title: Long-term outcome of aortic dissection with patent false lumen: predictive role of entry tear size and location.
abstract: BACKGROUND
  Patent false lumen in aortic dissection has been associated with poor prognosis. We aimed to assess the natural evolution of this condition and predictive factors.
  
  
  RESULTS
  One hundred eighty-four consecutive patients, 108 surgically treated type A and 76 medically treated type B, were discharged after an acute aortic dissection with patent false lumen. Transesophageal echocardiography was performed before discharge, and computed tomography was performed at 3 months and yearly thereafter. Median follow-up was 6.42 years (quartile 1 to quartile 3: 3.31-10.49). Forty-nine patients died during follow-up (22 type A, 27 type B), 31 suddenly. Surgical or endovascular treatment was indicated in 10 type A and 25 type B cases. Survival free from sudden death and surgical-endovascular treatment was 0.90, 0.81, and 0.46 (95% CI, 0.36-0.55) at 3, 5, and 10 years, respectively. Multivariate analysis identified baseline maximum descending aorta diameter (hazard ratio [HR]: 1.32 [1.10-1.59]; P=0.003), proximal location (HR: 1.84 [1.06-3.19]; P=0.03), and entry tear size (HR: 1.13 [1.08-1.2]; P<0.001) as predictors of dissection-related adverse events, whereas mortality was predicted by baseline maximum descending aorta diameter (HR: 1.36 [1.08-1.70]; P=0.008), entry tear size (HR: 1.1 [1.04-1.16]; P=0.001), and Marfan syndrome (HR: 3.66 [1.65-8.13]; P=0.001).
  
  
  CONCLUSIONS
  Aortic dissection with persistent patent false lumen carries a high risk of complications. In addition to Marfan syndrome and aorta diameter, a large entry tear located in the proximal part of the dissection identifies a high-risk subgroup of patients who may benefit from earlier and more aggressive therapy.
authors.affiliation: Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, P° Vall d'Hebron 119, 08035 Barcelona, Spain. aevangel@vhebron.net
authors.forename: Artur
authors.initials: A
authors.lastname: Evangelista
authors.forename: Armando
authors.initials: A
authors.lastname: Salas
authors.forename: Aida
authors.initials: A
authors.lastname: Ribera
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira-González
authors.forename: Hug
authors.initials: H
authors.lastname: Cuellar
authors.forename: Victor
authors.initials: V
authors.lastname: Pineda
authors.forename: Teresa
authors.initials: T
authors.lastname: González-Alujas
authors.forename: Bart
authors.initials: B
authors.lastname: Bijnens
authors.forename: Gaietà
authors.initials: G
authors.lastname: Permanyer-Miralda
authors.forename: David
authors.initials: D
authors.lastname: Garcia-Dorado
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography