Effect of Medical and Surgical Therapy on Aortic Dissection Evaluated by

Background. Aortic dissection still has a poor prognosis despite progress in therapy. Therefore, this prospective follow-up study was designed to determine whether the degree of communication between true and false lumen in relation to the type of dissection, analyzed by transesophageal echocardiography, influences the risk after initiation of medical or surgical therapy. Methods and Results. In eight centers, 168 patients (124 men and 44 women) of age range of23-84 years with proven aortic dissection were examined by transesophageal echocardiography in the acute phase, after start of medical and/or surgical therapy, and during follow-up (0-65 months; mean, 10 months). Analyses were performed prospectively according to a detailed study protocol. Patients were subdivided by transesophageal echocardiography according to a modified DeBakey classification. Type I aortic dissection was found in 35%, typeII aortic dissection in 17%, and typem aortic dissection in 48%o. Preoperative mortality was 3%, 7%, and2%, and survival rates were 52%, 69%, and 70%/o, respectively. Typem aortic dissection could be subdivided into those with communication and antegrade dissection (ca) (50%v), with communication and retrograde dissection limited to the descending aorta (cr desc) (10%1), with dissection extended to the aortic arch and ascending aorta (cr asc) (27%), and withnoncommunicating (nc) aortic dissection (13%). An open false lumen with no thrombus formation was present in typesI,II,m ca andm cr asc aortic dissection in 17 % 21%1, 39%7, and 27 % respectively, although it was most pronounced in typesm nc andm cr desc (75 % and 78%o). Durin