Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kokura Northern Ward, Kitakyushu, Fukuoka, Japan.
Ann Thorac Surg. 2013 Dec;96(6):2142-6. doi: 10.1016/j.athoracsur.2013.06.060. Epub 2013 Aug 28.
There are contradictory reports on outcomes of patients treated for Stanford type A acute intramural hematoma (IMH) and acute aortic dissections (AAD) with thrombosed false lumens. We evaluated short-term clinical outcomes and predictors of adverse outcomes.
We retrospectively analyzed 59 symptomatic patients with type A acute IMH and AAD with thrombosed thoracic false lumens who initially received treatment. Survival, aortic death (death from aortic events and sudden deaths), and aortic event-free survival rates were investigated. False lumen thickness ratios (FTR [false lumen thickness/aortic diameter]) were measured by computed tomography scan and the relationship with aortic events was evaluated.
Survival, aortic death-free survival, and aortic event-free survival rates at 2 years were 90.0%, 96.6%, and 55.8%, respectively. Ascending aortic diameters, false lumen thickness of the ascending aortas, and rate of penetrating aortic ulcers in the ascending aortas were higher among patients with aortic events. The FTR of the ascending aorta (FTRA)/FTR of the descending aorta (FTRD) was also higher in these patients (1.3 ± 0.9 versus 0.8 ± 0.5, p = 0.0021). Multivariate analysis revealed FTRA/FTRD greater than 0.98 (odds ratio 5.35; 95% confidence interval: 0.05 to 1.72; p = 0.0431) as an independent predictor of aortic events. An FTRA/FTRD greater than 0.98 predicted aortic events with 87.1% sensitivity and 58.4% specificity.
High aortic event rates were seen after treatment for type A acute IMH and AAD with thrombosed thoracic false lumens. Nevertheless, short-term survival rates were favorable. An FTRA/FTRD greater than 0.98 may be a highly sensitive predictor for aortic events.
对于 Stanford 型 A 型急性壁内血肿（IMH）和急性主动脉夹层（AAD）伴血栓形成的假腔患者，其治疗结果存在相互矛盾的报道。我们评估了短期临床结果和不良预后的预测因素。
我们回顾性分析了 59 例有症状的 Stanford 型 A 型急性 IMH 和 AAD 伴血栓形成的胸段假腔患者，这些患者最初接受了治疗。研究了生存率、主动脉死亡（主动脉事件和猝死所致死亡）和主动脉无事件生存率。通过计算机断层扫描测量假腔厚度比（FTR [假腔厚度/主动脉直径]），并评估其与主动脉事件的关系。
2 年时的生存率、主动脉无死亡生存率和主动脉无事件生存率分别为 90.0%、96.6%和 55.8%。主动脉事件患者的升主动脉直径、升主动脉假腔厚度和穿透性主动脉溃疡的发生率较高。这些患者的升主动脉 FTR（FTRA）/降主动脉 FTR（FTRD）也较高（1.3 ± 0.9 比 0.8 ± 0.5，p = 0.0021）。多变量分析显示，FTRA/FTRD 大于 0.98（比值比 5.35；95%置信区间：0.05 至 1.72；p = 0.0431）是主动脉事件的独立预测因子。FTRA/FTRD 大于 0.98 预测主动脉事件的敏感性为 87.1%，特异性为 58.4%。
Stanford 型 A 型急性 IMH 和 AAD 伴血栓形成的胸段假腔患者治疗后主动脉事件发生率较高，但短期生存率较好。FTRA/FTRD 大于 0.98 可能是主动脉事件的高度敏感预测因子。
