Long-Term Outcome of Aortic Dissection with Patent False Lumen: Predictive Role of Entry Tear Size and Location
Background—Patent false lumen in aortic dissection (AD) has been associated with poor prognosis. We aimed to assess the natural evolution of this condition and predictive factors.
Methods and Results—One hundred and eighty-four consecutive patients, 108 surgically treated type A and 76 medically-treated type B, were discharged after an acute AD with patent false lumen. Transesophageal echocardiography was performed prior to discharge, and computed tomography at 3 months and yearly thereafter. Median follow-up was 6.42 years (Quartile 1-Quartile 3 [Q1-Q3]: 3.31-10.49). Forty-nine patients died during follow-up (22 type A, 27 type B), 31 suddenly. Surgical or endovascular treatment was indicated in 10 type A and 25 type B cases. Survival free from sudden death and surgical-endovascular treatment was 0.90, 0.81 and 0.46 (95% confidence interval [CI]: 0.36-0.55) at 3, 5 and 10 years, respectively. Multivariable analysis identified baseline maximum descending aorta diameter (Hazard Ratio [HR]: 1.32 (1.10-1.59); p=0.003], proximal location [HR: 1.84 (1.06-3.19); p=0.03] and entry tear size [HR: 1.13 (1.08-1.2); p<0.001] as predictors of dissection-related adverse events, while mortality was predicted by baseline maximum descending aorta diameter [HR: 1.36 (1.08-1.70); p=0.008], entry tear size [HR: 1.1 (1.04-1.16); p=0.001] and Marfan syndrome [HR: 3.66 (1.65-8.13); p=0.001].
Conclusions—Aortic dissection with persistent patent false lumen carries a high risk of complications. In addition to Marfan syndrome and aorta diameter, a large entry tear located in the proximal part of the dissection identifies a high-risk subgroup of patients who may benefit from earlier and more aggressive therapy.
- Received December 28, 2011.
- Accepted May 4, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited