Kim Yun Seok, Kim Jeong Heon, Kim Joon Bum, Yang Dong Hyun, Kang Joon-Won, Hwang Su Kyung, Choo Suk Jung, Chung Cheol Hyun
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea.
Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Korea.
Korean J Thorac Cardiovasc Surg. 2014 Feb;47(1):6-12. doi: 10.5090/kjtcs.2014.47.1.6. Epub 2014 Feb 5.
Although a residual intimal tear may contribute to the dilatation of the descending aorta following surgical repair of acute type I aortic dissection (AD), its causal relationship has not been elucidated by clinical data due to the limited resolution of imaging modalities.
This study enrolled 41 patients (age, 55.2±11.9 years) who were evaluated with dual-source computed tomography (CT) imaging of the whole aorta in the setting of the surgical repair of acute type I AD. Logistic regression models were used to determine the predictors of a composite of the aortic aneurysm formation (diameter >55 mm) and rapid aortic expansion (>5 mm/yr).
On initial CT, a distal re-entry tear was identified in 9 patients. Two patients failed to achieve proximal tear exclusion by the surgery. Serial follow-up CT evaluations (median, 24.6 months; range, 6.0 to 67.2 months) revealed that 14 patients showed rapid expansion of the descending aorta or aortic aneurysm formation. A multivariate analysis revealed that the residual intimal tear (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.02 to 19.31) and the patent false lumen in the early postoperative setting (OR, 4.64; 95% CI, 0.99 to 43.61) were predictive of the composite endpoint.
The presence of a residual intimal tear following surgery for acute type I AD adversely influenced the expansion of the descending aorta.
尽管残余内膜撕裂可能促成急性I型主动脉夹层（AD）手术修复后降主动脉扩张，但其因果关系尚未被临床数据阐明，因为成像方式的分辨率有限。
本研究纳入41例患者（年龄55.2±11.9岁），这些患者在急性I型AD手术修复过程中接受了全主动脉双源计算机断层扫描（CT）成像评估。使用逻辑回归模型确定主动脉瘤形成（直径>55 mm）和主动脉快速扩张（>5 mm/年）这一复合终点的预测因素。
在初次CT检查时，9例患者发现有远端再入撕裂。2例患者手术未能实现近端撕裂封闭。系列随访CT评估（中位时间24.6个月；范围6.0至67.2个月）显示，14例患者出现降主动脉快速扩张或主动脉瘤形成。多因素分析显示，残余内膜撕裂（比值比[OR]，4.31；95%置信区间[CI]，1.02至19.31）和术后早期假腔通畅（OR，4.64；95% CI，0.99至43.61）是复合终点的预测因素。
急性I型AD手术后存在残余内膜撕裂对降主动脉扩张产生不利影响。
