Long-term prognosis of type A aortic dissection in non-Marfan patients with histologic pattern of cystic medial necrosis.
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.
Girdauskas
Evaldas
E
Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany. evagird@centras.lt
Kuntze
Thomas
T
Borger
Michael A
MA
Doenst
Torsten
T
Mochalski
Michael
M
Walther
Thomas
T
Falk
Volkmar
V
Mohr
Friedrich W
FW
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