A new mechanism why an acute type B aortic dissection is primary complicated, becomes complicated or remains uncomplicated

• Published in: The Thoracic and Cardiovascular Surgeon
• Main Authors: Czerny, M, Loewe, C, Sodeck, G, Ta, J, Schoder, M, Funovics, M, Dumfarth, J, Grimm, M
• Format: Conference Proceeding
• Language: English
• Published: 01.02.2011
• ISSN: 0171-6425; 1439-1902
• DOI: 10.1055/s-0030-1269218

Aims: To evalute if different primary entry sites result in primary complicated, secondary complicated or uncomplicated acute type B aortic dissection. Methods: Sixty-five patients were analyzed. Patients were stratified according to the location of the primary entry tear. Primary entry tears in axial CT scans at the upper circumference (180°) of the distal aortic arch were defined as convex (group A) and the remaining as concave (group B). Detailed morphometry was done and clinical outcome including need for thoracic endovascular aortic repair (TEVAR) was evaluated. Results: Forty-two patients (group A) had the primary entry tear at the convexity and 23 patients (group B) had the primary entry tear at the concavity of the distal aortic arch. There was a significant difference regarding time to TEVAR [group A- 9 days (9–37) vs. group B- 0 days (0–13), p=0.03] and regarding the incidence of primary complicated type B aortic dissection (group A- 21% vs. group B- 61%, p=0.003). Cox regression analysis revealed a primary entry tear at the concavity as the only independent predictor of primary or secondary development of a complicated acute type B aortic dissection. Conclusion: A primary entry tear at the concavity of the distal aortic arch is associated with a significant increase of the occurence of complicated acute type B aortic dissection. Due to low procedural risk and high success rate, closure of the primary entry tear with TEVAR is strongly recommended in this newly defined high-risk subgroup of patients.