Remnant aortic remodelling in younger patients after acute type I aortic dissection surgery

초록

OBJECTIVES: To study the influence of age on remnant aortic remodelling after acute DeBakey type I aortic dissection (AD) surgery. METHODS: Between January 1999 and December 2013, 118 acute type I AD patients (26 aged < 50 years, Group A; 92 aged 50 years, Group B) with either ascending or ascending hemiarch replacement in whom preoperative and > 1-month postoperative chest computed tomography (CT) were available were included. RESULTS: At median CT follow-up of 35.1 (interquartile range, 14.1-65.2) months, the aortic dimensions in Group A increased significantly from the baseline values at the root, arch and descending thoracic aorta levels at 40.8 +/- 5.3 mm to 43.1 +/- 6.5 mm (P = 0.010), 36.8 +/- 7.1 mm to 40.7 +/- 8.8 mm (P = 0.043) and 36.7 +/- 6.8 mm to 42.8 +/- 11.4 mm (P = 0.009), respectively. In Group B, only the descending thoracic aorta had increased significantly from the baseline at 37.8 +/- 4.8 mm to 40.7 +/- 9.4 mm (P = 0.002). Linear regression analysis showed a significant correlation between younger age and aortic size increase, especially at the aortic sinus level. No significant between-group differences in mortality and reoperation rates were seen during the follow-up of 45.0 +/- 33.6 months vs 44.1 +/- 31.7 months, respectively. CONCLUSIONS: A significantly greater tendency for the remnant aorta to undergo more rapid and generalized adverse remodelling was seen in younger patients after acute type I AD surgery.

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