Recurrent Aortic Dissection: IRAD Registry Observations

Isselbacher EM, Bonaca MP, Di Eusanio M, et al.
Recurrent Aortic Dissection: Observations From the International Registry of Aortic Dissection (IRAD). Circulation 2016;Sep 1:[Epub ahead of print].

Patients who suffer acute aortic dissection are at increased risk for future aortic events, including progressive aortic aneurysm expansion, aortic rupture, and recurrent aortic dissection. This study, using the International Registry of Aortic Dissection (IRAD), helps elucidate patient and disease characteristics associated with recurrent aortic dissection. The following are 10 points to remember:

  1. IRAD is a multicenter registry of all cases of acute aortic dissection at participating sites. For this study, the IRAD database was queried for all cases of acute, nontraumatic, noniatrogenic aortic dissection that occurred from December 1995 through February 2013.
  2. A cohort of 3,843 patients with acute, nontraumatic, noniatrogenic aortic dissection were identified. Of those, there were 204 cases (5.3%) of aortic dissection among patients with history of prior aortic dissection (recurrent aortic dissection).
  3. Marfan syndrome was significantly more common among patients with recurrent aortic dissection than in the group as a whole (21.5% vs. 3.1%, p < 0.001), whereas the presence of bicuspid aortic valve was not (3.6% vs. 3.2%, p = 0.77). The presence of Marfan syndrome was a strong independent predictor of recurrent aortic dissection (hazard ratio, 8.6; 95% confidence interval, 5.8-12.8; p < 0.001).
  4. Independent predictors of recurrent aortic dissection among patients without Marfan syndrome included history of known aortic aneurysm, history of aortic valve replacement, and nonwhite race.
  5. There was a higher prevalence of type B compared to type A dissection among patients with recurrent aortic dissection.
  6. The mean diameter of the descending thoracic aorta was significantly larger among patients with recurrent aortic dissection compared to those with initial aortic dissection, both overall and when stratified by dissection type (type A and type B).
  7. Rates of early complications including stroke, coma, myocardial infarction, and in-hospital death were not significantly different between the patients with recurrent aortic dissection and those with initial aortic dissection.
  8. Among patients with recurrent aortic dissection, increased late mortality was associated with age >70 years at the time of recurrent dissection, known aortic aneurysm at presentation, and a history of atherosclerosis.
  9. Based on subgroup analysis at three participating sites, the pattern of aortic dissection was closely related to age at the time of first dissection. Patients with recurrent aortic dissection who had first proximal and then distal dissections were younger than patients who first experienced distal followed by proximal dissection.
  10. The occurrence of recurrent aortic dissection should raise suspicion of a genetic etiology of aortic disease, and therefore, lower the threshold for performing a cardiovascular genetic evaluation.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Vascular Medicine, Aortic Surgery, Cardiac Surgery and CHD & Pediatrics, Cardiac Surgery and VHD, Congenital Heart Disease, CHD & Pediatrics and Interventions, Interventions and Structural Heart Disease, Interventions and Vascular Medicine

Keywords: Aneurysm, Dissecting, Aortic Aneurysm, Aortic Aneurysm, Thoracic, Aortic Rupture, Atherosclerosis, Cardiac Surgical Procedures, Heart Defects, Congenital, Heart Valve Diseases, Marfan Syndrome, Myocardial Infarction, Stroke, Vascular Diseases

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