Long-term outcomes after recurrent acute thoracic aortic dissection: Insights from the International Registry of Aortic Dissection

Takuya Ogami; George J Arnaoutakis; Eric M Isselbacher; Guillaume S C Geuzebroek; Joseph S Coselli; Carlo De Vincentiis; Clayton A Kaiser; Stuart Hutchison; Qing-Guo Li; Derek R Brinster; Bradley G Leshnower; Derek Serna-Gallegos; Chih-Wen Pai; Bradley S Taylor; Himanshu J Patel; Kim A Eagle; Ibrahim Sultan

doi:10.1016/j.jtcvs.2024.03.029

Long-term outcomes after recurrent acute thoracic aortic dissection: Insights from the International Registry of Aortic Dissection

J Thorac Cardiovasc Surg. 2024 Apr 26:S0022-5223(24)00283-6. doi: 10.1016/j.jtcvs.2024.03.029. Online ahead of print.

Authors

Takuya Ogami¹, George J Arnaoutakis², Eric M Isselbacher³, Guillaume S C Geuzebroek⁴, Joseph S Coselli⁵, Carlo De Vincentiis⁶, Clayton A Kaiser⁷, Stuart Hutchison⁸, Qing-Guo Li⁹, Derek R Brinster¹⁰, Bradley G Leshnower¹¹, Derek Serna-Gallegos¹², Chih-Wen Pai¹³, Bradley S Taylor¹⁴, Himanshu J Patel¹⁵, Kim A Eagle¹³, Ibrahim Sultan¹⁶

Affiliations

¹ Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
² Division of Cardiovascular and Thoracic Surgery, Institute for Cardiovascular Health, The University of Texas at Austin, Austin, Tex.
³ Cardiology Department, Thoracic Aortic Center, Massachusetts General Hospital, Boston, Mass.
⁴ Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
⁵ Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex.
⁶ Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato, Italy.
⁷ Cardiothoracic Surgery, Saint Thomas Heart, Nashville, Tenn.
⁸ Department of Cardiac Sciences, University of Calgary Medical Centre, Calgary, Alberta, Canada.
⁹ Cardiac Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
¹⁰ Department of Cardiac Surgery, Northwell Health, New York, NY.
¹¹ Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
¹² Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
¹³ Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich.
¹⁴ Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
¹⁵ Department of Cardiac Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich.
¹⁶ Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: sultani@upmc.edu.

PMID: 38678471
DOI: 10.1016/j.jtcvs.2024.03.029

Abstract

Objective: With an aging population and advancements in imaging, recurrence of thoracic aortic dissection is becoming more common.

Methods: All patients enrolled in the International Registry of Aortic Dissection from 1996 to 2023 with type A and type B acute aortic dissection were identified. Among them, initial dissection and recurrent dissection were discerned. The study period was categorized into 3 eras: historic era, 1996 to 2005; middle era, 2006 to 2015; most recent era, 2016 to 2023. Propensity score matching was applied between initial dissection and recurrent dissection. Outcome of interests included long-term survival and cumulative incidence of major aortic events defined by the composite of reintervention, aortic rupture, and new dissection.

Results: The proportion of recurrent dissection increased from 5.9% in the historic era to 8.0% in the most recent era in the entire dissection cohort. In patients with type A dissection, propensity score matching between initial dissection and recurrent dissection yielded 326 matched pairs. Kaplan-Meier curves showed similar long-term survival between the 2 groups. However, the cumulative incidence of major aortic events was significantly higher in the recurrent dissection group (40.3% ± 6.2% vs 17.8% ± 5.1% at 4 years in the initial dissection group, P = .02). For type B dissection, 316 matched pairs were observed after propensity score matching. Long-term survival and the incidence of major aortic events were equivalent between the 2 groups.

Conclusions: The case volume of recurrent dissection or the ability to detect recurrent dissection has increased over time. Acute type A recurrent dissection was associated with a higher risk of major aortic events than initial dissection. Further judicious follow-up may be crucial after type A recurrent dissection.

Keywords: International Registry of Acute Aortic Dissection; acute thoracic aortic dissection; recurrent dissection; thoracic aortic disease.