Locational impact of luminal communication on aortic diameter changes and reintervention in acute type i aortic dissection

The aim of this study is to evaluate the locational impact of a luminal communication on aortic diameter changes and reintervention after surgical repair of acute type I aortic dissection. Between 2009 and 2017, 304 patients underwent operation for acute type I aortic dissection. Among them, 93 patients were enrolled. The luminal communications were analysed in segment 1 (the proximal descending thoracic aorta), segment 2 (the distal descending thoracic aorta) and segment 3 (the abdominal aorta). The aortic diameter was measured at the pulmonary artery bifurcation, coeliac axis, maximal abdominal aorta and maximal thoraco-abdominal aorta using serial follow-up computed tomography scans. The linear mixed model was used, and the rate of freedom from reintervention was analysed. In the adjusted analysis, the initial diameter of the maximal abdominal aorta and the first luminal communication in segment 1 was statistically significant. However, the slope value of the maximal abdominal aorta was smaller than that of the first luminal communication in segment 1 (0.024 vs 0.198). The 3-year freedom from reintervention rate was significantly higher in patients without a luminal communication than in those with an initial luminal communication in segment 1 (96% vs 47%, log rank, P = 0.003). A luminal communication at the proximal descending thoracic aorta (segment 1) is a significant factor for an increasing aortic diameter and reintervention after surgical repair of acute type I aortic dissection.