Policlinico San Donato IRCCS, Cardiovascular Center E. Malan, University of Milano, Milan, Italy.
J Thorac Cardiovasc Surg. 2011 Sep;142(3):e101-7. doi: 10.1016/j.jtcvs.2010.12.032. Epub 2011 May 17.
The risk of acute type B aortic dissection is thought to increase with descending thoracic aortic diameter. Currently, elective repair of the descending thoracic aorta is indicated for an aortic diameter of 5.5 cm or greater. We sought to investigate the relationship between aortic diameter and acute type B aortic dissection, and the utility of aortic diameter as a predictor of acute type B aortic dissection.
We examined the descending aortic diameter at presentation of 613 patients with acute type B aortic dissection who were enrolled in the International Registry of Acute Aortic Dissection between 1996 and 2009, and analyzed the subset of patients with acute type B aortic dissection with an aortic diameter less than 5.5 cm.
The median aortic diameter at the level of acute type B aortic dissection was 4.1 cm (range 2.1-13.0 cm). Only 18.4% of patients with acute type B aortic dissection in the International Registry of Acute Aortic Dissection had an aortic diameter of 5.5 cm or greater. Patients with Marfan syndrome represented 4.3% and had a slightly larger aortic diameter than patients without Marfan syndrome (4.68 vs 4.32 cm, P = .121). Complicated acute type B aortic dissection was more common among patients with an aortic diameter of 5.5 cm or greater (52.2% vs 35.6%, P < .001), and the in-hospital mortality for patients with an aortic diameter less than 5.5 cm and 5.5 cm or greater was 6.6% and 23.0% (P < .001), respectively.
The majority of patients with acute type B aortic dissection present with a descending aortic diameter less than 5.5 cm before dissection and are not within the guidelines for elective descending thoracic aortic repair. Aortic diameter measurements do not seem to be a useful parameter to prevent aortic dissection, and other methods are needed to identify patients at risk for acute type B aortic dissection.
据认为，急性 B 型主动脉夹层的风险会随着降主动脉直径的增加而增加。目前，对于降主动脉直径为 5.5 厘米或更大的患者，建议进行选择性修复。我们试图研究主动脉直径与急性 B 型主动脉夹层之间的关系，以及主动脉直径作为急性 B 型主动脉夹层预测因子的作用。
我们检查了 1996 年至 2009 年期间登记在国际急性主动脉夹层注册中心的 613 例急性 B 型主动脉夹层患者的降主动脉直径，并分析了主动脉直径小于 5.5 厘米的急性 B 型主动脉夹层患者亚组。
急性 B 型主动脉夹层部位的主动脉直径中位数为 4.1 厘米（范围 2.1-13.0 厘米）。国际急性主动脉夹层注册中心只有 18.4%的急性 B 型主动脉夹层患者的主动脉直径为 5.5 厘米或更大。马凡综合征患者占 4.3%，其主动脉直径略大于无马凡综合征患者（4.68 厘米比 4.32 厘米，P =.121）。主动脉直径为 5.5 厘米或更大的患者中，复杂型急性 B 型主动脉夹层更为常见（52.2%比 35.6%，P <.001），主动脉直径小于 5.5 厘米和 5.5 厘米或更大的患者住院死亡率分别为 6.6%和 23.0%（P <.001）。
大多数急性 B 型主动脉夹层患者在夹层发生前降主动脉直径小于 5.5 厘米，不符合择期修复降主动脉的指南要求。主动脉直径测量似乎不是预防主动脉夹层的有用参数，需要其他方法来识别发生急性 B 型主动脉夹层的高危患者。
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