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Original Articles: Cardiovascular

Long-Term Prognosis of Type A Aortic Dissection in Non-Marfan Patients With Histologic Pattern of Cystic Medial Necrosis

Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany

Accepted for publication October 12, 2007.

^_* Address correspondence to Dr Girdauskas, Department of Cardiac Surgery, Heart Center Leipzig, Strümpellstrasse 39, Leipzig, 04289, Germany (Email: evagird{at}centras.lt).

Background: The aim of this study was to evaluate long-term results of surgery for type A aortic dissection in non-Marfan patients with histologically confirmed cystic medial necrosis.

Methods: We reviewed our institutional database to identify non-Marfan patients who underwent surgery for acute type A dissection between October 1994 and May 2006 (n = 188). Pathology reports and histologic analyses were available in 174 patients, which form the focus of this study. Long-term results of patients with histologic evidence of cystic medial necrosis in their resected aorta were compared with patients with other causes of aortic dissection.

Results: A total of 137 patients (79%) survived to discharge from the hospital. Cystic medial necrosis was present in 89 of these 137 patients (65%, group 1). The remaining 48 patients showed a different histologic pattern (group 2). Long-term follow-up was available in 100% of survivors and was 41 ± 30 months long. Freedom from late death was 82% in group 1 and 74% in group 2 (p = 0.24). Although aortic reoperation was required in more group 1 patients (17% versus 10%), this difference failed to reach statistical significance (p = 0.3).

Conclusions: The aortic reoperation rate after acute type A dissection may be higher among patients having cystic medial necrosis. We recommend that non-Marfan patients with histologically confirmed cystic medial necrosis undergo the same thorough postoperative surveillance as Marfan patients do.

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Invited Commentary

Martin Czerny and Michael Grimm
Ann. Thorac. Surg. 2008 85: 977. [Extract] [Full Text] [PDF]

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				M. Czerny and M. Grimm Invited Commentary Ann. Thorac. Surg., March 1, 2008; 85(3): 977 - 977. [Full Text] [PDF]