Aortic enlargement in two weeks is associated with subsequent aortic events in patients with type B acute aortic syndrome

Objectives: To determine whether aortic enlargement in 2 weeks in patients with type B acute aortic syndrome is associated with aorta-related adverse events.Methods: This retrospective, single-center study included 183 patients who were diagnosed with uncomplicated type B acute aortic syndrome (classic aortic dissec-tion and intramural hematoma) between 2010 and 2019 and had follow-up computed tomography at second or third week. Aortic diameter was measured at admission and at predischarge follow-up. Aorta-related adverse events were defined by a composite of aortic rupture, surgical or endovascular aortic repair, re-dissection, severe intestinal malperfusion, and aortic enlargement.Results: The patients whose aortic diameter enlarged >2 mm but<5 mm in 2 weeks were categorized as moderate aortic enlargement group. During follow-up, 51 pa-tients (28%) had aorta-related adverse events and 36 patients (20%) had moder-ate aortic enlargement. Patients with moderate aortic enlargement showed lower aorta-related event-free survival rates than those without moderate enlargement (48 + 9% vs 90 + 3% at 1 year, P < .001). On multivariable analysis, moderate aortic enlargement (subhazard ratio, 3.64; 95% confidence interval, 2.08-6.35; P < .001) and aortic diameter >40 mm at admission (subhazard ratio, 2.96; 95% confidence interval, 1.60-5.48; P <.001) were associated with aorta-related adverse events. Conclusions: Moderate aortic enlargement in 2 weeks is a significant risk factor of aorta-related adverse events in patients with uncomplicated type B acute aortic syndrome. Patients with moderate aortic enlargement should be followed up care-fully and may be candidates for subsequent endovascular treatment. (J Thorac Car-diovasc Surg 2023;166:410-8)