Abstract 9455: Fate of Aorta and Clinical Outcomes in Patients With Chronic Type B Aortic Dissection: Over 20-Year Experience
Objectives: The management of type B double-barrel aortic dissection (AD) has been treated with medical therapy in patients without complications. However, the fate of affected aorta, causes of death, and very long-term clinical outcomes have not been completely clear. The purpose of this study was to clarify the fate of affected aorta and long-term clinical outcomes in patients with type B AD during chronic phase.
Methods: One hundred four patients were entered into this study, and regular follow-up CT studies (mean; 87.4 months) were performed. Also, clinical data including AD-related aortic events (including aneurysm formation, rupture, ischemia, and re-dissection), AD-related deaths, and long-term survival were retrospectively reviewed in 104 patients with type B AD, who were admitted to two institutions from 1987 to 2008.
Results: Forty-six of 104 patients (44.2%) had one more AD-related aortic event during follow-up period. The actuarial event-free rates for any AD-related aortic events of all patients were 95+/−2%, 75+/−5%, 53+/−6%, and 13+/−7% at 1, 5, 10, and 20 years, respectively. Initial aortic diameter > or =40 mm (hazard ratio, 2.72; 95% CI, 1.27–5.83; P=0.0101) and the presence of blood flow in the false lumen (hazard ratio, 3.40; 95% CI, 1.50–7.71; P=0.034) were the significant risk factors for AD-related aortic events in the univariate and multivariate analysis. During follow-up period, there were 11 AD-related deaths (10.6%). The actuarial survival rates of all patients were 99+/−1%, 94+/−3%, 86+/−4%, and 80+/−7% at 1, 5, 10, and 20 years, respectively. Initial aortic diameter > or =50 mm (hazard ratio, 6.18; 95% CI, 1.34–28.50; P=0.019) and the presence of chronic renal failure (hazard ratio, 5.61; 95% CI, 1.20–26.25; P=0.028) were the significant risk factors for AD-related deaths in the univariate and multivariate analysis.
Conclusions: In type B chronic aortic dissection, the affected aortas have shown a high incidence of AD-related aortic events during the follow-up period, and long-term follow-up studies are needed. Initial aortic diameter is an important predictor for AD-related aortic events and deaths.
- © 2010 by American Heart Association, Inc.