Predicting late aortic complications after acute type A dissection surgery with volumetric measurements in a Singapore cohort

Jasmine Ge; Vinay Bahadur Panday; Siew-Pang Chan; Bernard Wee; Julian Chi Leung Wong; Leok Kheng Kristine Teoh; Moe Thu San; Carlos A Mestres; Theodoros Kofidis; Vitaly A Sorokin

doi:10.4103/singaporemedj.SMJ-2021-222

Predicting late aortic complications after acute type A dissection surgery with volumetric measurements in a Singapore cohort

Singapore Med J. 2023 Apr 27. doi: 10.4103/singaporemedj.SMJ-2021-222. Online ahead of print.

Affiliations

¹ Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore.
² Department of Medicine, National University Hospital, Singapore.
³ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore; Cardiovascular Research Institute, National University Heart Centre, Singapore; College of Science, Health and Engineering, La Trobe University, Australia.
⁴ Department of Diagnostic Imaging, National University Hospital, Singapore.
⁵ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁶ Department of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Switzerland; Department of Cardiothoracic Surgery, The University of the Free State, Bloemfontein, South Africa.
⁷ Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

PMID: 37171433
DOI: 10.4103/singaporemedj.SMJ-2021-222

Abstract

Introduction: This study was conducted to evaluate the efficacy of postoperative computed tomography (CT) measurements of aortic lumen volumes in predicting aortic-related complications following acute type A aortic dissection (ATAAD) repair.

Methods: We conducted a single-institution retrospective aortic volumetric analysis of patients after ascending aorta replacement performed during 2001-2015. The volumetric measurements of total lumen (total-L), true lumen (TL), false lumen (FL), as well as the TL:FL ratio from the first and second postoperative computer angiograms were obtained. A generalised structural equation model was created to analyse the predictive utility of TL:FL ratio.

Results: One hundred and twenty-five patients underwent surgical intervention, of whom 97 patients were eventually discharged and analysed for postoperative complications. A total of 19 patients were included in the final analysis. Patients with late postoperative aortic complications had a significantly higher FL volume and total-L volume on the first (FL volume P = 0.041, total-L volume P = 0.05) and second (FL volume P = 0.01, total-L volume P = 0.007) postoperative scans. The odds of having aortic complications were raised by 1% with a 1 cm³ increase in total-L volume and by 2% with a 1 cm³ increase in FL volume. The TL:FL ratio was significantly lower in patients who developed complications.

Conclusion: Postoperative CT volumetric measurements in patients who developed complications are characterised by a significant increase in the FL volume and total-L volume from the first postoperative scans. Patients with disproportionately expanded FL presenting with TL:FL ratios less than 1 were associated with aortic complications. Hence, the TL:FL ratio may be a reliable and useful parameter to monitor postoperative disease progression and to evaluate the risk of late complications in ATAAD patients.

Keywords: Aorta; aortic dissection; late complication.