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Long-term outcomes after recurrent acute thoracic aortic dissection: Insights from the International Registry of Aortic Dissection.
Ogami, Takuya; Arnaoutakis, George J; Isselbacher, Eric M; Geuzebroek, Guillaume S C; Coselli, Joseph S; De Vincentiis, Carlo; Kaiser, Clayton A; Hutchison, Stuart; Li, Qing-Guo; Brinster, Derek R; Leshnower, Bradley G; Serna-Gallegos, Derek; Pai, Chih-Wen; Taylor, Bradley S; Patel, Himanshu J; Eagle, Kim A; Sultan, Ibrahim.
Afiliación
  • Ogami T; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
  • Arnaoutakis GJ; Division of Cardiovascular and Thoracic Surgery, Institute for Cardiovascular Health, The University of Texas at Austin, Austin, Tex.
  • Isselbacher EM; Cardiology Department, Thoracic Aortic Center, Massachusetts General Hospital, Boston, Mass.
  • Geuzebroek GSC; Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Coselli JS; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex.
  • De Vincentiis C; Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato, Italy.
  • Kaiser CA; Cardiothoracic Surgery, Saint Thomas Heart, Nashville, Tenn.
  • Hutchison S; Department of Cardiac Sciences, University of Calgary Medical Centre, Calgary, Alberta, Canada.
  • Li QG; Cardiac Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
  • Brinster DR; Department of Cardiac Surgery, Northwell Health, New York, NY.
  • Leshnower BG; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
  • Serna-Gallegos D; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
  • Pai CW; Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich.
  • Taylor BS; Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
  • Patel HJ; Department of Cardiac Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich.
  • Eagle KA; Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich.
  • Sultan I; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: sultani@upmc.edu.
Article en En | MEDLINE | ID: mdl-38678471
ABSTRACT

OBJECTIVE:

With an aging population and advancements in imaging, recurrence of thoracic aortic dissection is becoming more common.

METHODS:

All patients enrolled in the International Registry of Aortic Dissection from 1996 to 2023 with type A and type B acute aortic dissection were identified. Among them, initial dissection and recurrent dissection were discerned. The study period was categorized into 3 eras historic era, 1996 to 2005; middle era, 2006 to 2015; most recent era, 2016 to 2023. Propensity score matching was applied between initial dissection and recurrent dissection. Outcome of interests included long-term survival and cumulative incidence of major aortic events defined by the composite of reintervention, aortic rupture, and new dissection.

RESULTS:

The proportion of recurrent dissection increased from 5.9% in the historic era to 8.0% in the most recent era in the entire dissection cohort. In patients with type A dissection, propensity score matching between initial dissection and recurrent dissection yielded 326 matched pairs. Kaplan-Meier curves showed similar long-term survival between the 2 groups. However, the cumulative incidence of major aortic events was significantly higher in the recurrent dissection group (40.3% ± 6.2% vs 17.8% ± 5.1% at 4 years in the initial dissection group, P = .02). For type B dissection, 316 matched pairs were observed after propensity score matching. Long-term survival and the incidence of major aortic events were equivalent between the 2 groups.

CONCLUSIONS:

The case volume of recurrent dissection or the ability to detect recurrent dissection has increased over time. Acute type A recurrent dissection was associated with a higher risk of major aortic events than initial dissection. Further judicious follow-up may be crucial after type A recurrent dissection.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2024 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2024 Tipo del documento: Article