Early Outcomes of Acute Retrograde Dissection From the International Registry of Acute Aortic Dissection

Foeke J H Nauta, Joon Bum Kim, Himanshu J Patel, Mark D Peterson, Hans-Henning Eckstein, Ali Khoynezhad, Marek P Ehrlich, Marco Di Eusanio, Alessandro Della Corte, Daniel G Montgomery, Christoph A Nienaber, Eric M Isselbacher, Kim A Eagle, Thoralf M Sundt, Santi Trimarchi

Research output: Contribution to journalArticle

Abstract

To provide data on the management and outcomes of patients with acute retrograde aortic dissection (AD) originating from a tear in the descending aorta with extension into the aortic arch or ascending aorta. All patients enrolled in the International Registry of Acute Aortic Dissection from 1996-2015 were reviewed. Retrograde AD was defined by primary tear in the descending aorta with proximal extension into the arch or ascending aorta. Primary end points were in-hospital management strategy and mortality. We identified 101 patients with retrograde AD (67 men; 63.2 ± 14.0 years). During index hospitalization, medical (MED), open surgical (SURG), and endovascular (ENDO) therapies were undertaken in 44, 33, and 22 patients, respectively. The SURG group presented with larger ascending aorta (P = 0.04) and more frequent ascending aortic involvement (81.8% [27/33] vs 22.7% [15/66], P < 0.001) compared with the MED and ENDO groups. Early mortality rate was 9.1% (4/44), 18.2% (6/33), and 13.6% (3/22), for the MED, SURG, and ENDO groups (P = 0.51), respectively. A favorable early mortality rate was observed in patients with retrograde extension limited to the arch (8.6% [5/58]) vs into the ascending aorta (18.6% [8/43], P = 0.14). Early mortality rate of patients with retrograde AD with primary tear in the descending aorta (12.9% [13/101]) was significantly lower than those with classic type A AD presenting with primary tear in the ascending aorta (20.0% [195/977], P = 0.001). A subset of patients with acute retrograde AD originating from primary tear in the descending aorta might be managed less invasively with acceptable early results, particularly among those with proximal extension limited to the arch.

Original languageEnglish
Pages (from-to)150-159
Number of pages10
JournalSeminars in Thoracic and Cardiovascular Surgery
Volume29
Issue number2
DOIs
Publication statusPublished - Aug 22 2017

    Fingerprint

Keywords

  • Acute Disease
  • Aged
  • Aneurysm, Dissecting/diagnostic imaging
  • Aortic Aneurysm/diagnosis
  • Aortography/methods
  • Blood Vessel Prosthesis Implantation/adverse effects
  • Computed Tomography Angiography
  • Endovascular Procedures/adverse effects
  • Female
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Registries
  • Retrospective Studies
  • Treatment Outcome

Cite this

Nauta, F. J. H., Kim, J. B., Patel, H. J., Peterson, M. D., Eckstein, H-H., Khoynezhad, A., Ehrlich, M. P., Eusanio, M. D., Corte, A. D., Montgomery, D. G., Nienaber, C. A., Isselbacher, E. M., Eagle, K. A., Sundt, T. M., & Trimarchi, S. (2017). Early Outcomes of Acute Retrograde Dissection From the International Registry of Acute Aortic Dissection. Seminars in Thoracic and Cardiovascular Surgery, 29(2), 150-159. https://doi.org/10.1053/j.semtcvs.2016.10.004