Acute type B aortic dissection: Does aortic arch involvement affect management and outcomes? Insights from the International Registry of Acute Aortic Dissection (IRAD)

Thomas T. Tsai, Eric M. Isselbacher, Santi Trimarchi, Eduardo Bossone, Linda Pape, James L. Januzzi, Arturo Evangelista, Jae Kuen Oh, Alfredo Llovet, Joshua Beckman, Jeanna V. Cooper, Dean E. Smith, James B. Froehlich, Rossella Fattori, Kim A. Eagle, Christoph A. Nienaber

Research output: Contribution to journalArticle

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Abstract

BACKGROUND - Stanford Type B acute aortic dissection (TB-AAD) spares the ascending aorta and is optimally managed with medical therapy in the absence of complications. However, the treatment of TB-AAD with aortic arch involvement (AAI) remains an unresolved issue. METHODS AND RESULTS - We examined 498 patients with TB-AAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. Kaplan-Meier mortality curves were constructed and multivariate regression models were performed to identify independent predictors of AAI and to evaluate whether AAI was an independent predictor of follow-up mortality. We found that 371 (74.5%) patients with TB-AAD did not have AAI versus 127 (25.5%) with AAI. Independent predictors of AAI were a history of previous aortic surgery (OR 3.4; 95% CI, 1.6 to 7.6; P=0.002), absence of back pain (OR 1.6; 95% CI, 1.1 to 2.5; P=0.05), and any pulse deficit (1.9; 95% CI, 1.1 to 3.3, P=0.03). Mortality for patients without AAI was 9.4%±4.3% and 21.0%±6.9% at 1 and 3 years versus 9.2%±7.7% and 19.9%±11.1% with AAI, respectively (mean follow-up overall, 2.3 years, log rank P=0.82). AAI was not an independent predictor of long-term mortality. CONCLUSIONS - Patients with TB-AAD and aortic arch involvement do not differ with regards to mortality at 3 years. Whether or not AAI involvement impacts other measures of morbidity such as freedom from operation or endovascular intervention deserves further study.

Original languageEnglish (US)
JournalCirculation
Volume116
Issue number11 SUPPL. 1
DOIs
StatePublished - Sep 2007

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Thoracic Aorta
Registries
Dissection
Mortality
Back Pain
Pulse
Aorta
Morbidity

Keywords

  • Aorta
  • Mortality
  • Risk factors
  • Surgery

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Acute type B aortic dissection : Does aortic arch involvement affect management and outcomes? Insights from the International Registry of Acute Aortic Dissection (IRAD). / Tsai, Thomas T.; Isselbacher, Eric M.; Trimarchi, Santi; Bossone, Eduardo; Pape, Linda; Januzzi, James L.; Evangelista, Arturo; Oh, Jae Kuen; Llovet, Alfredo; Beckman, Joshua; Cooper, Jeanna V.; Smith, Dean E.; Froehlich, James B.; Fattori, Rossella; Eagle, Kim A.; Nienaber, Christoph A.

In: Circulation, Vol. 116, No. 11 SUPPL. 1, 09.2007.

Research output: Contribution to journalArticle

Tsai, TT, Isselbacher, EM, Trimarchi, S, Bossone, E, Pape, L, Januzzi, JL, Evangelista, A, Oh, JK, Llovet, A, Beckman, J, Cooper, JV, Smith, DE, Froehlich, JB, Fattori, R, Eagle, KA & Nienaber, CA 2007, 'Acute type B aortic dissection: Does aortic arch involvement affect management and outcomes? Insights from the International Registry of Acute Aortic Dissection (IRAD)', Circulation, vol. 116, no. 11 SUPPL. 1. https://doi.org/10.1161/CIRCULATIONAHA.106.681510
Tsai, Thomas T. ; Isselbacher, Eric M. ; Trimarchi, Santi ; Bossone, Eduardo ; Pape, Linda ; Januzzi, James L. ; Evangelista, Arturo ; Oh, Jae Kuen ; Llovet, Alfredo ; Beckman, Joshua ; Cooper, Jeanna V. ; Smith, Dean E. ; Froehlich, James B. ; Fattori, Rossella ; Eagle, Kim A. ; Nienaber, Christoph A. / Acute type B aortic dissection : Does aortic arch involvement affect management and outcomes? Insights from the International Registry of Acute Aortic Dissection (IRAD). In: Circulation. 2007 ; Vol. 116, No. 11 SUPPL. 1.
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abstract = "BACKGROUND - Stanford Type B acute aortic dissection (TB-AAD) spares the ascending aorta and is optimally managed with medical therapy in the absence of complications. However, the treatment of TB-AAD with aortic arch involvement (AAI) remains an unresolved issue. METHODS AND RESULTS - We examined 498 patients with TB-AAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. Kaplan-Meier mortality curves were constructed and multivariate regression models were performed to identify independent predictors of AAI and to evaluate whether AAI was an independent predictor of follow-up mortality. We found that 371 (74.5{\%}) patients with TB-AAD did not have AAI versus 127 (25.5{\%}) with AAI. Independent predictors of AAI were a history of previous aortic surgery (OR 3.4; 95{\%} CI, 1.6 to 7.6; P=0.002), absence of back pain (OR 1.6; 95{\%} CI, 1.1 to 2.5; P=0.05), and any pulse deficit (1.9; 95{\%} CI, 1.1 to 3.3, P=0.03). Mortality for patients without AAI was 9.4{\%}±4.3{\%} and 21.0{\%}±6.9{\%} at 1 and 3 years versus 9.2{\%}±7.7{\%} and 19.9{\%}±11.1{\%} with AAI, respectively (mean follow-up overall, 2.3 years, log rank P=0.82). AAI was not an independent predictor of long-term mortality. CONCLUSIONS - Patients with TB-AAD and aortic arch involvement do not differ with regards to mortality at 3 years. Whether or not AAI involvement impacts other measures of morbidity such as freedom from operation or endovascular intervention deserves further study.",
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T1 - Acute type B aortic dissection

