Magnus Larsen has used an international registry to study factors that determine the long-term prognosis after an acute aortic dissection.


MAIN RESULTS:

  1. Clotted blood in the false lumen of an acute aortic dissection does not influence the prognosis.
  2. Survival is similar following extended and limited arch replacement in acute aortic dissection.
  3. More patients than before are treated with surgical therapies when presenting with aortic dissection.

THESIS DEFENCE:

Thesis: Prognosis in acute aortic dissection – Insights from the International Registry of Acute Aortic Dissection
Candidate: Magnus Larsen
Time: June 20, 2018 at 12:15
Place: UiT The Arctic University of Norway, Farmasibygget: Tabletten
Link to university website (in Norwegian)


SUMMARY:

(1) The presence of clotted blood in the so-called false lumen in an acute aortic dissection does not influence the prognosis. 85 % of the patients who survived to discharge were still alive five years later, and false lumen thrombosis was not associated with survival. A total of 522 patients treated surgically for acute aortic dissection type A were included in the study, and 108 of them had partial or complete thrombosis of the false lumen.

(2) Each surgeon should determine whether or not to clamp the aorta when constructing the distal anastomosis during surgery for acute aortic dissection. Larsen and co-workers have conducted a review of the current litterature, and recommends that the surgeon’s choice should to a certain extent be based on the patient’s age and life expectancy.

(3) Survival improved following type A acute aortic dissection between 1995 and 2013, but not following type B, where the dissection is located further down the aorta. Symptoms at presentation and physical findings did not change during the period, but more patients were managed with interventional procedures. Patients presenting with type A aortic dissection were more often given surgery, whereas patients with type B aortic dissection were treated with endovascular therapy.

The study includes 4428 patients enrolled in the International Registry of Acute Aortic Dissection.

(4) The extent of aortic resection does not influence short- og long-term outcome after acute aortic dissection. The study includes 334 patients where the surgeon chose to give extended replacement of the aortic arch, and 907 patients who underwent hemiarch replacement. Approximately 70 % were still alive after five years in both groups.


REFERENCES:

(1) Larsen, M., Bartnes, K., Tsai, T. T., Eagle, K. A., Evangelista, A., Nienaber, C. A., Suzuki, T., Fattori, R., Froehlich, J. B., Hutchison, S., Sundt, T. M., Januzzi, J. L., Isselbacher, E. M., Montgomery, D. G., & Myrmel, T. (2013). Extent of preoperative false lumen thrombosis does not influence long-term survival in patients with acute type A aortic dissectionJournal of the American Heart Association2(4), e000112.

(2) Myrmel, T., Larsen, M., & Bartnes, K. (2014). Does an Open Distal Anastomosis Confer Prognostic Benefit in Acute Dissection Surgery?. In Controversies in Aortic Dissection and Aneurysmal Disease (pp. 183-190). Springer, London.

(3) Pape, L. A., Awais, M., Woznicki, E. M., Suzuki, T., Trimarchi, S., Evangelista, A., Myrmel, T., Larsen, M., Harris, K. M., Greason, K., Di Eusanio, M., Bossone, E., Montgomery, D. G., Eagle, K. A., Nienaber, C. A., Isselbacher, E. M., & O’Gara, P. (2015). Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic DissectionJournal of the American College of Cardiology66(4), 350-358.

(4) Larsen, M., Trimarchi, S., Patel, H. J., Di Eusanio, M., Greason, K. L., Peterson, M. D., Fattori, R., Hutchison, S., Desai, N. D., Korach, A., Montgomery, D. G., Isselbacher, E. M., Nienaber, C. A., Eagle, K. A., Bartnes, K,. & Myrmel, T.  (2017). Extended versus limited arch replacement in acute Type A aortic dissectionEuropean Journal of Cardio-Thoracic Surgery52(6), 1104-1110.

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