Differential impact of intimal tear location on aortic dilation and reintervention in acute type I aortic dissection after total arch replacement
The study objective was to evaluate the differential impact of intimal tear location on aortic dilation and reintervention after total arch replacement for acute type I aortic dissection. From 2009 to 2016, 85 patients underwent total arch replacement for acute type I aortic dissection with residual...
Gespeichert in:
| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2019-08, Vol.158 (2), p.327-338.e2 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 338.e2 |
|---|---|
| container_issue | 2 |
| container_start_page | 327 |
| container_title | The Journal of thoracic and cardiovascular surgery |
| container_volume | 158 |
| creator | Heo, Woon Song, Suk-Won Kim, Tae-Hoon Lee, Jin-Seong Yoo, Kyung-Jong Cho, Bum-Koo Lee, Hye Sun |
| description | The study objective was to evaluate the differential impact of intimal tear location on aortic dilation and reintervention after total arch replacement for acute type I aortic dissection.
From 2009 to 2016, 85 patients underwent total arch replacement for acute type I aortic dissection with residual dissected thoracoabdominal aorta. Forty patients (47%) underwent serial computed tomography scans that were sufficient for analysis. Among these, 14 (35%) underwent total arch replacement via the frozen elephant trunk procedure. Intimal tears were analyzed (size and number) at 3 different levels (level 1, proximal descending thoracic aorta; level 2, distal descending thoracic aorta; level 3, abdominal aorta). Aortic diameter was measured at 4 levels (pulmonary artery bifurcation, celiac axis, maximal abdominal aorta, and maximal thoracoabdominal aorta) using serial follow-up computed tomography scans. The linear mixed model for a repeated-measures random intercept and slope model was used. The rate of freedom from reintervention was analyzed.
In the unadjusted analysis, initial diameter of pulmonary artery bifurcation level, number of intimal tears, presence of 3- or 5-mm intimal tears, and frozen elephant trunk were not significant factors for aortic dilation or shrinking. The significant factors for aortic dilation were intimal tear location and number of visceral branches from the false lumen. The 3-year freedom from reintervention rate was significantly higher in patients with intimal tears 3 mm or greater at level 3 than in those with tears at level 1 (94.1% vs 37.5%, log-rank, P |
| doi_str_mv | 10.1016/j.jtcvs.2018.09.110 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2209598101</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022522318326540</els_id><sourcerecordid>2209598101</sourcerecordid><originalsourceid>FETCH-LOGICAL-c470t-a97e2c4acf86a4922776d1a369e5585959d36b84172c775e03f26027aabb0a703</originalsourceid><addsrcrecordid>eNp9kUFr3DAUhEVpaDZpf0Gh6NiL3Sd5ZVmHHkrSNoFALwnkJrTyM9ViW66kXcjP6D_u2zptbwWDYfhmHpph7K2AWoBoP-zrffHHXEsQXQ2mFgJesI0Ao6u2U48v2QZAykpJ2Zyzi5z3AKBBmFfsvCFIKSU27Od1GAZMOJfgRh6mxfnC48ADCRMpBV3iY_SuhDhz-lxMJXjeh3GV3NzzhIRjOp5SSAqk-kNBXp4W5Lf_LDmjX00D4bzEQhdc8t8pYRmdx4kSXrOzwY0Z3zz_L9nDl8_3VzfV3bevt1ef7iq_1VAqZzRKv3V-6Fq3NVJq3fbCNa1BpTpllOmbdtdthZZea4XQDLIFqZ3b7cBpaC7Z-zV3SfHHAXOxU8gex9HNGA_ZSgkU0lHVhDYr6lPMOeFgl0TtpCcrwJ62sHv7ewt72sKCsbQFud49HzjsJuz_ev6UT8DHFUB65jFgstkHnD32IVFRto_hvwd-AdAcnmU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2209598101</pqid></control><display><type>article</type><title>Differential impact of intimal tear location on aortic dilation and reintervention in acute type I aortic dissection after total arch replacement</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><source>EZB Electronic Journals Library</source><creator>Heo, Woon ; Song, Suk-Won ; Kim, Tae-Hoon ; Lee, Jin-Seong ; Yoo, Kyung-Jong ; Cho, Bum-Koo ; Lee, Hye Sun</creator><creatorcontrib>Heo, Woon ; Song, Suk-Won ; Kim, Tae-Hoon ; Lee, Jin-Seong ; Yoo, Kyung-Jong ; Cho, Bum-Koo ; Lee, Hye Sun</creatorcontrib><description>The study objective was to evaluate the differential impact of intimal tear location on aortic dilation and reintervention after total arch replacement for acute type I aortic dissection.
From 2009 to 2016, 85 patients underwent total arch replacement for acute type I aortic dissection with residual dissected thoracoabdominal aorta. Forty patients (47%) underwent serial computed tomography scans that were sufficient for analysis. Among these, 14 (35%) underwent total arch replacement via the frozen elephant trunk procedure. Intimal tears were analyzed (size and number) at 3 different levels (level 1, proximal descending thoracic aorta; level 2, distal descending thoracic aorta; level 3, abdominal aorta). Aortic diameter was measured at 4 levels (pulmonary artery bifurcation, celiac axis, maximal abdominal aorta, and maximal thoracoabdominal aorta) using serial follow-up computed tomography scans. The linear mixed model for a repeated-measures random intercept and slope model was used. The rate of freedom from reintervention was analyzed.
In the unadjusted analysis, initial diameter of pulmonary artery bifurcation level, number of intimal tears, presence of 3- or 5-mm intimal tears, and frozen elephant trunk were not significant factors for aortic dilation or shrinking. The significant factors for aortic dilation were intimal tear location and number of visceral branches from the false lumen. The 3-year freedom from reintervention rate was significantly higher in patients with intimal tears 3 mm or greater at level 3 than in those with tears at level 1 (94.1% vs 37.5%, log-rank, P < .001).
Intimal tear in the proximal descending thoracic aorta is the most important factor for aortic dilation and reintervention in acute type I aortic dissection after total arch replacement.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2018.09.110</identifier><identifier>PMID: 30975551</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aneurysm, Dissecting - diagnostic imaging ; Aneurysm, Dissecting - pathology ; Aneurysm, Dissecting - surgery ; Aorta, Thoracic - diagnostic imaging ; Aorta, Thoracic - pathology ; Aorta, Thoracic - surgery ; aortic dissection ; aortic operation ; Computed Tomography Angiography ; Female ; Humans ; imaging ; Male ; Middle Aged ; Reoperation - statistics & numerical data ; Retrospective Studies ; Tunica Intima - diagnostic imaging ; Tunica Intima - pathology ; Tunica Intima - surgery</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2019-08, Vol.158 (2), p.327-338.e2</ispartof><rights>2018 The American Association for Thoracic Surgery</rights><rights>Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-a97e2c4acf86a4922776d1a369e5585959d36b84172c775e03f26027aabb0a703</citedby><cites>FETCH-LOGICAL-c470t-a97e2c4acf86a4922776d1a369e5585959d36b84172c775e03f26027aabb0a703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522318326540$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30975551$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Heo, Woon</creatorcontrib><creatorcontrib>Song, Suk-Won</creatorcontrib><creatorcontrib>Kim, Tae-Hoon</creatorcontrib><creatorcontrib>Lee, Jin-Seong</creatorcontrib><creatorcontrib>Yoo, Kyung-Jong</creatorcontrib><creatorcontrib>Cho, Bum-Koo</creatorcontrib><creatorcontrib>Lee, Hye Sun</creatorcontrib><title>Differential impact of intimal tear location on aortic dilation and reintervention in acute type I aortic dissection after total arch replacement</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>The study objective was to evaluate the differential impact of intimal tear location on aortic dilation and reintervention after total arch replacement for acute type I aortic dissection.
From 2009 to 2016, 85 patients underwent total arch replacement for acute type I aortic dissection with residual dissected thoracoabdominal aorta. Forty patients (47%) underwent serial computed tomography scans that were sufficient for analysis. Among these, 14 (35%) underwent total arch replacement via the frozen elephant trunk procedure. Intimal tears were analyzed (size and number) at 3 different levels (level 1, proximal descending thoracic aorta; level 2, distal descending thoracic aorta; level 3, abdominal aorta). Aortic diameter was measured at 4 levels (pulmonary artery bifurcation, celiac axis, maximal abdominal aorta, and maximal thoracoabdominal aorta) using serial follow-up computed tomography scans. The linear mixed model for a repeated-measures random intercept and slope model was used. The rate of freedom from reintervention was analyzed.
In the unadjusted analysis, initial diameter of pulmonary artery bifurcation level, number of intimal tears, presence of 3- or 5-mm intimal tears, and frozen elephant trunk were not significant factors for aortic dilation or shrinking. The significant factors for aortic dilation were intimal tear location and number of visceral branches from the false lumen. The 3-year freedom from reintervention rate was significantly higher in patients with intimal tears 3 mm or greater at level 3 than in those with tears at level 1 (94.1% vs 37.5%, log-rank, P < .001).
Intimal tear in the proximal descending thoracic aorta is the most important factor for aortic dilation and reintervention in acute type I aortic dissection after total arch replacement.</description><subject>Aneurysm, Dissecting - diagnostic imaging</subject><subject>Aneurysm, Dissecting - pathology</subject><subject>Aneurysm, Dissecting - surgery</subject><subject>Aorta, Thoracic - diagnostic imaging</subject><subject>Aorta, Thoracic - pathology</subject><subject>Aorta, Thoracic - surgery</subject><subject>aortic dissection</subject><subject>aortic operation</subject><subject>Computed Tomography Angiography</subject><subject>Female</subject><subject>Humans</subject><subject>imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Reoperation - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Tunica Intima - diagnostic imaging</subject><subject>Tunica Intima - pathology</subject><subject>Tunica Intima - surgery</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFr3DAUhEVpaDZpf0Gh6NiL3Sd5ZVmHHkrSNoFALwnkJrTyM9ViW66kXcjP6D_u2zptbwWDYfhmHpph7K2AWoBoP-zrffHHXEsQXQ2mFgJesI0Ao6u2U48v2QZAykpJ2Zyzi5z3AKBBmFfsvCFIKSU27Od1GAZMOJfgRh6mxfnC48ADCRMpBV3iY_SuhDhz-lxMJXjeh3GV3NzzhIRjOp5SSAqk-kNBXp4W5Lf_LDmjX00D4bzEQhdc8t8pYRmdx4kSXrOzwY0Z3zz_L9nDl8_3VzfV3bevt1ef7iq_1VAqZzRKv3V-6Fq3NVJq3fbCNa1BpTpllOmbdtdthZZea4XQDLIFqZ3b7cBpaC7Z-zV3SfHHAXOxU8gex9HNGA_ZSgkU0lHVhDYr6lPMOeFgl0TtpCcrwJ62sHv7ewt72sKCsbQFud49HzjsJuz_ev6UT8DHFUB65jFgstkHnD32IVFRto_hvwd-AdAcnmU</recordid><startdate>201908</startdate><enddate>201908</enddate><creator>Heo, Woon</creator><creator>Song, Suk-Won</creator><creator>Kim, Tae-Hoon</creator><creator>Lee, Jin-Seong</creator><creator>Yoo, Kyung-Jong</creator><creator>Cho, Bum-Koo</creator><creator>Lee, Hye Sun</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201908</creationdate><title>Differential impact of intimal tear location on aortic dilation and reintervention in acute type I aortic dissection after total arch replacement</title><author>Heo, Woon ; Song, Suk-Won ; Kim, Tae-Hoon ; Lee, Jin-Seong ; Yoo, Kyung-Jong ; Cho, Bum-Koo ; Lee, Hye Sun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-a97e2c4acf86a4922776d1a369e5585959d36b84172c775e03f26027aabb0a703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aneurysm, Dissecting - diagnostic imaging</topic><topic>Aneurysm, Dissecting - pathology</topic><topic>Aneurysm, Dissecting - surgery</topic><topic>Aorta, Thoracic - diagnostic imaging</topic><topic>Aorta, Thoracic - pathology</topic><topic>Aorta, Thoracic - surgery</topic><topic>aortic dissection</topic><topic>aortic operation</topic><topic>Computed Tomography Angiography</topic><topic>Female</topic><topic>Humans</topic><topic>imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Reoperation - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Tunica Intima - diagnostic imaging</topic><topic>Tunica Intima - pathology</topic><topic>Tunica Intima - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Heo, Woon</creatorcontrib><creatorcontrib>Song, Suk-Won</creatorcontrib><creatorcontrib>Kim, Tae-Hoon</creatorcontrib><creatorcontrib>Lee, Jin-Seong</creatorcontrib><creatorcontrib>Yoo, Kyung-Jong</creatorcontrib><creatorcontrib>Cho, Bum-Koo</creatorcontrib><creatorcontrib>Lee, Hye Sun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Heo, Woon</au><au>Song, Suk-Won</au><au>Kim, Tae-Hoon</au><au>Lee, Jin-Seong</au><au>Yoo, Kyung-Jong</au><au>Cho, Bum-Koo</au><au>Lee, Hye Sun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Differential impact of intimal tear location on aortic dilation and reintervention in acute type I aortic dissection after total arch replacement</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2019-08</date><risdate>2019</risdate><volume>158</volume><issue>2</issue><spage>327</spage><epage>338.e2</epage><pages>327-338.e2</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>The study objective was to evaluate the differential impact of intimal tear location on aortic dilation and reintervention after total arch replacement for acute type I aortic dissection.
