Clinical Research Article
Increasing false lumen diameter is a risk factor for the rupture of acute type A aortic dissection
Zhang Liang, Wang De, Qiu Juntao, Yang Xiubin, Yu Cuntao, Chang Qian, Shu Chang
Published 2019-11-30
Cite as Chin J Vasc Surg, 2019, 04(4): 219-225. DOI: 10.3760/cma.j.issn.2096-1863.2019.04.007
Abstract
ObjectiveTo analyze the characteristics of changes in diameters of ascending aorta and false lumen in patients with acute type-A aortic dissection, hereby to determine the risk factors of preoperative dissection rupture.
MethodsBetween January 2010 and December 2016, a total of 794 patients with acute type A dissection were selected. The total diameters of aortic sinus, ascending aorta and the proximal arch as well as the diameter of the false lumen were measured in aortic enhanced CT images. And the competitive risk analysis was used to determine the independent risk factors for dissection rupture.
Results90 patients (11.3%) died of rupture before surgical treatment. The mean age of all patients was 52.2 years. The mean interval time from onset to endpoint was 90.9 h in the rupture group, which was shorter than that in the surgery group (119.7 h, P=0.058) . More patients in the rupture group manifested with syncope than in the surgery group (11.1% vs 1.3%, P<0.001) . The preoperative shock in the rupture group was significantly higher than in the surgery group (7.8%vs 2.7%, P=0.021) . The average diameter of the ascending aorta was 48.6 mm, and it was significantly greater in the rupture group than in the surgery group (50.0 mm vs 47.3 mm, P=0.003) . The average diameter of the false lumen of the ascending aorta was 28.0 mm, which was significantly greater in the rupture group than in the surgery group (34.3 mm vs 22.4 mm, P<0.001) . The average ratio of false lumen diameter/true lumen diameter of the ascending aorta was 2.9; it was significantly greater in the rupture group than in the surgery group (3.4vs 2.5, P<0.001) . The preoperative rupture rate increased with the diameter of the false lumen; For a diameter of the false lumen of ≥31 mm, the degree of dominance ratio was the maximum under the premise of statistical significance with a rupture rate of 20% (64/320) , while the rupture rate was 6.82% (32/474) for a diameter of the false lumen of <31 mm. When the false lumen/true lumen ratio was ≥3.38, the degree of dominance ratio reached the maximum value under the premise of statistical significance. A multivariate regression analysis showed that a diameter of ascending aorta of <45 mm, the diameter of the false lumen (OR=1.04, 95%CI 1-1.10; P=0.041) and false lumen/true lumen ratio ≥4 (OR=1.24, 95%CI 1.06-5.28; P=0.029) were closely associated with preoperative rupture.
ConclusionsThe rupture of acute type-A dissection is closely correlated to the diameter of false lumen of ascending aorta and false lumen/true lumen ratio. When the total diameter of ascending aorta is <45 mm, the risk of dissection rupture is closely associated with the diameter of false lumen and false lumen/true lumen ratio.
Key words:
Acute aortic dissection; Preoperative rupture; Diameter; Ascending aorta false lumen
Contributor Information
Zhang Liang
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China
Wang De
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China
Qiu Juntao
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China
Yang Xiubin
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China
Yu Cuntao
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China
Chang Qian
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China
Shu Chang
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China
