Risk factors for secondary dilatation of the aorta after acute type A aortic dissection
Risk factors for secondary dilatation of the aorta after acute type A aortic dissection
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DOI：
10.1016/j.ejcts.2004.11.031
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发表时间：
2005-04-01
影响因子：
3.4
通讯作者：
Carrel, TP
中科院分区：
文献类型：
--
作者：
Immer, FF;Hagen, U;Carrel, TP
目的：及时诊断夹层主动脉扩张对降低这些患者的晚期死亡率至关重要。本研究的重点是A型主动脉夹层（AADA）后影响正常大小或轻度扩张主动脉的主动脉扩张的风险因素。方法：对531例CT扫描资料进行分析。如果手术修复后至少有3次CT扫描可用，则患者被纳入研究。107例患者中有64例（59.8%）符合全视野入选标准。对主动脉进行容积分析。患者分为3组：A组包括26例（40.6%）主动脉直径无进展的患者，第2组包括27例（42.2%）轻度进展的患者，第3组包括11例（17.2%）重要进展的患者，其中9例（81.8%）需要手术。分析并比较两组间主动脉尺寸进展的风险因素。结果如下：第3组的患者年龄更小，为57.7 ± 13.4%，而第1组为61.9 ± 11.6%（P < 0.05），女性患者更常见（45.4%对23.1%; P < 0.05）。主动脉上支夹层（100 vs. 80.8%; P < 0.05），术前存在脑、内脏或外周灌注不良（54.6vs.26.9%，P < 0.05），假腔增强（72.7 vs. 57.7%; P = 0.07）是这些患者中晚期主动脉扩张的额外风险因素。结论：急性A型主动脉夹层在年轻患者中，涉及主动脉上分支和/或合并灌注不良综合征有利于二次扩张。必须进行密切随访，以预防AADA修复后下游患病主动脉的急性并发症。(c)2004 Elsevier B. V.保留所有权利。
Objectives: Prompt diagnosis of subsequent dilatation of the dissected aorta is crucial to reduce late mortality in these patients. This study focuses on risk factors for dilatation of the aorta after type A aortic dissection (AADA) affecting a normal-sized or slightly dilated aorta. Methods: Overall 531 CT scans were analysed. Patients were included in the study if at least 3 CT scans were available after operative repair. 64 patients (59.8%) out of 107 patients full-field the inclusion criteria. Volumetric analyses of the aorta were performed. Patients were divided in 3 groups: group A included 26 patients (40.6%) without progression of the aortic diameter, group 2, 27 patients (42.2%) with slight progression and group 3, 11 patients (17.2%) with important progression, requiring surgery in 9 patients (81.8%). Risk-factors for progression of the aortic size were analysed and compared between the groups. Results: Patients from group 3 were younger 57.7 +/- 13.4 vs. 61.9 +/- 11.6 in group 1 (P < 0.05) and were more frequent female (45.4 vs. 23.1%; P < 0.05). Dissection of the supraaortic branches (100 vs. 80.8%; P < 0.05), the presence of preoperative cerebral, visceral or peripheral malperfusion (54.6 vs. 26.9%; P < 0.05) and contrast enhancement in the false lumen during the follow-up (72.7 vs. 57.7%; P = 0.07) were additional risk factors for late aortic dilatation in these patients. Conclusions: Acute type A aortic dissection in younger patients, involving the supraaortic branches and/or combined with malperfusion syndrome favour secondary dilatation. A close follow-up is mandatory to prevent acute complications of the diseased downstream aorta following repair of a AADA. (c) 2004 Elsevier B.V. All rights reserved.