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J Thorac Cardiovasc Surg 2007;134:1163-1170
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Degree of fusiform dilatation of the proximal descending aorta in type B acute aortic dissection can predict late aortic events

^a Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan
^b Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
^c Department of Cardiovascular Surgery, Shin-Katsushika Hospital, Tokyo, Japan
^d Department of Thoracic and Cardiovascular Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.

Received for publication January 31, 2007; revisions received July 4, 2007; accepted for publication July 10, 2007.

^_* Address for reprints: Akira Marui, MD, PhD, Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara, Sakyo-ku, Kyoto, 606-8507, Japan. (Email: marui{at}kuhp.kyoto-u.ac.jp).

Objective: Predicting the risk factors for late aortic events in patients with type B acute aortic dissection without complications may help to determine a therapeutic strategy for this disorder. We investigated whether late aortic events in type B acute aortic dissection can be predicted accurately by an index that expresses the degree of fusiform dilatation of the proximal descending aorta during the acute phase; this index can be calculated as follows: (maximum diameter of the proximal descending aorta)/(diameter of the distal aortic arch + diameter of the descending aorta at the pulmonary artery level).

Methods: Patients with type B acute aortic dissection without complications (n = 141) were retrospectively analyzed to determine the predictors of late aortic events; these include aortic dilatation, rupture, refractory pain, organ ischemia, rapid aortic enlargement, and rapid enlargement of ulcer-like projections.

Results: The fusiform index in patients with late aortic events (0.59) was higher than that in patients without late aortic events (0.53, P < .01). Patients with a higher fusiform index exhibited aortic dilatation earlier than those with a lower fusiform index. By multivariate analysis, we conclude that the predominant independent predictors of late aortic events were a maximum aortic diameter of 40 mm or more, a patent false lumen, and a fusiform index of 0.64 or more (hazard ratios, 3.18, 2.64, and 2.73, respectively). The values of actuarial freedom from aortic events for patients with all 3 predictors at 1, 5, and 10 years were 22%, 17%, and 8%, respectively, whereas the values in those without these predictors were 97%, 94%, and 90%, respectively.

Conclusions: The degree of fusiform dilatation of the proximal descending aorta, a patent false lumen, and a large aortic diameter can be predominant predictors of late aortic events in patients with type B acute aortic dissection. Patients with these predictors should be recommended to undergo early interventions (surgery or stent-graft implantation) or at least be closely followed up during the chronic phase before such events develop.

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