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Multicenter Study
. 2019 Mar 19;8(6):e011943.
doi: 10.1161/JAHA.119.011943.

Thoracic Aortic Dissection in Tetralogy of Fallot: A Review of the National Inpatient Sample Database

Alexander C Egbe  1 , Juan Crestanello  2 , William R Miranda  1 , Heidi M Connolly  1
Affiliations
Multicenter Study

Thoracic Aortic Dissection in Tetralogy of Fallot: A Review of the National Inpatient Sample Database

Alexander C Egbe et al. J Am Heart Assoc. .

Abstract

Background Thoracic aortic aneurysm is common in patients with tetralogy of Fallot ( TOF ); the incidence of thoracic aortic dissection ( TAD ) is unknown, but generally considered to be uncommon. The purpose of this study was to determine incidence and risk factors for TAD in TOF patients. Methods and Results This work is a retrospective review of the National Inpatient Sample ( NIS ) database for cases of ascending TAD among all hospital admissions in adults with TOF , 2000-2014. Of 18 353 admissions in TOF patients, 11 (0.06%; 6 per 10 000 admissions) of these were TAD -related admissions. For the TAD -related admissions, mean age was 49.8±7.2 years; aortic surgical interventions were performed during 8 of the admissions, and overall in-hospital mortality was 45% (5 of 11). Risk factors associated with TAD -related admission were age >60 years (odds ratio, 2.41; 95% CI, 1.23-3.25; P=0.013), male sex ( odds ratio, 6.91; 95% CI, 4.85-8.54; P<0.001), and hypertension (odds ratio, 1.74; 95% CI, 1.06-3.19; P=0.037). Conclusions This is the first population-based study of TAD outcomes in patients with TOF , and it showed a low risk of TAD in this population. This has important clinical implication with regard to surveillance and surgical intervention. Given that prevalence of thoracic aortic aneurysm is higher in TOF patients compared with the general population; therefore, making clinical decisions based on outcomes data and practice guidelines derived from patients with degenerative and bicuspid aortic valve-related aortopathies may lead to overtreatment. Further studies are required to better understand the pathobiology of this disease in order to make evidence-based recommendations for surveillance and treatment.

Keywords: aortic aneurysm; tetralogy of Fallot; thoracic aortic dissection.

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Figures

Figure 1
Figure 1
Bar graph comparing incidence of TAD‐related admissions, per 10 000 admissions by sex (A) and age group (B). TAD indicates thoracic aortic dissection.
See this image and copyright information in PMC

References

    1. Ordovas KG, Keedy A, Naeger DM, Kallianos K, Foster E, Liu J, Saloner D, Hope MD. Dilatation of the ascending aorta is associated with presence of aortic regurgitation in patients after repair of tetralogy of Fallot. Int J Cardiovasc Imaging. 2016;32:1265–1272. - PMC - PubMed
    1. Dennis M, Laarkson M, Padang R, Tanous DJ, Robinson P, Pressley L, O'Meagher S, Celermajer D, Puranik R. Long term followup of aortic root size after repair of tetralogy of Fallot. Int J Cardiol. 2014;177:136–138. - PubMed
    1. Mongeon FP, Gurvitz MZ, Broberg CS, Aboulhosn J, Opotowsky AR, Kay JD, Valente AM, Earing MG, Lui GK, Fernandes SM, Gersony DR, Cook SC, Ting JG, Nickolaus MJ, Landzberg MJ, Khairy P; Alliance for Adult Research in Congenital Cardiology (AARCC). Aortic root dilatation in adults with surgically repaired tetralogy of fallot: a multicenter cross‐sectional study. Circulation. 2013;127:172–179. - PubMed
    1. Bonello B, Shore DF, Uebing A, Diller GP, Keegan J, Burman ED, Shiina Y, Swan L, Pennell DJ, Kilner PJ, Beurtheret S, Gatzoulis MA, Babu‐Narayan SV. Aortic dilatation in repaired tetralogy of Fallot. JACC Cardiovasc Imaging. 2018;11:150–152. - PubMed
    1. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55:e27–e129. - PubMed

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