![]() The findings of these studies constituted the baseline information. All admitted patients underwent TEE before discharge, and computed tomography (CT) and/or magnetic resonance imaging (MRI) were performed during the first month of follow-up. Patients underwent a strict clinical and imaging protocol, and no patient was lost to follow-up. The aim of the present study was to assess the long-term outcome of aortic dissection with persistent patent false lumen in the descending aorta and define the clinical and imaging variables obtained in subacute phase that could predict adverse events during follow-up. Therefore, identification of clinical and imaging predictors of poor prognosis seems mandatory to select patients for whom more aggressive management may be beneficial. Recent Investigation of Stent Grafts in Aortic Dissection (INSTEAD) trial 16 results failed to show an improvement in 2-year survival and adverse event rates. ![]() However, to date, no study has shown that elective endovascular treatment in subacute phase of aortic dissection reduces mortality. The advent of thoracic endovascular aortic repair raised new expectations for the early management of complicated aortic dissection 14 – 16 by occluding the intimal tear, restoring true lumen flow, and inducing false lumen thrombosis. 9, 10Īdvances in imaging techniques may provide significant information 11 – 13 for identifying patients at higher risk of adverse events. 3 – 7 However, the majority of series of type A and B dissections did not exclude cases with absence of residual dissection, total false lumen thrombosis, or intramural hematomas, 3 – 8 which implies a different natural history. 3 Persistent patent false lumen in the descending aorta is common in both types and has been strongly associated with poor prognosis. Several studies have reported long-term overall survival of 50% to 80% at 5 years and 30% to 60% at 10 years, 1 – 3 with no differences between Stanford type A and B dissections. The long-term outcome of patients with successful initial treatment of acute aortic dissection and persistent patent false lumen in the descending aorta is not well established. Multivariate analysis identified baseline maximum descending aorta diameter (hazard ratio : 1.32 P=0.003), proximal location (HR: 1.84 P=0.03), and entry tear size (HR: 1.13 P<0.001) as predictors of dissection-related adverse events, whereas mortality was predicted by baseline maximum descending aorta diameter (HR: 1.36 P=0.008), entry tear size (HR: 1.1 P=0.001), and Marfan syndrome (HR: 3.66 P=0.001). Survival free from sudden death and surgical-endovascular treatment was 0.90, 0.81, and 0.46 (95% CI, 0.36–0.55) at 3, 5, and 10 years, respectively. Surgical or endovascular treatment was indicated in 10 type A and 25 type B cases. Forty-nine patients died during follow-up (22 type A, 27 type B), 31 suddenly. Median follow-up was 6.42 years (quartile 1 to quartile 3: 3.31–10.49). Transesophageal echocardiography was performed before discharge, and computed tomography was performed at 3 months and yearly thereafter. One hundred eighty-four consecutive patients, 108 surgically treated type A and 76 medically treated type B, were discharged after an acute aortic dissection with patent false lumen. Customer Service and Ordering Information.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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