Original Paper

The International Journal of Cardiovascular Imaging

, Volume 24, Issue 6, pp 633-640

First online:

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

  • Ana G. AlmeidaAffiliated withCardiology and Cardiothoracic Surgery Service, University Hospital Santa Maria, Faculty of Medicine, Lisbon University Email author 
  • , Ângelo L. NobreAffiliated withCardiology and Cardiothoracic Surgery Service, University Hospital Santa Maria, Faculty of Medicine, Lisbon University
  • , Ricardo A. PereiraAffiliated withCardiology and Cardiothoracic Surgery Service, University Hospital Santa Maria, Faculty of Medicine, Lisbon University
  • , Altamiro Costa-PereiraAffiliated withDepartment of Biostatistics and Medical Informatics, Faculty of Medicine, Porto University
  • , Clara TavaresAffiliated withDepartment of Biostatistics and Medical Informatics, Faculty of Medicine, Porto University
  • , João CravinoAffiliated withCardiology and Cardiothoracic Surgery Service, University Hospital Santa Maria, Faculty of Medicine, Lisbon University
  • , Mário G. LopesAffiliated withCardiology and Cardiothoracic Surgery Service, University Hospital Santa Maria, Faculty of Medicine, Lisbon University

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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.

Keywords

Aortic dissection Cardiovascular Magnetic Resonance Cardiovascular surgery Prognosis