Should the distal tears of aortic dissection be treated? The risk of distal tears after proximal repair of aortic dissection

Zhang, Simeng; Chen, Yanqing; Zhang, Yongxue; Shi, Dongchen; Shen, Yu; Bao, Junmin; Zhao, Zhi‐Qing; Xiao, Feng; Feng, Rui; Zhou, Jian; Lu, Qingsheng; Jing, Zaiping

doi:10.1016/j.ijcard.2018.01.028

Cited by 36 publications

(29 citation statements)

References 26 publications

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“…Maximilian Kreibich and his colleagues reported similar long-term survival among all BMI groups in patients with type A aortic dissection, which was consistent with our findings [ 3 ]. Although obesity may increase the risk of hypertension, coronary heart disease, diabetes, etc., the long-term survival of patients with aortic dissection is mainly related to the progression of residual dissection, which is profoundly influenced by the location and size of remained tears [ 25 ]. This may explain the similar mid-term survival among the BMI groups.…”

Section: Discussionmentioning

confidence: 99%

Impact of body mass index on early and mid-term outcomes after surgery for acute Stanford type A aortic dissection

Liu

Zhang

Liang

et al. 2021

J Cardiothorac Surg

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Background Obesity is dramatically increasing worldwide, and more obese patients may develop aortic dissection and present for surgical repair. The study aims to analyse the impact of body mass index (BMI) on surgical outcomes in patients with acute Stanford type A aortic dissection (ATAAD). Methods From January 2017 to June 2019, the clinical data of 268 ATAAD patients in a single centre were retrospectively reviewed. They were divided into three groups based on the BMI: normal weight (BMI 18.5 to < 25 kg/m2, n = 110), overweight (BMI 25 to < 30 kg/m2, n = 114) and obese (BMI ≥30 kg/m2, n = 44). Results There was no statistical difference among the three groups in terms of the composite adverse events including 30-day mortality, stroke, paraplegia, renal failure, hepatic failure, reintubation or tracheotomy and low cardiac output syndrome (20.9% vs 21.9% vs 18.2% for normal, overweight and obese, respectively; P = 0.882). No significant difference was found in the mid-term survival among the three groups. The proportion of prolonged ventilation was highest in the obese group followed by the overweight and normal groups (59.1% vs 45.6% vs 34.5%, respectively; P = 0.017). Multivariable logistic regression analysis suggested that BMI was not associated with the composite adverse events, while BMI ≥30 kg/m2 was an independent risk factor for prolonged ventilation (OR 2.261; 95% CI 1.056–4.838; P = 0.036). Conclusions BMI had no effect on the early major adverse outcomes and mid-term survival after surgery for ATAAD. Satisfactory surgical outcomes can be obtained in patients with ATAAD at all weights.

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Section: Discussionmentioning

confidence: 99%

Impact of body mass index on early and mid-term outcomes after surgery for acute Stanford type A aortic dissection

Liu

Zhang

Liang

et al. 2021

J Cardiothorac Surg

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“…They found that more proximal and larger entry tears after surgical repair were correlated with greater FL pressurization, leading to a greater incidence of negative remodeling. 49…”

Section: Anastomotic Insufficiency and Fl Pressurizationmentioning

confidence: 99%

“…The presence of a DANE has been identified in more than 70% of standard hemiarch repairs and results in significant rates of negative remodeling and accelerated growth. 45 Several factors have been identified that contribute to ongoing FL pressurization after surgical repair, including the presence of a DANE, 46 , 47 , 48 re-entry tear size, 3 , 46 , 49 and primary and re-entry tear location. 44 , 48 , 50 In addition to the DANE, distal re-entry tears can contribute to the flow into and the pressurization of the FL, inducing negative remodeling if the relative flow through the FL exceeds that through the TL.…”

Section: Anastomotic Insufficiency and Fl Pressurizationmentioning

confidence: 99%

Acute type A aortic dissection and the consequences of a patent false lumen

et al. 2021

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Acute type A aortic dissection (ATAAD) is a lifethreatening condition associated with high mortality and morbidity. 1 Without immediate surgical repair, mortality rates approach 50% within the first 48 hours. [2][3][4][5] Despite improvements in surgical technique and critical care, the short-and long-term mortality and morbidity associated with ATAAD, particularly the DeBakey I subgroup, remains high. Although standard repair for ATAAD involves resection of the primary intimal tear in the proximal aorta, persistence of flow through a large distal tear or a new entry tear at the distal aortic anastomosis may lead to persistent false lumen (FL) perfusion with unfavorable downstream consequences. 6 This manuscript aims to discuss the following concepts: (1) aortic true lumen (TL) and FL behavior after repair of ATAAD; (2) the concept of distal anastomotic new entry tear (DANE) following standard hemiarch repair; (3) how this impacts short-and long-term outcome of patients; and (4) strategies to prevent DANE. Better understanding of these hemodynamic conditions may serve to improve surgical technique, guide the creation of novel devices toward new therapeutic targets, reduce surgical risk, and ultimately improve patient outcomes.

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“…A survey from our center reported that the average number of residual tears was 6.10 ± 3.16. Among them, the numbers in thoracic descending aorta, visceral segment, infra-renal abdominal aorta and iliac artery were 1.07 ± 1.59, 1.53 ± 1.27, 2.30 ± 1.41 and 1.20 ± 0.80, respectively [ 2 ]. The most drawback of traditional TEAVR is that it is limited to exclude the entry tears in thoracic descending aorta.…”

Section: Trans-tl Repairmentioning

confidence: 99%

“…However, backflow from distal entry tears maintains perfusion to FL, inducing aneurysm formation. About 13.4–62.5% of patients show different degree of distal aneurysmal dilatation after TEVAR [ 2 , 3 ]. The presence of distal residual tears affects the long-term survival of patients [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Endovascular strategies for post-dissection aortic aneurysm (PDAA)

Zeng

Zhao

et al. 2020

J Cardiothorac Surg

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Residual patent false lumen (FL) after type B aortic dissection (TBAD) repair is independently associated with poor long-term survival. Open surgery and endovascular repair result in good clinical outcomes in patients with AD. However, both treatments focus on proximal dissection but not distal dissection. About 13.4–62.5% of these patients present with different degrees of distal aneurysmal dilatation after primary repair. Although open surgery is the first-choice treatment for post-dissection aortic aneurysm (PDAA), there is a need for high technical demand since open surgery is associated with high mortality and morbidity. As a treatment strategy with minimal invasion, endovascular repair shows early benefits and low morbidity. For PDAA, the narrow true lumen (TL), rigid initial flap and branch arteries originating from FL have increased difficulties in operation. The aim of endovascular treatment is to promote FL thrombosis and aortic remodeling. Endovascular repair includes intervention from FL and TL sides. TL intervention techniques (parallel stent-graft, branched and fenestrated stent-graft among others) have been proven to be safe and effective in PDAA. Other FL intervention techniques that have been used in selected patients include FL embolization and candy-plug techniques. This article introduces available endovascular techniques and their outcomes for the treatment of PDAA.

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Should the distal tears of aortic dissection be treated? The risk of distal tears after proximal repair of aortic dissection

Cited by 36 publications

References 26 publications

Impact of body mass index on early and mid-term outcomes after surgery for acute Stanford type A aortic dissection

Impact of body mass index on early and mid-term outcomes after surgery for acute Stanford type A aortic dissection

Acute type A aortic dissection and the consequences of a patent false lumen

Endovascular strategies for post-dissection aortic aneurysm (PDAA)

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