Abstract 14984: Cervical Branch Re-entry in Patients With Type A Acute Aortic Dissection is Related to a Patent False Lumen in the Aortic Arch and Enlargement After Ascending Aortic Replacement
Background: In some patients with Stanford type A acute aortic dissection (A-AAD) who undergo resection of the entry site by ascending aortic replacement, the aortic arch false lumen is not thrombosed postoperatively, leading to late enlargement. This is attributed to blood leaking into the false lumen at the distal anastomosis. In addition, we hypothesized that a re-entry tear occurring in the distal part of cervical branches can act as an entry after operation.
Patients and Methods: We retrospectively studied 85 patients (49 men; mean age 62 ± 12 years). Computed tomographic (CT) scans were evaluated before and after ascending aortic replacement, performed from 2006 through 2014. Patients with intramural hematoma were excluded. The presence of a patent false lumen in one or more cervical branches on preoperative CT was defined as cervical branch re-entry.
Results: On preoperative CT, 41 patients (48%) had cervical branch re-entry. The prevalence of hypertension (61% vs. 84%, P = 0.027) and sex (proportion of men, 71% vs. 45%, P = 0.02) differed significantly between patients who had cervical branch re-entry and those who did not. A total of 47 patients (55%) had a patent false lumen in the aortic arch, caused by reverse blood flow from the cervical branch re-entry site in 20 patients, leakage at the distal anastomosis in 13 patients, and both factors in 14 patients. The false lumen remained patent after operation in 34 (83%) of the 41 patients with cervical branch re-entry, as compared with 13 (30%) of the 44 patients without re-entry. The proportion of patients with a patent false lumen after operation was significantly higher in the presence of cervical branch re-entry before operation (P<0.01). The late follow-up rate was 85.9% (73 of 85 patients), with a mean follow-up of 46 ± 26 months. Significant risk factors for a late increase in aortic arch diameter to ≥10 mm were younger age (P = 0.02) and cervical branch re-entry (P = 0.02).
Conclusions: The preoperative presence of a cervical branch re-entry in patients with A-AAD is related to a patent false lumen in the aortic arch early after ascending aortic replacement and is a risk factor for late aortic arch enlargement. Total aortic arch replacement should be considered in patients who have A-AAD with cervical branch re-entry.
Author Disclosures: S. Yasuda: None. K. Imoto: None. K. Uchida: None. S. Isoda: None. N. Karube: None. K. Kasama: None. T. Minami: None. T. Miyamoto: None. Y. Uranaka: None. M. Goda: None. S. Suzuki: None. M. Masuda: None.
- © 2015 by American Heart Association, Inc.