title: Long-term prognosis of type A aortic dissection in non-Marfan patients with histologic pattern of cystic medial necrosis.
abstract: BACKGROUND
  The aim of this study was to evaluate long-term results of surgery for type A aortic dissection in non-Marfan patients with histologically confirmed cystic medial necrosis.
  
  
  METHODS
  We reviewed our institutional database to identify non-Marfan patients who underwent surgery for acute type A dissection between October 1994 and May 2006 (n = 188). Pathology reports and histologic analyses were available in 174 patients, which form the focus of this study. Long-term results of patients with histologic evidence of cystic medial necrosis in their resected aorta were compared with patients with other causes of aortic dissection.
  
  
  RESULTS
  A total of 137 patients (79%) survived to discharge from the hospital. Cystic medial necrosis was present in 89 of these 137 patients (65%, group 1). The remaining 48 patients showed a different histologic pattern (group 2). Long-term follow-up was available in 100% of survivors and was 41 +/- 30 months long. Freedom from late death was 82% in group 1 and 74% in group 2 (p = 0.24). Although aortic reoperation was required in more group 1 patients (17% versus 10%), this difference failed to reach statistical significance (p = 0.3).
  
  
  CONCLUSIONS
  The aortic reoperation rate after acute type A dissection may be higher among patients having cystic medial necrosis. We recommend that non-Marfan patients with histologically confirmed cystic medial necrosis undergo the same thorough postoperative surveillance as Marfan patients do.
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany. evagird@centras.lt
authors.forename: Evaldas
authors.initials: E
authors.lastname: Girdauskas
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuntze
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Torsten
authors.initials: T
authors.lastname: Doenst
authors.forename: Michael
authors.initials: M
authors.lastname: Mochalski
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000473:pathology* / Q000601:surgery*; D001013:Aorta, Thoracic / Q000473:pathology*; D017545:Aortic Aneurysm, Thoracic / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009336:Necrosis; D011379:Prognosis; D013997:Time Factors