DETERMINING SURGICAL INDICATIONS FOR ACUTE TYPE-B DISSECTION BASED ONENLARGEMENT OF AORTIC DIAMETER DURING THE CHRONIC PHASE

Citation
M. Kato et al., DETERMINING SURGICAL INDICATIONS FOR ACUTE TYPE-B DISSECTION BASED ONENLARGEMENT OF AORTIC DIAMETER DURING THE CHRONIC PHASE, Circulation, 92(9), 1995, pp. 107-112
Citations number
23
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
Circulation → ACNP
ISSN journal
0009-7322
Volume
92
Issue
9
Year of publication
1995
Supplement
S
Pages
107 - 112
Database
ISI
SICI code
0009-7322(1995)92:9<107:DSIFAT>2.0.ZU;2-L
Abstract
Background In patients with Stanford type B dissection who have been t reated successfully with medical hypotensive therapy during the acute phase, a large number have incurred the risk of surgery during their c hronic phases because of enlargement of the dissected aorta. The purpo se of this study was to determine the indications for surgical treatme nt of acute type B dissection by studying chronic-phase enlargements o f aortic dissections in patients treated successfully with medical hyp otensive therapy during the acute phase. Methods and Results In 41 pat ients with type B dissection who had been treated medically during the acute phase, univariate and multivariate factor analyses were made to determine the predominant predictors for chronic-phase enlargement (g reater than or equal to 60 mm) of the dissected aorta. Computed tomogr aphy was performed every 4 to 14 months to observe whether there was e nlargement of the maximum aortic diameter. The predominant predictors for aortic enlargement in the chronic phase were the existence of a ma ximum aortic diameter of greater than or equal to 40 mm during the acu te phase (P<.001) and a patent primary entry site in the thoracic aort a (P=.001). The values of actuarial freedom from aortic enlargement fo r the patients with a large aortic diameter (greater than or equal to 40 mm) during the acute phase and a patent primary entry site in the t horax at: 1, 3, and 5 years were 70%, 29%, and 22%, respectively. No a ortic enlargement was observed in the other patients throughout the en tire follow-up period. Conclusions These data suggest that patients wi th acute type B dissection who have a large aortic diameter (greater t han or equal to 40 mm) and a patent primary entry site in the thorax s hould be treated surgically during the acute phase on the condition th at the surgical risk in this phase is limited.