%0 Journal Article
%T Diameter and dissection of the abdominal aorta and the risk of distal aortic reoperation after surgery for type A aortic dissection.
%A Biancari F
%A Perrotti A
%A Juvonen T
%A Mariscalco G
%A Pettinari M
%A Lega JR
%A Di Perna D
%A Mäkikallio T
%A Onorati F
%A Wisniewki K
%A Demal T
%A Pol M
%A Gatti G
%A Vendramin I
%A Rinaldi M
%A Quintana E
%A Peterss S
%A Field M
%A Fiore A
%J Int J Cardiol
%V 404
%N 0
%D 2024 Jun 1
%M 38458387
%F 4.039
%R 10.1016/j.ijcard.2024.131938
%X BACKGROUND: Surgery for Stanford type A aortic dissection (TAAD) is associated with an increased risk of late aortic reoperations due to degeneration of the dissected aorta.
METHODS: The subjects of this analysis were 990 TAAD patients who survived surgery for acute TAAD and had complete data on the diameter and dissection status of all aortic segments.
RESULTS: After a mean follow-up of 4.2 ± 3.6 years, 60 patients underwent 85 distal aortic reoperations. Ten-year cumulative incidence of distal aortic reoperation was 9.6%. Multivariable competing risk analysis showed that the maximum preoperative diameter of the abdominal aorta (SHR 1.041, 95%CI 1.008-1.075), abdominal aorta dissection (SHR 2.133, 95%CI 1.156-3.937) and genetic syndromes (SHR 2.840, 95%CI 1.001-8.060) were independent predictors of distal aortic reoperation. Patients with a maximum diameter of the abdominal aorta >30 mm and/or abdominal aortic dissection had a cumulative incidence of 10-year distal aortic reoperation of 12.0% compared to 5.7% in those without these risk factors (adjusted SHR 2.076, 95%CI 1.062-4.060).
CONCLUSIONS: TAAD patients with genetic syndromes, and increased size and dissection of the abdominal aorta have an increased the risk of distal aortic reoperations. A policy of extensive surgical or hybrid primary aortic repair, completion endovascular procedures for aortic remodeling and tight surveillance may be justified in these patients.
BACKGROUND: ClinicalTrials.gov Identifier: NCT04831073.