title: Outcomes of acute retrograde type A aortic dissection with an entry tear in descending aorta.
abstract: BACKGROUND
  Optimal management strategy of acute aortic dissection (AD) with retrograde extension from entry tear in the descending aorta into the ascending aorta remains undetermined.
  
  
  RESULTS
  Of the 538 patients who were diagnosed as having acute AD from 1999 through 2011, 49 patients (37 men; 52.5±13.1 years) were identified as having entry tear in the descending aorta with retrograde extension of AD into the ascending aorta. Sixteen patients who were clinically stable with thrombosed false lumen in the ascending aorta were treated medically (MED group), whereas 33 patients underwent aortic replacement (SURG group) on an intention-to-treat basis. In the MED group, 1 patient was converted to urgent aortic surgery and 2 patients underwent endovascular stent grafting in the descending aorta during the initial hospitalization. The early (30-day or in-hospital) mortality rates were 0% and 9.1% in the MED and SURG group, respectively (P=0.54). Follow-up was complete in all patients (median, 61.4 months; Q1-Q3, 28.2-99.1 months). The 5-year 100% survival rate in the MED group was higher than that in the SURG group (81.2±7.0%; P=0.080), in the surgically treated patients with antegrade type A AD (74.5±2.8%; P=0.038), and in the patients with type B AD (75.3±3.3%; P=0.045). Aortic event-free survival at 5 years was 52.7±14.8% and 69.6±8.0% in the MED and SURG groups, respectively (P=0.98).
  
  
  CONCLUSIONS
  Patients with acute retrograde type A AD showed a more favorable prognosis than patients with antegrade AD. In selected patients with retrograde type A AD, excellent outcomes could be achieved with initial medical management combined with timely interventions.
authors.affiliation: From the Deparment of Thoracic and Cardiovascular Surgery (J.B.K., S.J.C., W.K.K., H.J.K., S.-H.J., C.H.C., J.W.L.) and Division of Cardiology (J.-K.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Joon Bum
authors.initials: JB
authors.lastname: Kim
authors.affiliation: From the Deparment of Thoracic and Cardiovascular Surgery (J.B.K., S.J.C., W.K.K., H.J.K., S.-H.J., C.H.C., J.W.L.) and Division of Cardiology (J.-K.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sjchoo@amc.seoul.kr.
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Choo
authors.affiliation: From the Deparment of Thoracic and Cardiovascular Surgery (J.B.K., S.J.C., W.K.K., H.J.K., S.-H.J., C.H.C., J.W.L.) and Division of Cardiology (J.-K.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Wan Kee
authors.initials: WK
authors.lastname: Kim
authors.affiliation: From the Deparment of Thoracic and Cardiovascular Surgery (J.B.K., S.J.C., W.K.K., H.J.K., S.-H.J., C.H.C., J.W.L.) and Division of Cardiology (J.-K.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Ho Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: From the Deparment of Thoracic and Cardiovascular Surgery (J.B.K., S.J.C., W.K.K., H.J.K., S.-H.J., C.H.C., J.W.L.) and Division of Cardiology (J.-K.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Jung
authors.affiliation: From the Deparment of Thoracic and Cardiovascular Surgery (J.B.K., S.J.C., W.K.K., H.J.K., S.-H.J., C.H.C., J.W.L.) and Division of Cardiology (J.-K.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.affiliation: From the Deparment of Thoracic and Cardiovascular Surgery (J.B.K., S.J.C., W.K.K., H.J.K., S.-H.J., C.H.C., J.W.L.) and Division of Cardiology (J.-K.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
authors.affiliation: From the Deparment of Thoracic and Cardiovascular Surgery (J.B.K., S.J.C., W.K.K., H.J.K., S.-H.J., C.H.C., J.W.L.) and Division of Cardiology (J.-K.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000473:pathology; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000209:etiology; D001019:Aortic Rupture / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002423:Cause of Death; D018572:Disease-Free Survival; D004630:Emergencies; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome
keywords: aorta; prognosis; surgery; survival