Extent of Preoperative False Lumen Thrombosis Does Not Influence Long‐Term Survival in Patients With Acute Type A Aortic Dissection. Issue 4 (5th July 2013)

• Record Type: Journal Article
• Authors: Larsen, Magnus; Bartnes, Kristian; Tsai, Thomas T.; Eagle, Kim A.; Evangelista, Arturo; Nienaber, Christoph A.; Suzuki, Toru; Fattori, Rossella; Froehlich, James B.; Hutchison, Stuart; Sundt, Thoralf M.; Januzzi, James L.; Isselbacher, Eric M.; Montgomery, Daniel G.; Myrmel, Truls
• Is Part Of: Journal of the American Heart Association. Volume 2:Issue 4(2013:Aug.)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2013-07-05
• Subjects: aortic dissection -- prognosis -- surgery -- thrombosis; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.113.000112
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: Partial thrombosis of the false lumen has been related to aortic growth, reoperations, and death in the chronic phase of type B and repaired type A aortic dissections. The impact of preoperative false lumen thrombosis has not been studied previously. We used data from a contemporary, multinational database on aortic dissections to evaluate whether different degrees of preoperative false lumen thrombosis influenced long‐term prognosis. Methods and Results: We examined the records of 522 patients with surgically treated acute type A aortic dissections who survived to discharge between 1996 and 2011. At the preoperative imaging, 414 (79.3%) patients had patent false lumens, 84 (16.1%) had partial thrombosis of the false lumen, and 24 (4.6%) had complete thrombosis of the false lumen. The annual median (interquartile range) aortic growth rates were 0.5 (−0.3 to 2.0) mm in the aortic arch, 2.0 (0.2 to 4.0) mm in the descending thoracic aorta, and similar regardless of the degree of false lumen thrombosis. The overall 5‐year survival rate was 84.7%, and it was not influenced by false lumen thrombosis ( P =0.86 by the log‐rank test). Independent predictors of long‐term mortality were age >70 years (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.20 to 4.56, P =0.012) and postoperative cerebrovascular accident, coma, and/or renal failure (HR, 2.62; 95% CI, 1.40 to 4.92, P =0.003). Conclusions: Patients with acute type A aortic dissection who survive to discharge have a favorable prognosis. Preoperative false lumen thrombosis does not influence long‐term mortality, reintervention rates, or aortic growth.