T2 - Does aortic arch involvement affect management and outcomes? Insights from the International Registry of Acute Aortic Dissection (IRAD)

AU - Tsai, Thomas T.

AU - Isselbacher, Eric M.

AU - Trimarchi, Santi

AU - Bossone, Eduardo

AU - Pape, Linda

AU - Januzzi, James L.

AU - Evangelista, Arturo

AU - Oh, Jae Kuen

AU - Llovet, Alfredo

AU - Beckman, Joshua

AU - Cooper, Jeanna V.

AU - Smith, Dean E.

AU - Froehlich, James B.

AU - Fattori, Rossella

AU - Eagle, Kim A.

AU - Nienaber, Christoph A.

PY - 2007/9

Y1 - 2007/9

N2 - BACKGROUND - Stanford Type B acute aortic dissection (TB-AAD) spares the ascending aorta and is optimally managed with medical therapy in the absence of complications. However, the treatment of TB-AAD with aortic arch involvement (AAI) remains an unresolved issue. METHODS AND RESULTS - We examined 498 patients with TB-AAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. Kaplan-Meier mortality curves were constructed and multivariate regression models were performed to identify independent predictors of AAI and to evaluate whether AAI was an independent predictor of follow-up mortality. We found that 371 (74.5%) patients with TB-AAD did not have AAI versus 127 (25.5%) with AAI. Independent predictors of AAI were a history of previous aortic surgery (OR 3.4; 95% CI, 1.6 to 7.6; P=0.002), absence of back pain (OR 1.6; 95% CI, 1.1 to 2.5; P=0.05), and any pulse deficit (1.9; 95% CI, 1.1 to 3.3, P=0.03). Mortality for patients without AAI was 9.4%±4.3% and 21.0%±6.9% at 1 and 3 years versus 9.2%±7.7% and 19.9%±11.1% with AAI, respectively (mean follow-up overall, 2.3 years, log rank P=0.82). AAI was not an independent predictor of long-term mortality. CONCLUSIONS - Patients with TB-AAD and aortic arch involvement do not differ with regards to mortality at 3 years. Whether or not AAI involvement impacts other measures of morbidity such as freedom from operation or endovascular intervention deserves further study.

AB - BACKGROUND - Stanford Type B acute aortic dissection (TB-AAD) spares the ascending aorta and is optimally managed with medical therapy in the absence of complications. However, the treatment of TB-AAD with aortic arch involvement (AAI) remains an unresolved issue. METHODS AND RESULTS - We examined 498 patients with TB-AAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. Kaplan-Meier mortality curves were constructed and multivariate regression models were performed to identify independent predictors of AAI and to evaluate whether AAI was an independent predictor of follow-up mortality. We found that 371 (74.5%) patients with TB-AAD did not have AAI versus 127 (25.5%) with AAI. Independent predictors of AAI were a history of previous aortic surgery (OR 3.4; 95% CI, 1.6 to 7.6; P=0.002), absence of back pain (OR 1.6; 95% CI, 1.1 to 2.5; P=0.05), and any pulse deficit (1.9; 95% CI, 1.1 to 3.3, P=0.03). Mortality for patients without AAI was 9.4%±4.3% and 21.0%±6.9% at 1 and 3 years versus 9.2%±7.7% and 19.9%±11.1% with AAI, respectively (mean follow-up overall, 2.3 years, log rank P=0.82). AAI was not an independent predictor of long-term mortality. CONCLUSIONS - Patients with TB-AAD and aortic arch involvement do not differ with regards to mortality at 3 years. Whether or not AAI involvement impacts other measures of morbidity such as freedom from operation or endovascular intervention deserves further study.

KW - Aorta

KW - Mortality

KW - Risk factors

KW - Surgery

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