Recurrent Aortic Dissection: Observations From the International Registry of Aortic Dissection

Eric M Isselbacher; Marc P Bonaca; Marco Di Eusanio; James Froehlich; Eduardo Bossone; Udo Sechtem; Reed Pyeritz; Himanshu Patel; Ali Khoynezhad; Hans-Henning Eckstein; Guillaume Jondeau; Fabio Ramponi; Mohammad Abbasi; Daniel Montgomery; Christoph A Nienaber; Kim Eagle; Mark E Lindsay; International Registry of Aortic Dissection (IRAD) Investigators

doi:10.1161/CIRCULATIONAHA.115.019359

Recurrent Aortic Dissection: Observations From the International Registry of Aortic Dissection

Circulation. 2016 Oct 4;134(14):1013-1024. doi: 10.1161/CIRCULATIONAHA.115.019359. Epub 2016 Sep 1.

Authors

Eric M Isselbacher¹, Marc P Bonaca¹, Marco Di Eusanio¹, James Froehlich¹, Eduardo Bossone¹, Udo Sechtem¹, Reed Pyeritz¹, Himanshu Patel¹, Ali Khoynezhad¹, Hans-Henning Eckstein¹, Guillaume Jondeau¹, Fabio Ramponi¹, Mohammad Abbasi¹, Daniel Montgomery¹, Christoph A Nienaber¹, Kim Eagle¹, Mark E Lindsay²; International Registry of Aortic Dissection (IRAD) Investigators

Affiliations

¹ From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and Cardiac Surgery (H.P.), University of Michigan, Ann Arbor; Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany (U.S.); Departments of Medicine and Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.P.); Division of Cardiothoracic Surgery, Cedars-Sinai Med Center, Los Angeles, CA (A.K.); Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany (H.-H.E.); Hopital Bichat, Université Paris, Paris, France (G.J.); Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia (F.R.); and Royal Brompton & Harefield NHS Trust, Cardiology and Aortic Centre, London, UK (C.A.N.).
² From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and Cardiac Surgery (H.P.), University of Michigan, Ann Arbor; Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany (U.S.); Departments of Medicine and Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.P.); Division of Cardiothoracic Surgery, Cedars-Sinai Med Center, Los Angeles, CA (A.K.); Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany (H.-H.E.); Hopital Bichat, Université Paris, Paris, France (G.J.); Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia (F.R.); and Royal Brompton & Harefield NHS Trust, Cardiology and Aortic Centre, London, UK (C.A.N.). lindsay.mark@mgh.harvard.edu.

PMID: 27587434
DOI: 10.1161/CIRCULATIONAHA.115.019359

Abstract

Background: Improved medical care after initial aortic dissection (AD) has led to increased survivorship and a population of individuals at risk for further cardiovascular events, including recurrent AD. Reports describing recurrent ADs have been restricted to small numbers of patients from single institutions. We used the IRAD (International Registry of Acute Aortic Dissection) database to examine the clinical profiles and outcomes of patients with recurrent AD.

Methods: We identified 204 patients enrolled in IRAD with recurrent AD. For the primary analysis, patient characteristics, interventions, and outcomes were analyzed and compared with 3624 patients with initial AD. Iterative logistic modeling was performed to investigate variables associated with recurrent AD. Cox regression analyses were used to determine variables associated with 5-year survival. A subset of recurrent AD patients was analyzed for anatomic and demographic details of initial and recurrent ADs.

Results: Patients with recurrent AD were more likely to have Marfan syndrome (21.5% versus 3.1%; P<0.001) but not bicuspid aortic valve (3.6% versus 3.2%; P=0.77). Descending aortic dimensions were greater in patients with recurrent AD than in patients with initial AD independently of sentinel dissection type (type A: 4.3 cm [3.5-5.6 cm] versus 3.3 cm [2.9-3.7 cm], P<0.001; type B: 5.0 cm [3.9-6.0 cm] versus 4.0 cm [3.5-4.8 cm], P<0.001), and this observation was accentuated among patients with Marfan syndrome. In multivariate analysis, the diagnosis of Marfan syndrome independently predicted recurrent AD (hazard ratio, 8.6; 95% confidence interval, 5.8-12.8; P<0.001). Patients with recurrent AD who presented with proximal followed by distal AD were younger than patients who experienced distal followed by proximal dissection AD (42.1±16.1 versus 54.3±14.8 years; P=0.004).

Conclusions: Among those suffering acute aortic dissection, 5% have a history of a prior aortic dissection. Recurrent AD is strongly associated with Marfan syndrome.

Keywords: Marfan syndrome; aorta; aortic aneurysm.

MeSH terms

Adult
Aged
Aortic Aneurysm / complications*
Aortic Aneurysm / diagnosis
Aortic Aneurysm / surgery*
Aortic Dissection / complications*
Aortic Dissection / diagnosis
Aortic Dissection / surgery*
Aortic Valve / surgery
Female
Hospital Mortality
Humans
Male
Marfan Syndrome / complications
Marfan Syndrome / surgery
Middle Aged
Recurrence
Registries / statistics & numerical data
Risk Factors