Risk factor analysis for acute type A aortic dissection after aortic valve replacement

• Published in: General thoracic and cardiovascular surgery Vol. 58; no. 12; pp. 601 - 605
• Main Authors: Tsutsumi, Koji, Inoue, Yoshito, Hashizume, Kenichi, Kimura, Naritaka, Takahashi, Ryuichi
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.12.2010; Springer Nature B.V
• Subjects: Acute Disease; Aged; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - etiology; Aortic Aneurysm - diagnostic imaging; Aortic Aneurysm - etiology; Aortic dissection; Aortic Valve - abnormalities; Aortic Valve - surgery; Aortic Valve Insufficiency - complications; Aortic Valve Insufficiency - surgery; Aortic Valve Stenosis - surgery; Aortography - methods; Cardiac Surgery; Cardiology; Chi-Square Distribution; Coronary vessels; Female; Heart Valve Prosthesis Implantation - adverse effects; Humans; Hypertension; Hypertension - complications; Japan; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors; Surgical Oncology; Thoracic Surgery; Time Factors; Tomography, X-Ray Computed; Acute aortic dissection; Ascending aortic diameter; Aortic valve replacement
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-010-0658-z

Purpose Previous aortic valve replacement (AVR) is considered to be an independent risk factor for late acute type A aortic dissection (AAAD). However, the predictors of late AAAD at the time of AVR have not been characterized. Methods A total of 285 patients who underwent isolated AVR were followed for 7.6 ± 8.1 years (mean ± SD). These 285 patients were divided into two groups. Group A consisted of 275 patients who did not develop late aortic complications after AVR, and group B consisted of 10 patients (3.5%) who developed late AAAD after AVR. Results The mean time interval between initial AVR and developing late AAAD was 6.1 ± 5.2 years. The diameter of the ascending aorta at the time of AVR was significantly greater in group B than those of group A (47.7 ± 4.6 vs. 35.6 ± 6.3 mm; P < 0.001). Univariate analysis identified other predictors as well: aortic regurgitation ( P = 0.029), systemic hypertension ( P < 0.001), thinning or fragility of the aortic wall ( P < 0.001), and male sex ( P = 0.039). Conclusion Aortic regurgitation combined with systemic hypertension, male sex, and thinned or fragile aortic walls in patients with ascending aortic dilatation (≥45 mm diameter) at the time of AVR may be predisposing factors for postsurgical aortic complications. These patients should be considered for concomitant replacement of the ascending aorta unless the patient has a high operative risk or older age.