Kunishige Hideyuki, Myojin Kazuhiro, Ishibashi Yoshimitsu, Ishii Koji, Kawasaki Masakazu, Oka Junichi
Division of Cardiovascular Surgery, National Hospital Organization Hokkaido Cancer Center, 4-2 Kikusui, Shiroishiku, Sapporo 003-0804, Japan.
Jpn J Thorac Cardiovasc Surg. 2006 Nov;54(11):477-82. doi: 10.1007/s11748-006-0039-9.
Patients with Stanford type B dissection who have been treated successfully with medical hypotensive therapy during the acute phase (< 14 days) have the risk of surgery during the chronic phase because of enlargement of the dissected aorta. The objective of this retrospective analysis is to determine the predictors of surgical indications for acute type B aortic dissection by studying chronic-phase enlargements of aortic dissection in patients treated successfully with medical hypotensive therapy.
Altogether, 131 patients with type B aortic dissection were treated medically during the acute phase between 1987 and 2004. Multivariate factor analyses were performed to determine the predictors of chronic-phase enlargement (> or = 55 mm, as defined for our surgical criteria) of the dissected aorta.
Overall dissection-related mortality was 17.6%. Patency of the false lumen was an independent risk factor for dissection-related death (P = 0.0238, hazard ratio 2.594, confidence interval 1.009-6.122) and for dissection-related events (P = 0.0157, hazard ratio 1.870, confidence interval 1.116-3.133). The incidence of patients treated surgically during the chronic phase was 32.8%. The predictors for aortic enlargement during the chronic phase were the condition of maximum aortic diameter > or = 45 mm with a patent false lumen during the acute phase. The rates of freedom from aortic enlargement (> or = 55 mm) for patients with maximum diameter (> or = 45 mm) with a patent false lumen during the acute phase at 1, 5, and 10 years were 72.6%, 66.0%, and 42.8%, respectively, whereas in patients with a maximum aortic diameter of < 45 mm with a thrombosed false lumen the values were 100%, 94.7%, and 89.2%, respectively (P < 0.005).
These data suggest that patients with acute type B dissection with a patent false lumen or a diameter > or = 45 mm (or both) during the acute phase are at risk for enlargement of the dissecting aorta. The patients with dissecting aortas > or = 45 mm or a patent false lumen (or both) therefore require close follow-up to detect enlargement of the dissecting aorta, whereas patients with a maximum aortic diameter of < 45 mm with a thrombosed false lumen can stay on conservative therapy.
急性B型主动脉夹层患者在急性期（<14天）经药物降压治疗成功后，由于夹层主动脉扩大，在慢性期存在手术风险。本回顾性分析的目的是通过研究经药物降压治疗成功的患者主动脉夹层的慢性期扩大情况，确定急性B型主动脉夹层手术指征的预测因素。
1987年至2004年期间，共有131例B型主动脉夹层患者在急性期接受了药物治疗。进行多因素分析以确定夹层主动脉慢性期扩大（≥55mm，根据我们的手术标准定义）的预测因素。
总体夹层相关死亡率为17.6%。假腔通畅是夹层相关死亡（P = 0.0238，风险比2.594，置信区间1.009 - 6.122）和夹层相关事件（P = 0.0157，风险比1.870，置信区间1.116 - 3.133）的独立危险因素。慢性期手术治疗患者的发生率为32.8%。慢性期主动脉扩大的预测因素是急性期最大主动脉直径≥45mm且假腔通畅。急性期最大直径≥45mm且假腔通畅的患者在1年、5年和10年时无主动脉扩大（≥55mm）的发生率分别为72.6%、66.0%和42.8%，而急性期最大主动脉直径<45mm且假腔血栓形成的患者该值分别为100%、94.7%和89.2%（P < 0.005）。
这些数据表明，急性期急性B型夹层患者假腔通畅或直径≥45mm（或两者皆有）有夹层主动脉扩大的风险。因此，夹层主动脉≥45mm或假腔通畅（或两者皆有）的患者需要密切随访以检测夹层主动脉扩大，而急性期最大主动脉直径<45mm且假腔血栓形成的患者可继续接受保守治疗。
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