Distal aortic remodeling after open repair of Stanford type A acute aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Xiaoye ¹ , LU Chen ² ,  HU Jia ²

1. West China Medical School, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

HU Jia, Email: humanjia@msn.com

Keywords：

Aortic dissection; distal aortic remodeling; negative remodeling; aortectasis; residual dissection

DOI：

10.7507/1007-4848.202011087

Video：

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The replacement of thoracic aorta and elimination of proximal intimal tear are the classic methods for the treatment of Stanford type A aortic dissection. However, some patients still have residual tears in the distal aorta after operation and lead to dilation of the false lumen due to continuous perfusion. As negative remodeling of distal aorta is closely related to the long-term prognosis of patients, the exploration of related influencing factors has attracted the attention of scholars recently. We aim to review the definition, pathological mechanism and risk factors of unfavorable remodeling after open surgery.

Citation： CHEN Xiaoye, LU Chen, HU Jia. Distal aortic remodeling after open repair of Stanford type A acute aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(9): 1102-1106. doi: 10.7507/1007-4848.202011087 Copy

1.	Ullery BW, Suh GY, Hirotsu K, et al. Geometric deformations of the thoracic aorta and supra-aortic arch branch vessels following thoracic endovascular aortic repair. Vasc Endovascular Surg, 2018, 52(3): 173-180.
2.	Takagi H, Umemoto T. A meta-analysis of total arch replacement with frozen elephant trunk in acute type A aortic dissection. Vasc Endovascular Surg, 2016, 50(1): 33-46.
3.	Assi R, Bavaria JE, Desai ND. Techniques and outcomes of secondary open repair for chronic dissection after acute repair of type A aortic dissection. J Cardiovasc Surg (Torino), 2018, 59(6): 759-766.
4.	Roselli EE, Loor G, He J, et al. Distal aortic interventions after repair of ascending dissection: The argument for a more aggressive approach. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S117-S124.
5.	Ma WG, Chen Y, Zhang W, et al. Extended repair for acute type A aortic dissection: Long-term outcomes of the frozen elephant trunk technique beyond 10 years. J Cardiovasc Surg (Torino), 2020, 61(3): 292-300.
6.	李向阳, 法宪恩. CRRT 在急性 Stanford A 型主动脉夹层术后急性肾损伤中的应用. 中国保健营养, 2019, 29(25): 307.
7.	Lansman SL, Goldberg JB, Kai M, et al. Extended arch procedures for acute type A aortic dissection: A downstream problem? Semin Thorac Cardiovasc Surg, 2019, 31(1): 17-20.
8.	Suzuki T, Asai T, Kinoshita T. Predictors for late reoperation after surgical repair of acute type A aortic dissection. Ann Thorac Surg, 2018, 106(1): 63-69.
9.	Kimura N, Itoh S, Yuri K, et al. Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S91-S98.
10.	Iafrancesco M, Goebel N, Mascaro J, et al. Aortic diameter remodelling after the frozen elephant trunk technique in aortic dissection: Results from an international multicentre registry. Eur J Cardiothorac Surg, 2017, 52(2): 310-318.
11.	Patterson BO, Vidal-Diez A, Karthikesalingam A, et al. Comparison of aortic diameter and area after endovascular treatment of aortic dissection. Ann Thorac Surg, 2015, 99(1): 95-102.
12.	Uchino G, Yoshida T, Kakii B, et al. Resternotomy plus left thoracotomy surgery after previous acute type A aortic dissection repair. Thorac Cardiovasc Surg, 2018, 66(3): 222-226.
