초록접수 현황
| 17F-128 | 구연 발표 |
The Fate of Unrepaired Type A Chronic Aortic Dissection
Wan Kee Kim¹, Hee Jung Kim², Min Ho Ju¹, Ho Jin Kim¹, Joon Bum Kim¹, Sung-Ho Jung¹, Suk Jung Choo¹, Cheol Hyun Chung¹, Jae Won Lee¹
¹Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea., ²Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, Republic of Korea
Purpose : The current guidelines do consider chronic type A aortic dissection (CAAD) as one of the triggers for elective aortic repair. The lack of sufficient data on the prognosis of unrepaired CAAD is the main hindering factor to establish appropriate surgical indications specific to these patients.
Methods : Using the institutional electronic database, we retrieved 83 patients (62.1±13.3 years; 56.6% females) who were diagnosed as having CAAD, but did not undergo immediate surgical repair from 1997 to 2016. Occurrence of aortic rupture and sudden death were evaluated by competing risk analyses.
Results : Baseline median maximal aortic was 52.2 mm (IQR, 45.3-59.8 mm). During median follow-up of 73.3 months (IQR, 29.4-129.2 months), 16 aortic events occurred (6 aortic ruptures, 10 sudden deaths). On multivariable analyses, baseline aortic diameter (HR 1.04; 95%CI 1.02-1.06; p<0.001) and age (HR 1.06; 95%CI 1.03-1.09; p<0.001) emerged as predictors of aortic events. Estimated rates of aortic events within 5 years were 6.7%, 22.2%, and 29.4% for aortic diameters of <55mm, 55-60mm, and >60 mm, respectively. During the study period, 60 patients underwent aortic repair for chronic type A AD (age, 61.3±14.1 years; aortic diameter, 66.0 ±13.9 mm) with resultant surgical mortality (30-day or inhospital) rate of 3.3% (2/60).
Conclusion : Although larger aortic diameter in chronic AD showed greater risks of adverse aortic events, patients with <55mm (55mm is the surgical indication in the current guidelines) still seemed to show higher observed risks compared with surgical risks. These findings suggest lowering the surgical threshold for chronic type A AD.
Methods : Using the institutional electronic database, we retrieved 83 patients (62.1±13.3 years; 56.6% females) who were diagnosed as having CAAD, but did not undergo immediate surgical repair from 1997 to 2016. Occurrence of aortic rupture and sudden death were evaluated by competing risk analyses.
Results : Baseline median maximal aortic was 52.2 mm (IQR, 45.3-59.8 mm). During median follow-up of 73.3 months (IQR, 29.4-129.2 months), 16 aortic events occurred (6 aortic ruptures, 10 sudden deaths). On multivariable analyses, baseline aortic diameter (HR 1.04; 95%CI 1.02-1.06; p<0.001) and age (HR 1.06; 95%CI 1.03-1.09; p<0.001) emerged as predictors of aortic events. Estimated rates of aortic events within 5 years were 6.7%, 22.2%, and 29.4% for aortic diameters of <55mm, 55-60mm, and >60 mm, respectively. During the study period, 60 patients underwent aortic repair for chronic type A AD (age, 61.3±14.1 years; aortic diameter, 66.0 ±13.9 mm) with resultant surgical mortality (30-day or inhospital) rate of 3.3% (2/60).
Conclusion : Although larger aortic diameter in chronic AD showed greater risks of adverse aortic events, patients with <55mm (55mm is the surgical indication in the current guidelines) still seemed to show higher observed risks compared with surgical risks. These findings suggest lowering the surgical threshold for chronic type A AD.
책임저자: Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
발표자: Wan Kee Kim, E-mail : sgwkwhite@gmail.com