Prognosis for patients with type B acute aortic dissection: risk analysis of early death and requirement for elective surgery.

摘要

BACKGROUND: The long-term outcome of medical treatment in patients with type B acute aortic dissection (BAD) was assessed and predictors of early in-hospital death were investigated, as well as the need for surgical intervention. METHODS AND RESULTS: In the past 11 years, 180 patients were admitted to hospital and medically treated at the time of onset. If the maximum diameter of the dissected aorta exceeded 60 mm, or rapid enlargement or vital organ ischemia were identified, early or elective surgery was performed. Emergency operation was required in 7 patients. Elective surgery was required for 31 patients (19.1%). The operation-free rate was 76.0% at 10 years. Actuarial survival rate was 89.4% at 5 years and 71.8% at 10 years. Multivariate analysis indicated that refractory hypertension (odds ratio (OR), 4.08, 95% confidence interval (CI), 3.06-21.44, p=0.0434) and rupture (OR 5.87, 95% CI, 2.21-9.12, p=0.0154) were predictors of early hospital mortality. The only significant predictor for elective surgery was a maximum diameter exceeding 40 mm at the time of onset (OR 13.4, 95% CI, 1.93-6.89, p=0.0003). CONCLUSIONS: Medical treatment for BAD produced good results. Strict control of blood pressure is important for patients with a dissected aortic diameter exceeding 40 mm at the time of onset.