A 型急性主動脈剝離症手術後遠側端主動脈的命運 - 基於假腔特異性及其每年成長率的分析

Abstract

Background: Acute aortic dissection (AD) is a disease with a high-risk of mortality. Early and late survival after repair of acute type A AD has improved progressively over 25 years. Nevertheless, whether partial patent false lumen (PPFL) is it or not an independent risk factor to a faster and a higher growth year rate and a worst outcome has being recently a topic of debate. Objectives: With this study we try to clarify whether a PPFL can affect aortic enlargement in patients with acute type A AD. Our aim is to compare and analyze the year growth rate (GR) of aortic diameter according to a patient group assignment based on the aortic false lumen characteristic (Patent false lumen, partial patent false lumen and complete thrombosed false lumen), and to identify any significant risk factor in the outcome after operation based on the patients’ demographic and patients’ group assignment. Methods: sixty-one patients (mean age, 56.3 years) who had experience acute type A AD and underwent operation were enrolled in this study. Regular follow-up computer tomography studies (mean, 2.6 years) were performed. During the follow-up period, aortic diameter was measured with computed tomography. Aortic year GR and fastest GR were calculated at 7 different aortic levels: aortic arch, proximal descending aorta, middle descending aorta, distal descending aorta, proximal abdominal aorta, middle descending aorta, and terminal aorta. Results: based on initial computed tomography findings, the patients were divided into three groups: those with complete patent false lumens (PFL, n=36), those with partial patent false lumen (PPFL, n=14), and those with complete thrombosed false lumen (CTFL, n=11). At the level of the aortic arch, the mean year aortic GR for groups with PFL, PPFL, and CTFL were 1.7±4.1, -0.7±3.1, and -0.2±2.1 mm/year (p=0.0821), respectively. At the level of the proximal descending aorta, the mean year aortic GR for groups with PFL, PPFL, and CTFL were 1.9±4.4, 0.0±1.9, and -1.0±2.6 mm/year (p=0.0523), respectively. At the level of the middle descending thoracic aorta, the mean year aortic GR for groups with PFL, PPFL, and CTFL were 1.5±2.5, -0.3±2.1, and 0.1±0.9 mm/year, respectively. The difference among the three was statistically significant (p=0.0194). Complete patent false lumen was associated with a higher aortic enlargement compared with partial patent false lumen, but no difference was found when analysis the risk for a fast aortic GR (1mm/year or more) between these two groups. There was no late mortality during the follow-up period within the group of partial patent false lumens. Conclusions: Affected aortas with PPFL do not exhibit the highest GR. The status of a PPFL is not a significant risk factor for postoperative aortic enlargement. Residual patent false lumen is not necessarily associated with secondary enlargement of the distal aorta, but when postoperative aortic enlargement does occur, the PFL group exhibit a higher growth rate when compared with the PPFL group.