Impact of initial aortic diameter and false-lumen area ratio on Type B aortic dissection prognosis

Akihito Matsushita, Takashi Hattori, Yu Tsunoda, Yasunori Sato, Wahei Mihara

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVES: Medical treatment is the gold standard for uncomplicated acute Type B aortic dissection (ATBAD). Although endovascular treatment could become an alternative therapy, it is unclear which ATBAD patients should undergo endovascular intervention. We aimed to evaluate the outcomes of patients with uncomplicated ATBAD and identify the risk factors for major adverse events. METHODS: We retrospectively reviewed 134 consecutive patients who underwent initial treatment for uncomplicated ATBAD between 2004 and 2015. Follow-up rate was 98.5%, and the median follow-up period was 47 months. We evaluated the incidence of major adverse events (aortic-related death, aortic surgery and dilated aorta >55 mm) and identified the predictors of major adverse events using multivariable analysis. RESULTS: In-hospital mortality rate was 0.7% (1/134). During follow-up, 46 patients had major adverse events. The 1-, 3-, and 5-year rates of freedom from major adverse events were 79.8%, 71.4%, and 63.6%, respectively. The independent risk factors for major adverse events were initial aortic diameter <40mm (hazard ratio 3.735, 95% confidence interval 1.888-7.390; P < 0.001) and false-lumen diameter < truelumen diameter (hazard ratio 3.411, 95% confidence interval 1.491-7.806; P = 0.004). CONCLUSIONS: Initial aortic diameter <40mm and false-lumen diameter < true-lumen diameter are predictors of major adverse events after uncomplicated ATBAD. Patients with these risk factors may benefit from early endovascular intervention. Clinical registration number: UMIN 000025388, https://upload.umin.ac.jp/cgi-open-bin/ctr-e/ctr-view.cgi?recptno=R000029229.

Original languageEnglish
Pages (from-to)176-182
Number of pages7
JournalInteractive cardiovascular and thoracic surgery
Volume26
Issue number2
DOIs
Publication statusPublished - 2018 Feb 1
Externally publishedYes

Fingerprint

Dissection
Confidence Intervals
Complementary Therapies
Hospital Mortality
Aorta
Therapeutics
Mortality
Incidence

Keywords

  • Acute Type B aortic dissection
  • Adverse events
  • Predictors
  • Uncomplicated

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of initial aortic diameter and false-lumen area ratio on Type B aortic dissection prognosis. / Matsushita, Akihito; Hattori, Takashi; Tsunoda, Yu; Sato, Yasunori; Mihara, Wahei.

In: Interactive cardiovascular and thoracic surgery, Vol. 26, No. 2, 01.02.2018, p. 176-182.

Research output: Contribution to journalArticle

Matsushita, Akihito ; Hattori, Takashi ; Tsunoda, Yu ; Sato, Yasunori ; Mihara, Wahei. / Impact of initial aortic diameter and false-lumen area ratio on Type B aortic dissection prognosis. In: Interactive cardiovascular and thoracic surgery. 2018 ; Vol. 26, No. 2. pp. 176-182.
@article{7b2cbbb896c146e49f998cef773e8dc4,
title = "Impact of initial aortic diameter and false-lumen area ratio on Type B aortic dissection prognosis",
abstract = "OBJECTIVES: Medical treatment is the gold standard for uncomplicated acute Type B aortic dissection (ATBAD). Although endovascular treatment could become an alternative therapy, it is unclear which ATBAD patients should undergo endovascular intervention. We aimed to evaluate the outcomes of patients with uncomplicated ATBAD and identify the risk factors for major adverse events. METHODS: We retrospectively reviewed 134 consecutive patients who underwent initial treatment for uncomplicated ATBAD between 2004 and 2015. Follow-up rate was 98.5{\%}, and the median follow-up period was 47 months. We evaluated the incidence of major adverse events (aortic-related death, aortic surgery and dilated aorta >55 mm) and identified the predictors of major adverse events using multivariable analysis. RESULTS: In-hospital mortality rate was 0.7{\%} (1/134). During follow-up, 46 patients had major adverse events. The 1-, 3-, and 5-year rates of freedom from major adverse events were 79.8{\%}, 71.4{\%}, and 63.6{\%}, respectively. The independent risk factors for major adverse events were initial aortic diameter <40mm (hazard ratio 3.735, 95{\%} confidence interval 1.888-7.390; P < 0.001) and false-lumen diameter < truelumen diameter (hazard ratio 3.411, 95{\%} confidence interval 1.491-7.806; P = 0.004). CONCLUSIONS: Initial aortic diameter <40mm and false-lumen diameter < true-lumen diameter are predictors of major adverse events after uncomplicated ATBAD. Patients with these risk factors may benefit from early endovascular intervention. Clinical registration number: UMIN 000025388, https://upload.umin.ac.jp/cgi-open-bin/ctr-e/ctr-view.cgi?recptno=R000029229.",
keywords = "Acute Type B aortic dissection, Adverse events, Predictors, Uncomplicated",
author = "Akihito Matsushita and Takashi Hattori and Yu Tsunoda and Yasunori Sato and Wahei Mihara",
year = "2018",
month = "2",
day = "1",
doi = "10.1093/icvts/ivx286",
language = "English",
volume = "26",
pages = "176--182",
journal = "Interactive Cardiovascular and Thoracic Surgery",
issn = "1569-9293",
publisher = "European Association for Cardio-Thoracic Surgery",
number = "2",

