107: Predicting factors of aortic expansion in cardiovascular imaging after surgery for a type-A aortic dissection or hematoma

Abstract

The monitoring of patients undergoing dissection (AD) or hematoma (HD) aortic type A is essential to detect complications, especially those related to aortic expansion. The objective of this study was to determine the parameters favoring the aortic expansion. In a cohort of 311 patients operated on for a DA or HD type A, 69 received a measure of progression of aortic diameter (Vmax Ao) calculated by cardiovascular imaging. Patients were divided into three groups: group 1 (no progression, N=25), group 2 (Vmax Ao < 2 mm / year, N=27), and group 3 (Vmax Ao >2 mm / year, N=17). Each patient underwent the following investigations: clinic and 24-hour blood pressure measurement, determination of hs-CRP and polysomnography. The distribution of aortic diseases were 60 DA and 9 HD, 77% of subjects were men, mean age=67±11 years. The Vmax Ao was significantly higher in patients with a circulating false lumen completely (1.7 [0.4 to 2.8] vs 0 [0 to 1.1] mm / year, p=0.001). In patients with a Vmax Ao positive (group 2 +3), the Vmax Ao was positively correlated with systolic blood pressure of 24 hours (p=0.026) and hs-CRP (p=0.005) and negatively to the nocturnal SaO2 average (p=0.026). In multivariate analysis, the relationship persists with systolic blood pressure of 24 hours (p=0.046) and hs-CRP (p=0.038). The factors associated with aortic expansion after surgical treatment of a DA or HD type A are the persistence of a circulating false lumen, systemic inflammation, a high systolic blood pressure by ABPM and nocturnal SaO2 low.