title: Risk factor analysis for acute type A aortic dissection after aortic valve replacement.
abstract: OBJECTIVE
  Previous aortic valve replacement (AVR) is considered to be an independent risk factor for late acute type A aortic dissection (AAAD). However, the predictors of late AAAD at the time of AVR have not been characterized.
  
  
  METHODS
  A total of 285 patients who underwent isolated AVR were followed for 7.6 ± 8.1 years (mean ± SD). These 285 patients were divided into two groups. Group A consisted of 275 patients who did not develop late aortic complications after AVR, and group B consisted of 10 patients (3.5%) who developed late AAAD after AVR.
  
  
  RESULTS
  The mean time interval between initial AVR and developing late AAAD was 6.1 ± 5.2 years. The diameter of the ascending aorta at the time of AVR was significantly greater in group B than those of group A (47.7 ± 4.6 vs. 35.6 ± 6.3 mm; P < 0.001). Univariate analysis identified other predictors as well: aortic regurgitation (P = 0.029), systemic hypertension (P < 0.001), thinning or fragility of the aortic wall (P < 0.001), and male sex (P = 0.039).
  
  
  CONCLUSIONS
  Aortic regurgitation combined with systemic hypertension, male sex, and thinned or fragile aortic walls in patients with ascending aortic dilatation (≥45 mm diameter) at the time of AVR may be predisposing factors for postsurgical aortic complications. These patients should be considered for concomitant replacement of the ascending aorta unless the patient has a high operative risk or older age.
authors.affiliation: Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi, 321-0974, Japan. koji_tsutsumi@saimiya.com
authors.forename: Koji
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Inoue
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hashizume
authors.forename: Naritaka
authors.initials: N
authors.lastname: Kimura
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Takahashi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology*; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007564:Japan; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed