Cluster analysis of acute ascending aortic dissection provides novel insight into mechanisms of distal progression

Whether primary tear size impacts extent of type A dissection is unclear. Using statistical groupings based on dissection morphology, we examined its relationship to primary tear area. We retrospectively reviewed 108 patients who underwent acute ascending dissection repair from 2000-2016. Dissection...

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Bibliographic Details
Published in:Journal of thoracic disease 2017-09, Vol.9 (9), p.2966-2973
Main Authors: Philip, Jennifer L, De Oliveira, Nilto C, Akhter, Shahab A, Rademacher, Brooks L, Goodavish, Christopher B, DiMusto, Paul D, Tang, Paul C
Format: Article
Language:English
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Summary:Whether primary tear size impacts extent of type A dissection is unclear. Using statistical groupings based on dissection morphology, we examined its relationship to primary tear area. We retrospectively reviewed 108 patients who underwent acute ascending dissection repair from 2000-2016. Dissection morphology was characterized using 3-dimensional (3D) reconstructions of computed tomography (CT) scan images. Two-step cluster analysis was performed to group the dissections by examining the true lumen area as a fraction of the total aortic area at various levels. Cluster analysis defined two distinct categories. This first grouping corresponds to DeBakey type I (n=71, 65.7%) with a dissection extending from the ascending aorta to the aortic bifurcation. The second grouping conforms more closely to DeBakey type II dissection (n=37, 34.3%). It differs however from the classic type II definition as the dissection may extend up to the distal arch from the ascending aorta. Compared to type I, this "extended" DeBakey type II had no malperfusion (P
ISSN:2072-1439
2077-6624
DOI:10.21037/jtd.2017.08.06