}

TY - JOUR

T1 - Impact of initial aortic diameter and false-lumen area ratio on Type B aortic dissection prognosis

AU - Matsushita, Akihito

AU - Hattori, Takashi

AU - Tsunoda, Yu

AU - Sato, Yasunori

AU - Mihara, Wahei

PY - 2018/2/1

Y1 - 2018/2/1

N2 - OBJECTIVES: Medical treatment is the gold standard for uncomplicated acute Type B aortic dissection (ATBAD). Although endovascular treatment could become an alternative therapy, it is unclear which ATBAD patients should undergo endovascular intervention. We aimed to evaluate the outcomes of patients with uncomplicated ATBAD and identify the risk factors for major adverse events. METHODS: We retrospectively reviewed 134 consecutive patients who underwent initial treatment for uncomplicated ATBAD between 2004 and 2015. Follow-up rate was 98.5%, and the median follow-up period was 47 months. We evaluated the incidence of major adverse events (aortic-related death, aortic surgery and dilated aorta >55 mm) and identified the predictors of major adverse events using multivariable analysis. RESULTS: In-hospital mortality rate was 0.7% (1/134). During follow-up, 46 patients had major adverse events. The 1-, 3-, and 5-year rates of freedom from major adverse events were 79.8%, 71.4%, and 63.6%, respectively. The independent risk factors for major adverse events were initial aortic diameter <40mm (hazard ratio 3.735, 95% confidence interval 1.888-7.390; P < 0.001) and false-lumen diameter < truelumen diameter (hazard ratio 3.411, 95% confidence interval 1.491-7.806; P = 0.004). CONCLUSIONS: Initial aortic diameter <40mm and false-lumen diameter < true-lumen diameter are predictors of major adverse events after uncomplicated ATBAD. Patients with these risk factors may benefit from early endovascular intervention. Clinical registration number: UMIN 000025388, https://upload.umin.ac.jp/cgi-open-bin/ctr-e/ctr-view.cgi?recptno=R000029229.

AB - OBJECTIVES: Medical treatment is the gold standard for uncomplicated acute Type B aortic dissection (ATBAD). Although endovascular treatment could become an alternative therapy, it is unclear which ATBAD patients should undergo endovascular intervention. We aimed to evaluate the outcomes of patients with uncomplicated ATBAD and identify the risk factors for major adverse events. METHODS: We retrospectively reviewed 134 consecutive patients who underwent initial treatment for uncomplicated ATBAD between 2004 and 2015. Follow-up rate was 98.5%, and the median follow-up period was 47 months. We evaluated the incidence of major adverse events (aortic-related death, aortic surgery and dilated aorta >55 mm) and identified the predictors of major adverse events using multivariable analysis. RESULTS: In-hospital mortality rate was 0.7% (1/134). During follow-up, 46 patients had major adverse events. The 1-, 3-, and 5-year rates of freedom from major adverse events were 79.8%, 71.4%, and 63.6%, respectively. The independent risk factors for major adverse events were initial aortic diameter <40mm (hazard ratio 3.735, 95% confidence interval 1.888-7.390; P < 0.001) and false-lumen diameter < truelumen diameter (hazard ratio 3.411, 95% confidence interval 1.491-7.806; P = 0.004). CONCLUSIONS: Initial aortic diameter <40mm and false-lumen diameter < true-lumen diameter are predictors of major adverse events after uncomplicated ATBAD. Patients with these risk factors may benefit from early endovascular intervention. Clinical registration number: UMIN 000025388, https://upload.umin.ac.jp/cgi-open-bin/ctr-e/ctr-view.cgi?recptno=R000029229.

KW - Acute Type B aortic dissection

KW - Adverse events

KW - Predictors

KW - Uncomplicated

UR - http://www.scopus.com/inward/record.url?scp=85041539226&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041539226&partnerID=8YFLogxK

U2 - 10.1093/icvts/ivx286

DO - 10.1093/icvts/ivx286

M3 - Article

VL - 26

SP - 176

EP - 182

JO - Interactive Cardiovascular and Thoracic Surgery

JF - Interactive Cardiovascular and Thoracic Surgery

SN - 1569-9293

IS - 2

ER -