Abstract 15676: Outcomes of Acute Retrograde Type A Aortic Dissection With an Entry Tear in Descending Aorta
Background: Optimal management strategy of acute aortic dissection (AD) with retrograde extension from entry tear in the descending aorta into the ascending aorta remains undetermined.
Methods: Of 538 patients who were diagnosed as having acute AD from 1999 through 2011, 49 patients (37 males, 52.5±13.1 years) were identified as having entry tear in the descending aorta with retrograde extension of AD into the ascending aorta. Sixteen patients who were clinically stable and had thrombosed false lumen in the ascending aorta were treated medically (MED group), whereas 33 patients underwent aortic replacement (SURG group) as the intention-to-treat basis.
Results: In the MED group, one patient was converted to urgent aortic surgery and two patients underwent endovascular stent grafting at the descending aorta during initial hospitalization. Early (30-day or in-hospital) mortality rate was 0% and 9.1% in the MED and SURG group, respectively (P=0.54). The early mortality rate of the patients with retrograde AD (6.1%, 3/49) was comparable to those with type B AD (8.6%, 17/198, P=0.77) whereas it was significantly lower than those with antegrade type A AD (18.2%; N=53/291; surgical therapy, 13.7% [36/262]; medical therapy, 58.5% [17/29]; P=0.037). Follow-up was complete in all patients (median, 61.4 months; IQR, 28.2-99.1 months). The 5-year survival rate in the MED group was 100%, and this rate was higher than the SURG group (81.2±7.0%, P=0.080), those with surgically treated antegrade type A AD (74.5±2.8%, P=0.038) and those with type B AD (75.3±3.3%, P=0.045) (Figure). Aortic event-free survival at 5 years was 72.2±12.2% and 69.6±8.0% in the MED and SURG groups, respectively (P=0.76).
Conclusion: Patients with acute retrograde type A AD showed more favorable prognosis compared with patients with antegrade AD. In selected patients with retrograde AD, excellent outcomes could be achieved with initial medical management combined with timely interventions.
- © 2013 by American Heart Association, Inc.