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Impact of aortic dimensions and pulse pressure on late aneurysm formation in operated type A aortic dissection. A magnetic resonance imaging study

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Abstract

Background Patients operated on for type A aortic dissection remain at risk of long-term aneurysm development, the main cause for late death. The aim of this study was to identify early predictors for aneurysm formation at three-years after surgery. Methods A study group of 70 consecutive patients (52 ± 10 years-old, 41 male), operated on for aortic dissection with replacement of the ascending segment, was evaluated prospectively for three-years. In order to detect aneurysm formation, the dimension of residual distal aortic segments was obtained soon after surgery and then annually for three years using cardiovascular magnetic resonance. Results During follow-up (38 ± 2.6 months), aneurysm was found in 25 patients (35%) involving residual segments. Larger initial dimension of segments, higher pulse pressure, lower distensibility of residual segments and the presence of a residual flap were univariately associated with aneurysm. Multivariate analysis identified the initial dimension (mm) of the descending thoracic aorta (OR 1.47, 95%CI: [1.19–1.82]) and pulse pressure (OR 1.43,95%CI: [1.10–1.86]) as independent variables for aneurysm formation. A risk score using pulse pressure and descending thoracic dimension was constructed. Patients with ≤24 points had no late aneurysm formation, while those with a score ≥45 yielded 100% of aneurysm frequency. Conclusions Type A aortic dissection treated by graft interposition is associated with a high risk of aneurysm formation. Early post-operative pulse pressure and the descending thoracic aortic dimension were independent variables and seem to be the main predictors for the outcome.

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Abbreviations

BSA:

Body surface area

ICC:

Interclass correlation coefficient

CMR:

Cardiovascular magnetic resonance

OR:

Odds ratio

ROC:

Receiver operator characteristic

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Acknowledgments

This study was supported by the Centro de Cardiologia da Universidade de Lisboa (CCUL), Foundation for Science and Technology (FCT), Ministry of Science. Technology and University, Portugal.

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Authors and Affiliations

  1. Cardiology and Cardiothoracic Surgery Service, University Hospital Santa Maria, Faculty of Medicine, Lisbon University, Av. Prof. Egas Moniz – 1600, Lisbon, Portugal

    Ana G. Almeida, Ângelo L. Nobre, Ricardo A. Pereira, João Cravino & Mário G. Lopes

  2. Department of Biostatistics and Medical Informatics, Faculty of Medicine, Porto University, Porto, Portugal

    Altamiro Costa-Pereira & Clara Tavares

Authors
  1. Ana G. Almeida
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  2. Ângelo L. Nobre
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  3. Ricardo A. Pereira
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  4. Altamiro Costa-Pereira
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  5. Clara Tavares
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  6. João Cravino
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  7. Mário G. Lopes
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Correspondence to Ana G. Almeida.

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Almeida, A.G., Nobre, Â.L., Pereira, R.A. et al. Impact of aortic dimensions and pulse pressure on late aneurysm formation in operated type A aortic dissection. A magnetic resonance imaging study. Int J Cardiovasc Imaging 24, 633–640 (2008). https://doi.org/10.1007/s10554-008-9296-2

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  • DOI: https://doi.org/10.1007/s10554-008-9296-2

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