13.	Chen Y, Ma WG, Zhi AH, et al. Fate of distal aorta after frozen elephant trunk and total arch replacement for type A aortic dissection in Marfan syndrome. J Thorac Cardiovasc Surg, 2019, 157(3): 835-849.
14.	Rhee R, Gupta A, Vechvitvarakul S, et al. Risk factors predictive of unfavorable distal aortic remodeling after surgical repair of type A thoracic aortic dissection. J Cardiovasc Surg (Torino), 2020, 61(3): 323-331.
15.	Omura A, Miyahara S, Yamanaka K, et al. Early and late outcomes of repaired acute DeBakey type Ⅰ aortic dissection after graft replacement. J Thorac Cardiovasc Surg, 2016, 151(2): 341-348.
16.	Geirsson A, Ahlsson A, Franco-Cereceda A, et al. The Nordic Consortium for Acute type A Aortic Dissection (NORCAAD): Objectives and design. Scand Cardiovasc J, 2016, 50(5-6): 334-340.
17.	Melby SJ, Zierer A, Damiano RJ, et al. Importance of blood pressure control after repair of acute type A aortic dissection: 25-year follow-up in 252 patients. J Clin Hypertens (Greenwich), 2013, 15(1): 63-68.
18.	Suzuki T, Asai T, Kinoshita T. Clinical differences between men and women undergoing surgery for acute Type A aortic dissection. Interact Cardiovasc Thorac Surg, 2018, 26(6): 944-950.
19.	Leontyev S, Haag F, Davierwala PM, et al. Postoperative changes in the distal residual aorta after surgery for acute type A aortic dissection: Impact of false lumen patency and size of descending aorta. Thorac Cardiovasc Surg, 2017, 65(2): 90-98.
20.	Kim JH, Lee SH, Lee S, et al. The impact of a reentry tear after open repair of nonsyndromic acute typeⅠaortic dissection. Ann Thorac Surg, 2020, 110(2): 475-482.
21.	Zhang S, Chen Y, Zhang Y, et al. Should the distal tears of aortic dissection be treated? The risk of distal tears after proximal repair of aortic dissection. Int J Cardiol, 2018, 261: 162-166.
22.	Suzuki T, Isselbacher EM, Nienaber CA, et al. Type-selective benefits of medications in treatment of acute aortic dissection [fromthe International Registry of Acute Aortic Dissection(IRAD)]. Am J Cardiol, 2012, 109(1): 122-127.
23.	Fukui T, Tabata M, Morita S, et al. Gender differences in patients undergoing surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2015, 150(3): 581-587.
24.	Uehara K, Matsuda H, Matsuo J, et al. Acute type A aortic dissection repair in younger patients. J Card Surg, 2018, 33(4): 184-189.
25.	Groenink M, den Hartog AW, Franken R, et al. Losartan reduces aortic dilatation rate in adults with Marfan syndrome: A randomized controlled trial. Eur Heart J, 2013, 34(45): 3491-3500.
26.	Rylski B, Hahn N, Beyersdorf F, et al. Fate of the dissected aortic arch after ascending replacement in type A aortic dissection. Eur J Cardiothorac Surg, 2017, 51(6): 1127-1134.
27.	Smedberg C, Hultgren R, Delle M, et al. Temporal and morphological patterns predict outcome of endovascular repair in acute complicated type B aortic dissection. Eur J Vasc Endovasc Surg, 2018, 56(3): 349-355.
28.	Rylski B, Beyersdorf F, Desai ND, et al. Distal aortic reintervention after surgery for acute DeBakey type Ⅰ or Ⅱ aortic dissection: Open versus endovascular repair. Eur J Cardiothorac Surg, 2015, 48(2): 258-263.
29.	Heo W, Song SW, Kim TH, et al. Impact of supraaortic intimal tears on aortic diameter changes after nontotal arch replacement. Ann Thorac Surg, 2020, 110(1): 20-26.