From 2009 to 2016, 85 patients underwent total arch replacement for acute type I aortic dissection with residual dissected thoracoabdominal aorta. Forty patients (47%) underwent serial computed tomography scans that were sufficient for analysis. Among these, 14 (35%) underwent total arch replacement via the frozen elephant trunk procedure. Intimal tears were analyzed (size and number) at 3 different levels (level 1, proximal descending thoracic aorta; level 2, distal descending thoracic aorta; level 3, abdominal aorta). Aortic diameter was measured at 4 levels (pulmonary artery bifurcation, celiac axis, maximal abdominal aorta, and maximal thoracoabdominal aorta) using serial follow-up computed tomography scans. The linear mixed model for a repeated-measures random intercept and slope model was used. The rate of freedom from reintervention was analyzed.
In the unadjusted analysis, initial diameter of pulmonary artery bifurcation level, number of intimal tears, presence of 3- or 5-mm intimal tears, and frozen elephant trunk were not significant factors for aortic dilation or shrinking. The significant factors for aortic dilation were intimal tear location and number of visceral branches from the false lumen. The 3-year freedom from reintervention rate was significantly higher in patients with intimal tears 3 mm or greater at level 3 than in those with tears at level 1 (94.1% vs 37.5%, log-rank, P < .001).
Intimal tear in the proximal descending thoracic aorta is the most important factor for aortic dilation and reintervention in acute type I aortic dissection after total arch replacement.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30975551</pmid><doi>10.1016/j.jtcvs.2018.09.110</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0022-5223 |
| ispartof | The Journal of thoracic and cardiovascular surgery, 2019-08, Vol.158 (2), p.327-338.e2 |
| issn | 0022-5223 1097-685X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2209598101 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete; EZB Electronic Journals Library |
| subjects | Aneurysm, Dissecting - diagnostic imaging Aneurysm, Dissecting - pathology Aneurysm, Dissecting - surgery Aorta, Thoracic - diagnostic imaging Aorta, Thoracic - pathology Aorta, Thoracic - surgery aortic dissection aortic operation Computed Tomography Angiography Female Humans imaging Male Middle Aged Reoperation - statistics & numerical data Retrospective Studies Tunica Intima - diagnostic imaging Tunica Intima - pathology Tunica Intima - surgery |
| title | Differential impact of intimal tear location on aortic dilation and reintervention in acute type I aortic dissection after total arch replacement |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-04T18%3A26%3A36IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Differential%20impact%20of%20intimal%20tear%20location%20on%20aortic%20dilation%20and%20reintervention%20in%20acute%20type%20I%20aortic%20dissection%20after%20total%20arch%20replacement&rft.jtitle=The%20Journal%20of%20thoracic%20and%20cardiovascular%20surgery&rft.au=Heo,%20Woon&rft.date=2019-08&rft.volume=158&rft.issue=2&rft.spage=327&rft.epage=338.e2&rft.pages=327-338.e2&rft.issn=0022-5223&rft.eissn=1097-685X&rft_id=info:doi/10.1016/j.jtcvs.2018.09.110&rft_dat=%3Cproquest_cross%3E2209598101%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2209598101&rft_id=info:pmid/30975551&rft_els_id=S0022522318326540&rfr_iscdi=true |