Diameter change in completely remodelled proximal descending aorta after acute type I dissection repair: implications for estimating the pre-dissection size. (1st March 2021)

• Record Type: Journal Article
• Authors: Jung, Joon Chul; Sohn, Bongyeon; Chang, Hyoung Woo; Lee, Jae Hang; Kim, Dong Jung; Kim, Jun Sung; Lim, Cheong; Park, Kay-Hyun
• Is Part Of: European journal of cardio-thoracic surgery. Volume 60:Number 3(2021)
• Page Start: 614
• Page End: 621
• Publication Date: 2021-03-01
• Subjects: Acute aortic dissection -- Elephant trunk -- Frozen elephant trunk -- Computed tomography; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezab096
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: : OBJECTIVES: Pre-dissection diameter of the proximal descending thoracic aorta (p-DTA), if available, would be the reference for determining the size of the stent graft or elephant trunk. Acute type B dissection is known to increase p-DTA diameter by 23% (Rylski factor). This study aimed to investigate the accuracy of estimating post-remodelling diameter of the p-DTA based on the Rylski factor and other post-dissection morphological parameters in acute type I dissection, based on the assumption that the post-remodelling diameter is similar to the pre-dissection diameter. METHODS: In 60 patients with acute type I dissection showing complete remodelling of the p-DTA false lumen after surgical repair, preoperative and post-remodelling computed tomography scans were reviewed. Parameters, including maximal true lumen diameter (TLDmax ) and aortic area-derived diameter divided by the Rylski factor (AoDRylski ), were measured at the p-DTA. RESULTS: After complete remodelling, p-DTA diameter decreased by 4.1 mm ( P < 0.001). The equivalent to the Rylski factor was 15%. Both TLDmax and AoDRylski frequently showed ≥2 mm discrepancy from post-remodelling aortic diameter (36.7% and 48.3%, respectively, P = 0.30). When 2 parameters coincided within 2 mm, two-third of their estimations were accurate. AoDRylski was more accurate than TLDmax in patients with a large extent of circumferential dissection, and vice versa with less circumferential dissection ( P = 0.027). CONCLUSIONS: Prediction of post-remodelling aortic diameter relying on a single morphologic parameter carries a substantial risk of overestimation and underestimation. Evaluation based on the extent of circumferential dissection together with the 2 parameters may provide a more reliable estimation.