Toward the best treatment for uncomplicated patients with type B acute aortic dissection: A consideration for sound surgical indication.
BACKGROUND
In the treatment of type B acute aortic dissection without complications, better results are obtained if surgery is performed before enlargement of the aorta in patients who are predicted to show aortic enlargement and if drug-based treatment is continued for patients who are predicted to show no enlargement. The purpose of this study was to predict the acute-phase factors that may affect chronic-phase aortic enlargement by studying chronic-phase enlargement of dissections in patients without complications during the acute phase.


RESULTS
In 101 patients with type B acute dissection who had no complications, univariate and multivariate factor analyses were performed to determine the predictors for chronic-phase enlargement (>/=60 mm) of the dissected aorta. The independent predominant predictors for aortic enlargement in the chronic phase were a maximum aortic diameter of >/=40 mm and a patent false lumen during the acute phase. The values of actuarial freedom from aortic enlargement for the patients with a maximum aortic diameter of 40 mm and a patent false lumen at 1, 5, and 10 years were 43%, 33%, and 22%, respectively, whereas in patients with a maximum aortic diameter of <40 mm and a closed false lumen, the values were 97%, 94%, and 84%, respectively.


CONCLUSIONS
These results suggest that patients with type B acute aortic dissection who show a maximum aortic diameter of >/=40 mm and a patent false lumen should undergo surgery earlier during the chronic phase before enlargement of aorta, whereas patients with a maximum aortic diameter of <40 mm and a closed false lumen should continue to receive hypotensive therapy.
Marui
A
A
Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan.
Mochizuki
T
T
Mitsui
N
N
Koyama
T
T
Kimura
F
F
Horibe
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology / Q000503:physiopathology; D001014:Aortic Aneurysm / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012307:Risk Factors