Proximal Aortic Dissection Late After Aortic Valve Surgery: 119 Cases of a Distinct Clinical Entity

Y. von Kodolitsch; R. Loose; A. J; D. Ostermeyer; A. Aydin; C. H. Koschyk; Y. Haverich; R. A. Nienaber; A. von Kodolitsch; D. Loose; A. J; C. Ostermeyer; null Aydin; H. Koschyk; null Haverich; A. Nienaber

doi:10.1055/s-2000-8346

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Thorac Cardiovasc Surg 2000; 48(6): 342-346
DOI: 10.1055/s-2000-8346

Original Cardiovascular

Original Paper
© Georg Thieme Verlag Stuttgart · New York

Proximal Aortic Dissection Late After Aortic Valve Surgery: 119 Cases of a Distinct Clinical Entity[*]

Y. von Kodolitsch¹ , R. Loose⁴ , J. Ostermeyer² , A. Aydin¹ , D. H. Koschyk¹ , A. Haverich³ , C. A. Nienaber¹ , Y. von Kodolitsch¹ , R. Loose⁴ , J. Ostermeyer² , A. Aydin¹ , D. H. Koschyk¹ , A. Haverich³ , C. A. Nienaber¹

¹Department of Internal Medicine, Division of Cardiology at the University Hospital Eppendorf, Hamburg, ²Department of Cardiovascular Surgery, St. Georg Hospital, Hamburg, ³Department of Cardiovascular Surgery of the Hannover Medical School, Hannover, ⁴Department of Cardiovascular Surgery, Christian-Albrechts-University, Kiel, Germany[1]

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Publication Date:
31 December 2000 (online)

Abstract
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Background: Besides systemic hypertension and Marfan syndrome, only previous aortic valve replacement (AVR) is independently associated with proximal (type A) aortic dissection. Little, however, is known to date about the characteristic features of this clinical entity. Methods: Clinical, prognostic and predisposing profiles in 119 cases of dissection and/or aneurysm occuring 1 month to 16 years after routine AVR were analyzed comprising 62 cases from our database and 57 reported cases. Results: Dissection after AVR has been observed in 0.6 % of all routine AVR procedures in the past four decades. With clinical signs, symptoms and anatomical features different from classic aortic dissection post-AVR dissection is a distinct clinical entity with a high intraoperative mortality of 44 % and a 30-day and 5-year survival of 62 % and 43 %, respectively. Aortic regurgitation and a thin and/or fragile aortic wall at AVR, however, predict late dissection. Using a prediction model, the risk of late dissection can be stratified based on information obtained during AVR surgery. Conclusions: Aortic dissection following AVR is likely to represent a distinct clinical entity which can be predicted and possibly prevented at AVR.

Key words:

Aneurysm - Aorta - Risk factors - Surgery - Valves

1 The material of this manuscript was presented at the International Congress on “Risk Stratification in Cardiac and Thoracic Surgery”, October 15/16, 1999, Cologne, Germany.

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2 Y. von Kodalitsch is supported by grants of the Deutsche Forschungsgemeinschaft (KO 1828/1 and KO 1828/ 1-2)

1 The material of this manuscript was presented at the International Congress on “Risk Stratification in Cardiac and Thoracic Surgery”, October 15/16, 1999, Cologne, Germany.

Dr. Y. von Kodolitsch

Department of Internal Medicine Division of Cardiology University Hospital Eppendorf

Martinistrasse 52, 20246 Hamburg, Germany

Phone: ++4940 42803 4308

Fax: ++4940 42803 8015

Email: kodolitsch@uke.uni-hamburg.de