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(Circulation. 2007;116:I-150 – I-156.)
© 2007 American Heart Association, Inc.

Surgery for Aortic Disease

Acute Type B Aortic Dissection: Does Aortic Arch Involvement Affect Management and Outcomes?

Insights From the International Registry of Acute Aortic Dissection (IRAD)

Thomas T. Tsai, MD, MSc; Eric M. Isselbacher, MD; Santi Trimarchi, MD; Eduardo Bossone, MD; Linda Pape, MD; James L. Januzzi, MD; Arturo Evangelista; Jae K. Oh, MD; Alfredo Llovet, MD; Joshua Beckman, MD; Jeanna V. Cooper, MS; Dean E. Smith, PhD; James B. Froehlich, MD; Rossella Fattori, MD; Kim A Eagle, MD; Christoph A. Nienaber, MD

On Behalf of the International Registry of Acute Aortic Dissection (IRAD). See Appendix for list of investigators.

Correspondence to Thomas T. Tsai, MD, MSc, University of Michigan Cardiovascular Center, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-5853. E-mail hsianshi{at}umich.edu

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.

Key Words: aorta • surgery • risk factors • mortality