From the Deparment of Thoracic and Cardiovascular Surgery (J.B.K., S.J.C., W.K.K., H.J.K., S.-H.J., C.H.C., J.W.L.) and Division of Cardiology (J.-K.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Circulation. 2014 Sep 9;130(11 Suppl 1):S39-44. doi: 10.1161/CIRCULATIONAHA.113.007839.
Optimal management strategy of acute aortic dissection (AD) with retrograde extension from entry tear in the descending aorta into the ascending aorta remains undetermined.
Of the 538 patients who were diagnosed as having acute AD from 1999 through 2011, 49 patients (37 men; 52.5±13.1 years) were identified as having entry tear in the descending aorta with retrograde extension of AD into the ascending aorta. Sixteen patients who were clinically stable with thrombosed false lumen in the ascending aorta were treated medically (MED group), whereas 33 patients underwent aortic replacement (SURG group) on an intention-to-treat basis. In the MED group, 1 patient was converted to urgent aortic surgery and 2 patients underwent endovascular stent grafting in the descending aorta during the initial hospitalization. The early (30-day or in-hospital) mortality rates were 0% and 9.1% in the MED and SURG group, respectively (P=0.54). Follow-up was complete in all patients (median, 61.4 months; Q1-Q3, 28.2-99.1 months). The 5-year 100% survival rate in the MED group was higher than that in the SURG group (81.2±7.0%; P=0.080), in the surgically treated patients with antegrade type A AD (74.5±2.8%; P=0.038), and in the patients with type B AD (75.3±3.3%; P=0.045). Aortic event-free survival at 5 years was 52.7±14.8% and 69.6±8.0% in the MED and SURG groups, respectively (P=0.98).
Patients with acute retrograde type A AD showed a more favorable prognosis than patients with antegrade AD. In selected patients with retrograde type A AD, excellent outcomes could be achieved with initial medical management combined with timely interventions.
急性主动脉夹层（AD）从降主动脉的入口撕裂处逆行延伸至升主动脉的最佳治疗策略仍未确定。
在 1999 年至 2011 年间诊断为急性 AD 的 538 名患者中，49 名（37 名男性；52.5±13.1 岁）被确定为降主动脉入口撕裂处，AD 逆行延伸至升主动脉。16 名升主动脉血栓形成假腔的临床稳定患者接受了药物治疗（MED 组），而 33 名患者根据意向治疗原则接受了主动脉置换术（SURG 组）。在 MED 组中，1 名患者转为紧急主动脉手术，2 名患者在住院期间接受了降主动脉腔内支架植入术。MED 组和 SURG 组的早期（30 天或住院期间）死亡率分别为 0%和 9.1%（P=0.54）。所有患者均完成随访（中位数 61.4 个月；Q1-Q3 28.2-99.1 个月）。MED 组的 5 年 100%生存率高于 SURG 组（81.2±7.0%；P=0.080）、手术治疗的顺行型 A AD 患者（74.5±2.8%；P=0.038）和 B 型 AD 患者（75.3±3.3%；P=0.045）。5 年时主动脉无事件生存率分别为 MED 组 52.7±14.8%和 SURG 组 69.6±8.0%（P=0.98）。
急性逆行性 A 型 AD 患者的预后优于顺行性 AD 患者。在选择的逆行性 A 型 AD 患者中，初始药物治疗结合及时干预可获得良好的结果。
