Aortic Expansion After Acute Type B Aortic Dissection

Abstract

Background. A considerable number of patients with acute type B aortic dissection (ABAD) treated with medical management alone will exhibit aortic enlargement during follow-up, which could lead to aortic aneurysm and rupture. the purpose of this study was to investigate predictors of aortic expansion among ABAD patients enrolled in the International Registry of Acute Aortic Dissection.Methods. We analyzed 191 ABAD patients treated with medical therapy alone enrolled in the registry between 1996 and 2010, with available descending aortic diameter measurements at admission and during follow-up. the annual aortic expansion rate was calculated for all patients, and multivariate regression analysis was used to investigate factors affecting the expansion rate.Results. Aortic expansion was observed in 59% of ABAD patients; mean expansion rate was 1.7 +/- 7 mm/y. in multivariate analysis, white race (regression coefficient [RC], 4.6; 95% confidence interval [CI], 1.4 to 7.7) and an initial aortic diameter less than 4.0 cm (RC, 6.3; 95% CI, 4.0 to 8.6) were associated with increased aortic expansion. Female sex (RC, -3.8; 95% CI, -6.1 to -1.4), intramural hematoma (RC, -3.8; 95% CI, -6.5 to -1.1), and use of calcium-channel blockers (RC, -3.8; 95% CI, -6.2 to -1.3) were associated with decreased aortic expansion.Conclusions. White race and a small initial aortic diameter were associated with increased aortic expansion during follow-up, and decreased aortic expansion was observed among women, patients with intramural hematoma, and those on calcium-channel blockers. These data raise the possibility that the use of calcium-channel blockers after ABAD may reduce the rate of aortic expansion, and therefore further investigation is warranted. (Ann Thorac Surg 2012; 94: 1223-9) (C) 2012 by the Society of Thoracic SurgeonsUniversity of Michigan Health SystemVarbedian Fund for Aortic ResearchMardigian FoundationGore Medical Inc (Flagstaff, AZ)Maasstad Hosp Rotterdam, Dept Surg, NL-3011 AB Rotterdam, NetherlandsPoliclin San Donato IRCCS, Milan, ItalyUniv Michigan Hlth Syst, Ann Arbor, MI USABrigham & Womens Hosp, Boston, MA 02115 USAUniv Toronto, Toronto, ON, CanadaS Orsola Univ Hosp, Bologna, ItalyUniv Med Ctr Utrecht, Utrecht, NetherlandsRobert Bosch Krankenhaus, Stuttgart, GermanyUniv Penn, Perelman Sch Med, Philadelphia, PA 19104 USAUniv Calgary, Calgary, AB, CanadaMassachusetts Gen Hosp, Boston, MA 02114 USAUniv Rostock, Rostock, GermanyUniversidade Federal de São Paulo, Cardiovasc Surg Discipline, Escola Paulista Med, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Cardiovasc Surg Discipline, Escola Paulista Med, BR-04023900 São Paulo, BrazilWeb of Scienc