Clinical Features and Long-Term Follow-up Results in Fifty Four Patients with Aortic Dissection

ABSTRACT

BACKGROUND: Aortic dissection is an uncommon disease but early mortality is as high as 1 percent per hour if untreated. However, major advances in the prompt noninvasive diagnosis and in the medical and surgical treatment of aortic dissection now improve the survival rate to an 75~82% of 5-year survival rate. In order to determine clinical features and long-term follow up results of patients with aortic dissection in Korea, we present a retrospective review of 54 patients with aortic dissection at our institute. METHODS: We review the medical records, echocardiograms and computed tomogram(CT) or magnetic resonance imaging(MRI) of 54 patients(mean age 59+/-12 years, male 27) who had aortic dissection between September 1991 and July 1997. Patients were classified according to DeBakey type. Clinical features were evaluated in relation to type. Long-term survival rate using Kaplan-Meier method were also evaluated in relation to type, sex and presence of undertaking operation. RESULTS: Of the 54 patients with aortic dissection, twenty two(41%) were classified to type I, eight(15%) to type II and twenty four(44%) to type III. Age(type I 60 yrs, type II 60 yrs, type III 57 yrs), sex(male in type I 10(45%)type II 4(50% ), type III 13(54%)) and pulse rate(type I 84, type II 75, type III 78) according to the type of aortic dissection show no signifiant difference. In regarding to predisposing factors, hypertension was found in 40(74%) overall, Marfan syndrome 1(2%), bicuspid aortic valve 4(7%), and iatrogenic vascular injury 3(6%). Four-year survival rate was 48% in all patients who were followed for 28+/-26 months(1-168 months), 61% in type I, 44% in type II and 44% in the III. But, there are no statistically significant difference in 4-year survival rate according to type and sex or presence of undertaking operation(data not shown). There are many kinds of cause of death; multi-organ failure, renal failure, congestive heart failure, sepsis, ruptured aortic dissection, gastrointestinal bleeding, cerebrovascular disease and postoperative weaning failure in the dead patients from aortic dissection. And also we found that there are some kinds of cause of death not directly related with aortic dissection(sepsis, gastrointestinal bleeding and cerebrovascular disease) in patients, especially in type III. CONCLUSION: Overall four-year survival rate in patients with aortic dissection was 48% and there were no significant differences in survival rate accoring to type, sex and presence of undertaking operation. There were many kinds of cause of death in patients with aortic dissection and some causes of death was not directly related with aortic dissection. The survival rate in patients with aortic dissection will be increased by strict control of blood pressure and optimal timing of operation before development of aortic rupture.