Impact of high-risk features on outcome of acute type B aortic dissectionCentral MessagePerspective
Johanna Herajärvi, MD, PhD,
Caius Mustonen, MD, PhD,
Risto Kesävuori, MD, PhD,
Peter Raivio, MD, PhD,
Fausto Biancari, MD, PhD,
Mikko Jormalainen, MD, PhD,
Tatu Juvonen, MD, PhD
Affiliations
Johanna Herajärvi, MD, PhD
Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Research Unit of Surgery, Anesthesia, and Critical Care, University of Oulu, Oulu, Finland
Caius Mustonen, MD, PhD
Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Research Unit of Surgery, Anesthesia, and Critical Care, University of Oulu, Oulu, Finland
Risto Kesävuori, MD, PhD
Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Radiology, Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Peter Raivio, MD, PhD
Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Fausto Biancari, MD, PhD
Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Mikko Jormalainen, MD, PhD
Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Tatu Juvonen, MD, PhD
Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Research Unit of Surgery, Anesthesia, and Critical Care, University of Oulu, Oulu, Finland; Address for reprints: Tatu Juvonen, MD, PhD, Heart and Lung Center, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland.
Background: Acute type B aortic dissection (TBAD) is a severe condition associated with significant morbidity and mortality. The optimal classification and treatment strategy of TBAD remain controversial and inconsistent. Methods: This analysis includes patients treated for acute TBAD at the Helsinki University Hospital, Finland between 2007 and 2019. The endpoints were early and late mortality, intervention of the aorta, and a composite of death and aortic intervention in uncomplicated patients and high-risk patients. Results: This study included 162 consecutive TBAD patients (27.8% females), 114 in the high-risk group and 48 in the uncomplicated group, with a mean age of 67.6 ± 13.9 years. Intramural hematoma was reported in 63 cases (38.9%). The mean follow-up was 5.1 ± 3.9 years. In-hospital/30-day mortality (n = 4; 3.5%) occurred solely in the high-risk group (P = .32). Additionally, TBAD-related adverse events (n = 23; 20.2%) were observed only in the high-risk group (P < .001). The cumulative incidences of the composite TBAD outcome with non–TBAD-related death as a competing risk were 6.6% (95% CI, 1.7%-16.5%) in the uncomplicated group and 29.5% (95% CI, 21.1%-38.3%) in the high-risk group at 5 years and 6.6% (95% CI, 1.7%-16.5%) and 33.0% (95% CI, 23.7%-42.6%) at 10 years (P = .001, Gray test). Extracardiac arteriopathy (subdistribution hazard ratio [SHR], 2.61; 95% CI, 1.08-6.27) and coronary artery disease (SHR, 2.24; 95% CI, 1.07-4.71) were risk factors for adverse aortic-related events in univariable competing-risk regression analysis. Conclusions: Recognition of risk factors underlying adverse events related to TBAD is essential because the disease progression impacts both early and late outcomes. Early aortic repair in high-risk TBAD may reduce long-term morbidity and mortality.
