title: Impact of the entry site on late outcome in acute Stanford type B aortic dissection†.
abstract: OBJECTIVE
  This study aimed to investigate whether the entry site of acute type B aortic dissection affects late outcomes.
  
  
  METHODS
  Inpatient and outpatient records were retrospectively reviewed.
  
  
  RESULTS
  We identified 224 cases of acute type B aortic dissection between 1998 and 2013. Of these 224 patients, 168 were men and the age was 64.2 ± 12.6 (range 23-94) years, from which 130 presented with the entry at a location downstream of the distal aortic arch, 67 with the entry at the outer curvature of the distal aortic arch and 27 with the entry at the inner curvature. At the initial presentation, 127 patients had descending false lumen thrombosis. The 30-day mortality rate was 2%, and 8% of patients had malperfusion. The entry at the outer curvature was associated with a higher risk of 30-day mortality. Patients with the entry at a location downstream were significantly older, and had a higher chance for primarily thrombosed descending false lumen and a lower risk of malperfusion. At follow-up (6.0 ± 4.1 years), the actuarial survival rates were 97, 83 and 60%, freedoms from open aortic surgery were 96, 91 and 86%, aortic intervention were 73, 66 and 63% and aortic events were 71, 60 and 52% at 1, 5 and 10 years, respectively. Multivariate logistic regression analysis revealed that the outer curvature entry and maximum aortic diameter were correlated with open aortic surgery, aortic intervention and aortic events. Of the 127 patients with primarily thrombosed false lumen, the outer curvature entry was significantly correlated with aortic events.
  
  
  CONCLUSIONS
  The primary entry at the outer curvature of the distal aortic arch, as well as the large aortic diameter, is associated with a higher risk of late open aortic surgery, aortic intervention and aortic events in acute type B aortic dissection. Thus, the entry site should be taken into consideration in the establishment of an appropriate treatment indication of type B aortic dissection.
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan funcorogash@hotmail.com.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kitamura
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Shinzo
authors.initials: S
authors.lastname: Torii
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Oka
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Horai
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Itatani
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshii
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Shibata
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Tamura
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Haruna
authors.initials: H
authors.lastname: Araki
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Yoshikiyo
authors.initials: Y
authors.lastname: Matsunaga
authors.affiliation: Department of Health Policy and Technology Assessment, National Institute of Public Health, Wako, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Sato
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Kagami
authors.initials: K
authors.lastname: Miyaji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology*; D001014:Aortic Aneurysm / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: Acute type B aortic dissection; Aortic event; Aortic intervention; Entry; Outcome