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(Circulation. 1999;100:II-275.)
© 1999 American Heart Association, Inc.

Aortic and Peripheral Vascular Surgery

Toward the Best Treatment for Uncomplicated Patients With Type B Acute Aortic Dissection

A Consideration for Sound Surgical Indication

Akira Marui, MD; Takaaki Mochizuki, MD; Norimasa Mitsui, MD; Tadaaki Koyama, MD; Fumiko Kimura, MD; Mayumi Horibe, MD

From the Departments of Cardiovascular Surgery (A.M., T.M., N.M., T.K.), Radiology (F.K.), and Anesthesiology (M.H.), Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan.

Correspondence to Akira Marui, MD, Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, 3-30 Nakajima, Naka, Hiroshima 730-8655, Japan. E-mail malmaru{at}tb3.so-net.ne.jp

Background—In the treatment of type B acute aortic dissection without complications, better results are obtained if surgery is performed before enlargement of the aorta in patients who are predicted to show aortic enlargement and if drug-based treatment is continued for patients who are predicted to show no enlargement. The purpose of this study was to predict the acute-phase factors that may affect chronic-phase aortic enlargement by studying chronic-phase enlargement of dissections in patients without complications during the acute phase.

Methods and Results—In 101 patients with type B acute dissection who had no complications, univariate and multivariate factor analyses were performed to determine the predictors for chronic-phase enlargement (60 mm) of the dissected aorta. The independent predominant predictors for aortic enlargement in the chronic phase were a maximum aortic diameter of 40 mm and a patent false lumen during the acute phase. The values of actuarial freedom from aortic enlargement for the patients with a maximum aortic diameter of 40 mm and a patent false lumen at 1, 5, and 10 years were 43%, 33%, and 22%, respectively, whereas in patients with a maximum aortic diameter of <40 mm and a closed false lumen, the values were 97%, 94%, and 84%, respectively.

Conclusions—These results suggest that patients with type B acute aortic dissection who show a maximum aortic diameter of 40 mm and a patent false lumen should undergo surgery earlier during the chronic phase before enlargement of aorta, whereas patients with a maximum aortic diameter of <40 mm and a closed false lumen should continue to receive hypotensive therapy.

Key Words: aorta • aneurysm • follow-up studies • risk factors • surgery