Kitada Yuichiro, Okamura Homare, Hasui Hidenari, Akiyoshi Kei, Nomura Yohei, Adachi Hideo
Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.
Interdiscip Cardiovasc Thorac Surg. 2024 May 2;38(5). doi: 10.1093/icvts/ivae063.
Risk factors for late-term aortic dilation after acute type A aortic dissection repair have not been well examined. The goal of this study was to determine the relationship between the abdominal aortic true lumen location and thoraco-abdominal aortic dilation after surgical repair for acute type A aortic dissection.
Patients who were preoperatively diagnosed with acute type A aortic dissection between April 2014 and July 2022 were included in this study. We evaluated the renal artery-level dissected aortic morphology and classified the study population into 2 groups: the ventral (those with the true lumen located on the ventral side) and the dorsal (other patients not assigned to the ventral group) groups, based on the location of the true lumen. Aortic dilation was defined as thoraco-abdominal aortic expansion ≥5 mm on 1-year postoperative computed tomography images.
We examined 49 surgical patients who were assigned to the ventral (n = 22) and dorsal (n = 27) groups. The number of patients with ≥5 mm thoraco-abdominal aortic dilation after the operation was significantly higher in the ventral group than in the dorsal group (90.9% vs 51.9%, P = 0.009). The multivariable logistic regression analysis showed that the ventral type was an independent prognostic factor for thoraco-abdominal aortic dilation after the operation (odds ratio, 6.01; 95% confidence interval, 1.56-23.77; P = 0.009).
The location of the true lumen of the abdominal aorta in acute type A aortic dissection may be a prognostic factor for thoraco-abdominal aortic dilation after surgical repair.
急性A型主动脉夹层修复术后晚期主动脉扩张的危险因素尚未得到充分研究。本研究的目的是确定急性A型主动脉夹层手术修复后腹主动脉真腔位置与胸腹主动脉扩张之间的关系。
本研究纳入了2014年4月至2022年7月期间术前诊断为急性A型主动脉夹层的患者。我们评估了肾动脉水平的主动脉夹层形态，并根据真腔位置将研究人群分为两组：腹侧组（真腔位于腹侧的患者）和背侧组（未分配到腹侧组的其他患者）。主动脉扩张定义为术后1年计算机断层扫描图像上胸腹主动脉扩张≥5mm。
我们检查了49例手术患者，他们被分为腹侧组（n = 22）和背侧组（n = 27）。术后胸腹主动脉扩张≥5mm的患者数量在腹侧组显著高于背侧组（90.9%对51.9%，P = 0.009）。多变量逻辑回归分析显示，腹侧类型是术后胸腹主动脉扩张的独立预后因素（优势比，6.01；95%置信区间，1.56 - 23.77；P = 0.009）。
急性A型主动脉夹层中腹主动脉真腔的位置可能是手术修复后胸腹主动脉扩张的一个预后因素。
