title: Proximal aortic dissection late after aortic valve surgery: 119 cases of a distinct clinical entity.
abstract: BACKGROUND
  Besides systemic hypertension and Marfan syndrome, only previous aortic valve replacement (AVR) is independently associated with proximal (type A) aortic dissection. Little, however, is known to date about the characteristic features of this clinical entity.
  
  
  METHODS
  Clinical, prognostic and predisposing profiles in 119 cases of dissection and/or aneurysm occuring 1 month to 16 years after routine AVR were analyzed comprising 62 cases from our database and 57 reported cases.
  
  
  RESULTS
  Dissection after AVR has been observed in 0.6% of all routine AVR procedures in the past four decades. With clinical signs, symptoms and anatomical features different from classic aortic dissection post-AVR dissection is a distinct clinical entity with a high intraoperative mortality of 44% and a 30-day and 5-year survival of 62% and 43%, respectively. Aortic regurgitation and a thin and/or fragile aortic wall at AVR, however, predict late dissection. Using a prediction model, the risk of late dissection can be stratified based on information obtained during AVR surgery.
  
  
  CONCLUSIONS
  Aortic dissection following AVR is likely to represent a distinct clinical entity which can be predicted and possibly prevented at AVR.
authors.affiliation: Department of Internal Medicine, University Hospital Eppendorf, Hamburg, Germany. kodolitsch@uke.uni-hamburg.de
authors.forename: Y
authors.initials: Y
authors.lastname: von Kodolitsch
authors.forename: R
authors.initials: R
authors.lastname: Loose
authors.forename: J
authors.initials: J
authors.lastname: Ostermeyer
authors.forename: A
authors.initials: A
authors.lastname: Aydin
authors.forename: D H
authors.initials: DH
authors.lastname: Koschyk
authors.forename: A
authors.initials: A
authors.lastname: Haverich
authors.forename: C A
authors.initials: CA
authors.lastname: Nienaber
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D001014:Aortic Aneurysm / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors