False lumen patency as a predictor of late outcome in aortic dissection

Aortic dissection (AD) is a disease with a high-risk of mortality. Late dea ths are often related to complications in nanoperated aortic segments. Betw een 1984 and 1996, we retrospectively analyzed the data of 109 patients wit h acute AD (81 men and 28 women; average age 61 +/- 14 years). All imaging examinations were reviewed, and a magnetic resonance imaging examination wa s performed at the time of the study. Aortic diameters were measured on eac h aortic segment. Predictive factors of mortality were determined by Cox's proportional hazard model, in univariate and multivariate analyses, using B MDP statistical software. Follow-up was an average of 44 +/- 46 months (ran ge 24 to 164). Actuarial survival rates were 52%, 46%, and 37% at 1, 5, and 10 years, respectively, for type A AD versus 76%, 72%, and 46% for type B AD. Predictors of late mortality were age > 70 years and postoperative fals e lumen potency of the thoracic descending aorta (RR 3.4, 95% confidence in tervals 1.20 to 9.8). Descending aorta diameter was larger when false lumen was patent (31 vs 44 mm; p = 0.02) in type A AD. Furthermore, patency was less frequent in operated type A AD when surgery had been extended to the a ortic arch. Thus, patency of descending aorta false lumen is responsible fo r progressive aortic dilation. In type A AD, open distal repair makes it po ssible to check the aortic arch and replace it when necessary, decreases th e false lumen patency rate, and improves late survival. (C) 2001 by Excerpt a Medica, Inc.