Results of a prospective follow-up study after type A aortic dissection repair: a high rate of distal aneurysmal evolution and reinterventions

Marine Gaudry (1) , Alizée Porto (1) , Carine Guivier-Curien (2) , Arnaud Blanchard (1) , Laurence Bal (1) , Noemie Resseguier (3) , Virgile Omnes (1) , Mariangela de Masi (1) , Meghann Ejargue (1) , Alexis Jacquier (1) , Vlad Gariboldi (1) , Valerie Deplano (2) , Philippe Piquet (1)

1 TIMONE - Hôpital de la Timone [CHU - APHM]
2 IRPHE - Institut de Recherche sur les Phénomènes Hors Equilibre
3 APHM - Assistance Publique - Hôpitaux de Marseille

OBJECTIVES We investigated the anatomical evolution of residual aortic dissection after type A repair and factors associated with poor prognosis at a high-volume aortic centre. METHODS Between 2017 and 2019, all type A aortic dissections were included for prospective follow-up. Patients without follow-up computed tomography (CT) scan available for radiological analysis and patients without residual aortic dissection were excluded from this study. The primary end point was a composite end point defined as dissection-related events including aneurysmal evolution (increased diameter > 5 mm/year), aortic reintervention for malperfusion syndrome, aortic diameter >55 mm, rapid aortic growth >10 mm/year or aortic rupture and death. The secondary end points were risk factors for dissection-related events and reintervention analysis. All immediate and last postoperative CT scans were analysed. RESULTS Among 104 patients, after a mean follow-up of 20.4 months (8–41), the risk of dissection-related events was 46.1% (48/104) and the risk of distal reintervention was 17.3% (18/104). Marfan syndrome (P < 0.01), aortic bicuspid valve (P = 0.038), innominate artery debranching (P = 0.025), short aortic cross-clamp time (P = 0.011), initial aortic diameter >40 mm (P < 0.01) and absence of resection of the primary entry tear (P = 0.015) were associated with an increased risk of dissection-related events or reintervention during follow-up. CONCLUSIONS Residual aortic dissection is a serious disease requiring close follow-up at an expert centre. This study shows higher reintervention and aneurysmal development rates than currently published. To improve long-term outcomes, the early demographic and anatomic poor prognostic factors identified may be used for more aggressive treatment at an early phase.

Mots clés: Prospective follow-up; Aortic centre; Type A aortic dissection; Residual aortic dissection; Aneurysmal evolution; Reinterventions

Domaines: Biomécanique [physics.med-ph]; Cardiologie et système cardiovasculaire

Marine Gaudry, Alizée Porto, Carine Guivier-Curien, Arnaud Blanchard, Laurence Bal, et al.. Results of a prospective follow-up study after type A aortic dissection repair: a high rate of distal aneurysmal evolution and reinterventions. European Journal of Cardio-Thoracic Surgery, 2022, 61, pp.152-159. ⟨10.1093/ejcts/ezab317⟩. ⟨hal-03428257⟩