Gaudry Marine, Guivier-Curien Carine, Blanchard Arnaud, Porto Alizée, Bal Laurence, Omnes Virgile, De Masi Mariangela, Lu Charlotte, Jacquier Alexis, Piquet Philippe, Deplano Valerie
Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France.
CNRS, Centrale Marseille, IRPHE, Aix Marseille University, 13013 Marseille, France.
J Cardiovasc Dev Dis. 2022 Oct 12;9(10):349. doi: 10.3390/jcdd9100349.
Background: The aim of this study was to evaluate the aortic diameter and volume during the first year after a type A repair to predict the long-term prognosis of a residual aortic dissection (RAD). Methods: All patients treated in our center for an acute type A dissection with a RAD and follow-up > 3 years were included. We defined two groups: group 1 with dissection-related events (defined as an aneurysmal evolution, distal reintervention, or aortic-related death) and group 2 without dissection-related events. The aortic diameters and volume analysis were evaluated on three postoperative CT scans: pre-discharge (T1), 3−6 months (T2) and 1 year (T3). Results: Between 2009 and 2016, 54 patients were included. Following a mean follow-up of 75.4 months (SD 31.5), the rate of dissection-related events was 62.9% (34/54). The total aortic diameters of the descending thoracic aorta were greater in group 1 at T1, T2 and T3, with greater diameters in the FL (p < 0.01). The aortic diameter evolution at 3 months was not predictive of long-term dissection-related events. The total thoracic aortic volume was significantly greater in group 1 at T1 (p < 0.01), T2 (p < 0.01), and T3 (p < 0.01). At 3 months, the increase in the FL volume was significantly greater in group 1 (p < 0.01) and was predictive for long-term dissection-related events. Conclusion: This study shows that an initial CT scan volume analysis coupled with another at 3 months is predictive for the long-term evolution in a RAD. Based on this finding, more aggressive treatment could be given at an earlier stage.
本研究旨在评估A型主动脉夹层修复术后第一年的主动脉直径和容积，以预测残余主动脉夹层（RAD）的长期预后。方法：纳入在本中心接受急性A型主动脉夹层合并RAD治疗且随访时间超过3年的所有患者。我们定义了两组：1组为发生夹层相关事件（定义为动脉瘤进展、远端再次干预或主动脉相关死亡）的患者，2组为未发生夹层相关事件的患者。在术后三次CT扫描上评估主动脉直径和容积分析：出院前（T1）、3至6个月（T2）和1年（T3）。结果：2009年至2016年期间，共纳入54例患者。平均随访75.4个月（标准差31.5）后，夹层相关事件的发生率为62.9%（34/54）。1组在T1、T2和T3时胸降主动脉的总直径更大，假腔（FL）直径更大（p<0.01）。3个月时的主动脉直径变化不能预测长期夹层相关事件。1组在T1（p<0.01）、T2（p<0.01）和T3（p<0.01）时胸主动脉总体积显著更大。在3个月时，1组假腔容积的增加显著更大（p<0.01），并且可预测长期夹层相关事件。结论：本研究表明，初始CT扫描容积分析以及3个月时的另一次分析可预测RAD的长期演变。基于这一发现，可在更早阶段给予更积极的治疗。
