Prognostic implications of descending thoracic aorta dilation after surgery for aortic dissection.
BACKGROUND
The present study assessed whether descending thoracic aorta growth can be measured reliably by volumetric analysis using multi-detector row computed tomography (MDCT) and whether growth influences the need for future aortic interventions in survivors of acute type A aortic dissection.


METHODS
A total of 51 patients (58 ± 11 years, 61% male) who underwent surgery for type A aortic dissection with ≥2 postoperative MDCT scans ≥5 months apart were included. Volumetric analysis of the descending thoracic aorta was performed with acceptable intraobserver variability. Growth of the complete, false and true lumen was estimated in ml/year and defined as slow growth (≤average growth) or fast growth (>average growth).


RESULTS
The complete lumen volume increased from 133 ± 8 ml to 163 ± 9 ml after 3.5 years follow-up (p < 0.001), with an average growth rate of 6.1 ml/year. The false lumen volume increased from 81 ± 7 ml to 106 ± 12 ml (p = 0.018) with an average growth rate of 2.8 ml/year. The true lumen changed only slightly from 59 ± 4 ml to 65 ± 8 ml (p = 0.205). Five-year freedom from descending thoracic aorta intervention was significantly lower in patients with above-average growth of the complete lumen (80 ± 9%) compared to slow growth (100%; p = 0.003). Similar observations were made for the false lumen (fast: 74 ± 12% vs. slow: 100%; p = 0.042).


CONCLUSIONS
Increased growth of the false lumen of the descending thoracic aorta after type A aortic dissection was associated with a higher risk of secondary interventions.
Department of Cardiology, Heart Center Leiden, Leiden University Medical Center, The Netherlands.
Madelien V
MV
Regeer
Department of Cardio-Thoracic Surgery, Heart Center Leiden, Leiden University Medical Center, The Netherlands.
Bryan
B
Martina
Department of Cardio-Thoracic Surgery, Heart Center Leiden, Leiden University Medical Center, The Netherlands.
Michel I M
MI
Versteegh
Department of Cardio-Thoracic Surgery, Heart Center Leiden, Leiden University Medical Center, The Netherlands.
Arend
A
de Weger
Department of Cardio-Thoracic Surgery, Heart Center Leiden, Leiden University Medical Center, The Netherlands.
Robert J M
RJ
Klautz
Department of Cardiology, Heart Center Leiden, Leiden University Medical Center, The Netherlands.
Martin J
MJ
Schalij
Department of Cardiology, Heart Center Leiden, Leiden University Medical Center, The Netherlands.
Jeroen J
JJ
Bax
Department of Cardiology, Heart Center Leiden, Leiden University Medical Center, The Netherlands.
Nina Ajmone
NA
Marsan
Department of Cardiology, Heart Center Leiden, Leiden University Medical Center, The Netherlands. Electronic address: v.delgado@lumc.nl.
Victoria
V
Delgado
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D000072226:Computed Tomography Angiography; D004108:Dilatation, Pathologic; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015588:Observer Variation; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
Aortic dilation; Aortic dissection; Computed tomography; Prognosis; Surgery