1. Ullery BW, Suh GY, Hirotsu K, et al. Geometric deformations of the thoracic aorta and supra-aortic arch branch vessels following thoracic endovascular aortic repair. Vasc Endovascular Surg, 2018, 52(3): 173-180.
2. Takagi H, Umemoto T. A meta-analysis of total arch replacement with frozen elephant trunk in acute type A aortic dissection. Vasc Endovascular Surg, 2016, 50(1): 33-46.
3. Assi R, Bavaria JE, Desai ND. Techniques and outcomes of secondary open repair for chronic dissection after acute repair of type A aortic dissection. J Cardiovasc Surg (Torino), 2018, 59(6): 759-766.
4. Roselli EE, Loor G, He J, et al. Distal aortic interventions after repair of ascending dissection: The argument for a more aggressive approach. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S117-S124.
5. Ma WG, Chen Y, Zhang W, et al. Extended repair for acute type A aortic dissection: Long-term outcomes of the frozen elephant trunk technique beyond 10 years. J Cardiovasc Surg (Torino), 2020, 61(3): 292-300.
6. 李向阳, 法宪恩. CRRT 在急性 Stanford A 型主动脉夹层术后急性肾损伤中的应用. 中国保健营养, 2019, 29(25): 307.
7. Lansman SL, Goldberg JB, Kai M, et al. Extended arch procedures for acute type A aortic dissection: A downstream problem? Semin Thorac Cardiovasc Surg, 2019, 31(1): 17-20.
8. Suzuki T, Asai T, Kinoshita T. Predictors for late reoperation after surgical repair of acute type A aortic dissection. Ann Thorac Surg, 2018, 106(1): 63-69.
9. Kimura N, Itoh S, Yuri K, et al. Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S91-S98.
10. Iafrancesco M, Goebel N, Mascaro J, et al. Aortic diameter remodelling after the frozen elephant trunk technique in aortic dissection: Results from an international multicentre registry. Eur J Cardiothorac Surg, 2017, 52(2): 310-318.
11. Patterson BO, Vidal-Diez A, Karthikesalingam A, et al. Comparison of aortic diameter and area after endovascular treatment of aortic dissection. Ann Thorac Surg, 2015, 99(1): 95-102.
12. Uchino G, Yoshida T, Kakii B, et al. Resternotomy plus left thoracotomy surgery after previous acute type A aortic dissection repair. Thorac Cardiovasc Surg, 2018, 66(3): 222-226.
13. Chen Y, Ma WG, Zhi AH, et al. Fate of distal aorta after frozen elephant trunk and total arch replacement for type A aortic dissection in Marfan syndrome. J Thorac Cardiovasc Surg, 2019, 157(3): 835-849.
14. Rhee R, Gupta A, Vechvitvarakul S, et al. Risk factors predictive of unfavorable distal aortic remodeling after surgical repair of type A thoracic aortic dissection. J Cardiovasc Surg (Torino), 2020, 61(3): 323-331.
15. Omura A, Miyahara S, Yamanaka K, et al. Early and late outcomes of repaired acute DeBakey type Ⅰ aortic dissection after graft replacement. J Thorac Cardiovasc Surg, 2016, 151(2): 341-348.
16. Geirsson A, Ahlsson A, Franco-Cereceda A, et al. The Nordic Consortium for Acute type A Aortic Dissection (NORCAAD): Objectives and design. Scand Cardiovasc J, 2016, 50(5-6): 334-340.
17. Melby SJ, Zierer A, Damiano RJ, et al. Importance of blood pressure control after repair of acute type A aortic dissection: 25-year follow-up in 252 patients. J Clin Hypertens (Greenwich), 2013, 15(1): 63-68.
18. Suzuki T, Asai T, Kinoshita T. Clinical differences between men and women undergoing surgery for acute Type A aortic dissection. Interact Cardiovasc Thorac Surg, 2018, 26(6): 944-950.
19. Leontyev S, Haag F, Davierwala PM, et al. Postoperative changes in the distal residual aorta after surgery for acute type A aortic dissection: Impact of false lumen patency and size of descending aorta. Thorac Cardiovasc Surg, 2017, 65(2): 90-98.
20. Kim JH, Lee SH, Lee S, et al. The impact of a reentry tear after open repair of nonsyndromic acute typeⅠaortic dissection. Ann Thorac Surg, 2020, 110(2): 475-482.
21. Zhang S, Chen Y, Zhang Y, et al. Should the distal tears of aortic dissection be treated? The risk of distal tears after proximal repair of aortic dissection. Int J Cardiol, 2018, 261: 162-166.
22. Suzuki T, Isselbacher EM, Nienaber CA, et al. Type-selective benefits of medications in treatment of acute aortic dissection [fromthe International Registry of Acute Aortic Dissection(IRAD)]. Am J Cardiol, 2012, 109(1): 122-127.
23. Fukui T, Tabata M, Morita S, et al. Gender differences in patients undergoing surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2015, 150(3): 581-587.
24. Uehara K, Matsuda H, Matsuo J, et al. Acute type A aortic dissection repair in younger patients. J Card Surg, 2018, 33(4): 184-189.
25. Groenink M, den Hartog AW, Franken R, et al. Losartan reduces aortic dilatation rate in adults with Marfan syndrome: A randomized controlled trial. Eur Heart J, 2013, 34(45): 3491-3500.
26. Rylski B, Hahn N, Beyersdorf F, et al. Fate of the dissected aortic arch after ascending replacement in type A aortic dissection. Eur J Cardiothorac Surg, 2017, 51(6): 1127-1134.
27. Smedberg C, Hultgren R, Delle M, et al. Temporal and morphological patterns predict outcome of endovascular repair in acute complicated type B aortic dissection. Eur J Vasc Endovasc Surg, 2018, 56(3): 349-355.
28. Rylski B, Beyersdorf F, Desai ND, et al. Distal aortic reintervention after surgery for acute DeBakey type Ⅰ or Ⅱ aortic dissection: Open versus endovascular repair. Eur J Cardiothorac Surg, 2015, 48(2): 258-263.
29. Heo W, Song SW, Kim TH, et al. Impact of supraaortic intimal tears on aortic diameter changes after nontotal arch replacement. Ann Thorac Surg, 2020, 110(1): 20-26.

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