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Eur J Cardiothorac Surg 2004;26:359-366
© 2004 Elsevier Science NL

Effects of the patent false lumen on the long-term outcome of type B acute aortic dissection

^a Intensive and Coronary Care Unit, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
^b First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
^c Department of Internal Medicine, Tsurumi University School of Dental Science, Kanagawa, Japan
^d Musashino Hospital, Tokyo, Japan
^e Second Department of Surgery, Nippon Medical School, Tokyo, Japan

Received 10 January 2004; received in revised form 12 March 2004; accepted 16 March 2004.

^* Corresponding author. Address: Intensive and Coronary Care Unit, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. Tel.: +81-3-3822-2131x6823; fax: +81-3-5685-3069
e-mail: nejima-j{at}tsurumi-u.ac.jp

Objective: To determine the most effective treatment, we performed a detailed comparative study of the clinical course of patients with type B aortic dissection with a patent or thrombosed false lumen who did not undergo surgery in the acute period. We examined the effect of patency of the false lumen on outcome. Methods: Computed tomography scans of 138 patients with type B acute aortic dissection were reviewed. Of 138 patients, 110 were medically treated and survived the acute period. We focused on the outcome of these 110 patients, 62 with medically treated thrombosed false lumen (thrombosed group) and 48 with medically treated patent false lumen (patent group). We investigated factors influencing outcome among the 110 patients. The follow-up period was up to 10 years after the onset of aortic dissection. The three study endpoints were death from any cause, dissection-related death (aortic rupture, perioperative death, or death due to organ ischemia), and a dissection-related event (aortic rupture or surgery). In the patent group, we investigated factors influencing long-term outcome. Results: Patency of the false lumen was an independent risk factor for dissection-related death (P=0.038, hazard ratio=5.6, confidence interval=1.1–28) and for a dissection-related event (P=0.000, hazard ratio=7.6, confidence interval=2.7–22) but not for death from any cause (P=0.769, hazard ratio=1.2, confidence interval=0.45–2.91). In the patent group, location of the most dilated aortic segment at the distal arch was an independent risk factor for dissection-related death (P=0.026, hazard ratio=13.6, confidence interval=1.4–135) and for a dissection-related event (P=0.048, hazard ratio=2.6, confidence interval=1.0–6.9). Conclusions: Patency of the false lumen is a strong independent prognostic factor for type B aortic dissection. Location of the most dilated aortic segment at the distal arch is a significant risk factor in the patients with a patent false lumen.

Key Words: Aortic dissection • Stanford type B • False lumen • Prognosis • Risk factor • Distal arch

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