All immediate and last postoperative CT scans were analysed.

RESULTS: Among 104 patients, after a mean follow-up of 20.4 months (8-41), the risk of dissection-related events was 46.1% (48/104) and the risk of distal reintervention was 17.3% (18/104). Marfan syndrome (P < 0.01), aortic bicuspid valve (P = 0.038), innominate artery debranching (P = 0.025), short aortic cross-clamp time (P = 0.011), initial aortic diameter >40 mm (P < 0.01) and absence of resection of the primary entry tear (P = 0.015) were associated with an increased risk of dissection-related events or reintervention during follow-up.

CONCLUSIONS: Residual aortic dissection is a serious disease requiring close follow-up at an expert centre. This study shows higher reintervention and aneurysmal development rates than currently published. To improve long-term outcomes, the early demographic and anatomic poor prognostic factors identified may be used for more aggressive treatment at an early phase.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Keywords: Aneurysmal evolution; Aortic centre; Prospective follow-up; Reinterventions; Residual aortic dissection; Type A aortic dissection

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