Akita Sho, Tokuda Yoshiyuki, Kato Wataru, Tanaka Keisuke, Mutsuga Masato
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, 466-8560, Japan.
Department of Cardiovascular Surgery, Nagoya Daini Redcross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, Aichi, 466-8650, Japan.
Gen Thorac Cardiovasc Surg. 2025 May;73(5):343-351. doi: 10.1007/s11748-024-02077-z. Epub 2024 Sep 17.
Type A acute aortic dissection (TAAAD) is a life-threatening condition often requiring emergency surgery, with approximately 30% of patients needing reoperation. This study aimed to identify predictors of long-term aortic events from early postoperative computed tomography (CT) examinations.
A total of 336 cases underwent TAAAD surgery at two institutions between 2002 and 2018. Of these, 302 patients received CT examinations immediately after initial TAAAD surgery. Predictors of aortic events were evaluated from these early postoperative CT exams. Aortic events were defined as any events involving aortic-related death, open surgery, reoperation, endovascular stenting, or thoracic aorta diameter enlargement to ≥ 55 mm.
Excluding 34 in-hospital deaths (10.1%; 34/336), the 1-, 5-, and 10-year actuarial survival rates after primary TAAAD surgery were 98.2%, 88.6%, and 81.7%, respectively. Over a mean follow-up period of 7.4 ± 5.1 years, 67 aortic events (proximal: 19, distal: 45, both: 3) were observed. Freedom from proximal aortic events was 98.6%, 93.9%, and 85.2% at 1, 5, and 10 years, respectively. Proximal anastomosis new entry was identified as a significant risk factor for aortic events, with a 92% vs. 42% incidence at 10 years (p < 0.001). Freedom from distal aortic events was 99.6%, 84.5%, and 67.2% at 1, 5, and 10 years, respectively. A false/true area ratio greater than 1 and distal anastomosis new entry were significant risk factors for aortic events (low-risk group: 83.3% vs. high-risk group: 42.3% at 10 years, p < 0.001).
Detailed analysis of early postoperative CT scans following primary TAAAD surgery may help identify predictors of subsequent aortic events, potentially improving long-term patient management and outcomes.
A型急性主动脉夹层（TAAAD）是一种危及生命的疾病，通常需要紧急手术，约30%的患者需要再次手术。本研究旨在从术后早期计算机断层扫描（CT）检查中识别长期主动脉事件的预测因素。
2002年至2018年期间，共有336例患者在两家机构接受了TAAAD手术。其中，302例患者在初次TAAAD手术后立即接受了CT检查。从这些术后早期CT检查中评估主动脉事件的预测因素。主动脉事件定义为任何涉及主动脉相关死亡、开放手术、再次手术、血管内支架置入或胸主动脉直径增大至≥55 mm的事件。
排除34例住院死亡患者（10.1%；34/336），初次TAAAD手术后1年、5年和10年的精算生存率分别为98.2%、88.6%和81.7%。在平均7.4±5.1年的随访期内，观察到67例主动脉事件（近端：19例，远端：45例，两者均有：3例）。1年、5年和10年时无近端主动脉事件的发生率分别为98.6%、93.9%和85.2%。近端吻合口新入口被确定为主动脉事件的一个重要危险因素，10年时发生率为92% vs. 42%（p<0.001）。1年、5年和10年时无远端主动脉事件的发生率分别为99.6%、84.5%和67.2%。假/真面积比大于1和远端吻合口新入口是主动脉事件的重要危险因素（低风险组：10年时为83.3% vs. 高风险组：42.3%，p<0.001）。
对初次TAAAD手术后早期CT扫描进行详细分析可能有助于识别后续主动脉事件的预测因素，从而有可能改善患者的长期管理和预后。
