OBJECTIVE

To determine the most significant predictors of accelerated distal aortic dilation.

MATERIAL AND METHODS

A retrospective cohort analysis of predictors of distal aortic dilation in patients who underwent surgical correction of acute aortic dissection type 1 was performed. Analysis included archival data of 41 patients who admitted for redo surgery due to aortic arch and descending thoracic aorta aneurysm between 2016 and 2024. All patients had patent false lumen. Baseline point was CT prior to the first surgery for ascending aortic dissection. The outcome was distal aortic aneurysm exceeding the reference values. Time interval between baseline CT and severe dilation ranged from 4 to 270 months. To standardize analysis, we stratified patients by a median of 59 months. Two subgroups were formed: early progression group — aortic dilation earlier than 59 months (n=19), slow progression group — dilation after 59 months (n=22). To identify possible predictors of dilation rate, we analyzed the following factors: age, Marfan syndrome, type 2 diabetes mellitus, smoking, arterial hypertension, chronic kidney disease, rhythm disturbances, chronic obstructive pulmonary disease, ischemic heart disease, body mass index >25 kg/m², proximal fenestration, distal fenestration, Bentall—DeBono surgery, ascending aortic replacement, warfarin intake, baseline aortic arch diameter >40 mm, intake of β-blockers.

RESULTS

Significant predictors were identified. In particular, young age, Marfan syndrome, proximal fenestration and intake of β-blockers had the most significant prognostic value.

CONCLUSION

In patients with patent false lumen after surgical correction of acute aortic dissection type 1, the key factors contributing to early distal dilation are young age, Marfan syndrome, proximal fenestration and no β-blocker therapy. Early detection of these factors is essential, since it allows not only predicting the risk of dilation progression, but also timely adjusting treatment strategy.