초록접수 현황
| 17F-010 | 구연 발표 |
Remnant Tear in the Aortic Arch branch is a Risk Factor for Major Adverse Aortic Events after Acute Type I Aortic Dissection Repair
Woon Heo¹, Suk-Won Song¹, Tae-Hoon Kim¹, Shin-Young Lee¹, Min-Young Baek¹, Kyung-Jong Yoo², Bum-Koo Cho³
¹Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea, ²Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea, ³The Korea Heart Foundation
Purpose : Tear-oriented surgery (TOS) is considered as a standard treatment for acute DeBakey type I aortic dissection (AIAD). However, it seems to be insufficient for the long-term fate of residual thoracoabdominal aorta focusing on aortic growth, and major adverse aortic events (MAAE).
Methods : Between 2009 and 2016, 274 patients underwent surgical repair for AIAD. Of those, 105 patients with both pre-discharge and follow-up computed tomographic scans were enrolled in this study. The surgical extent was determined by the location of primary entry tears (ascending, 1-partial, 2-partial or total arch replacement (TAR)). We measured aortic diameters (pulmonary artery bifurcation (PAB), maximum diameter of DTA (maxDTA), and celiac axis), and compared MAAE (defined as aorta growth rate > 5mm/year or maximal diameter of descending thoracic aorta (maxDTA > 55mm) according to the surgical extent.
Results : Patients underwent TAR (n=29) and non-TAR (n=76). In non-TAR group, patients without or with remnant tears in the aortic arch branches were classified as complete (non-TAR-CAR, n=52), or incomplete arch repair (non-TAR-IAR, n=24)(Figure 1). There were no difference between TAR and non-TAR group in the freedom from MAAE. And there were no difference between TAR and non-TAR-CAR group in the aorta growth, and freedom from MAAE. However, the freedom from MAAE at 5 years were significantly higher in non-TAR-CAR group than in non-TAR-IAR group (84.5% and 31.1%, Log-rank, p<0.001)(Figure 1).
Conclusion : In terms of MAAE, TOS is insufficient. Complete arch repair leads to favorable aorta remodeling, and prevents MAAE after AIAD repair.
Methods : Between 2009 and 2016, 274 patients underwent surgical repair for AIAD. Of those, 105 patients with both pre-discharge and follow-up computed tomographic scans were enrolled in this study. The surgical extent was determined by the location of primary entry tears (ascending, 1-partial, 2-partial or total arch replacement (TAR)). We measured aortic diameters (pulmonary artery bifurcation (PAB), maximum diameter of DTA (maxDTA), and celiac axis), and compared MAAE (defined as aorta growth rate > 5mm/year or maximal diameter of descending thoracic aorta (maxDTA > 55mm) according to the surgical extent.
Results : Patients underwent TAR (n=29) and non-TAR (n=76). In non-TAR group, patients without or with remnant tears in the aortic arch branches were classified as complete (non-TAR-CAR, n=52), or incomplete arch repair (non-TAR-IAR, n=24)(Figure 1). There were no difference between TAR and non-TAR group in the freedom from MAAE. And there were no difference between TAR and non-TAR-CAR group in the aorta growth, and freedom from MAAE. However, the freedom from MAAE at 5 years were significantly higher in non-TAR-CAR group than in non-TAR-IAR group (84.5% and 31.1%, Log-rank, p<0.001)(Figure 1).
Conclusion : In terms of MAAE, TOS is insufficient. Complete arch repair leads to favorable aorta remodeling, and prevents MAAE after AIAD repair.
책임저자: Suk-Won Song
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
발표자: Woon Heo, E-mail : woonheo@yuhs.ac