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Acute-on-Chronic Aortic Dissection: Management and Outcomes of the Unstable "Triple-Lumen" Aorta. | LitMetric

AI Article Synopsis

  • A study analyzed the incidence and characteristics of triple-lumen aortic dissection, impacting survival rates among patients with chronic distal aortic dissection from 2010 to 2021.
  • Out of 1149 patients, 33 (2.9%) were found to have triple-lumen dissection, with most patients experiencing their initial dissection at a median age of 46, and 85% required urgent surgical intervention due to serious complications.
  • The findings suggest that acute-on-chronic distal dissection should be labeled as a "complicated" type B dissection due to greater risks, including larger aneurysms and rapid false lumen expansion, resulting in a 30-day mortality rate of 12%.

Article Abstract

Background: The impact of acute aortic dissection of the chronically dissected distal aorta is unknown. This study sought to describe the incidence and characteristics of the triple-lumen aortic dissection and its impact on survival.

Methods: From 2010 to 2021, a query of a single-institution aortic database identified 1149 patients with chronic distal aortic dissection. Thirty-three (2.9%) patients with at least 3 distinct lumens and 2 separate "primary" intimal tears were identified by analysis of contrast-enhanced cross-sectional imaging. Triple-lumen patients were exactly matched with a cohort of double-lumen patients on a 1:1 ratio using 5 preoperative variables, and outcomes between the groups were assessed.

Results: The median age at time of initial dissection in patients with a triple-lumen dissection was 46 years. Initial dissection was a type A in 33% and a type B in 67% of patients. The median time from initial dissection to triple-lumen diagnosis was 4.2 years. On diagnosis of the triple-lumen aorta, 85% of patients required urgent aortic repair for rapid growth (36%), aortic diameter ≥55 mm (30%), malperfusion (6%), intractable pain (6%), and rupture/type A (6%). Thirty-day mortality after triple lumen dissection was 12%.

Conclusions: Acute-on-chronic distal dissection resulting in a triple-lumen aorta should be classified as a "complicated" type B dissection as these patients typically have large aneurysms and a high incidence of rapid false lumen expansion requiring urgent surgical repair.

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Source
http://dx.doi.org/10.1016/j.athoracsur.2023.10.029DOI Listing

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