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The long-term association between the status of the false lumen and poor patient outcomes in acute aortic dissection (AAD) remains unclear. This systematic review and meta-analysis investigated whether the status of the false lumen was a predictor of poor long-term survival in AAD.
The PubMed, Embase and Cochrane electronic databases were searched to identify relative studies exploring the association between status of false lumen and long-term outcomes (> 1year) in AAD, published up to December 2015. Studies were included if they reported multivariate-adjusted hazard ratio (HRs) with 95% CIs of long-term outcomes from different status of false lumen. Pooled HRs for mortality and aortic events were computed and weighted using generic inverse-variance and random-effect modeling.
Eleven cohort studies (2924 participants) exploring the association between the false lumen status and long-term outcomes (> 1 year) in AAD were included. Residual patent false lumen was an independent predictor of long-term mortality in AAD type A (HR, 1.71; 95% CI, 1.16-2.52; P = 0.007) and type B (HR, 2.79; 95% CI, 1.80-4.32; P < 0.001). AAD patients with residual patent false lumen exhibited an increased risk of aortic events (HR, 5.43; 95% CI, 2.95-9.99; P < 0.001). Partial false lumen thrombosis was independently associated with long-term mortality in type B AAD (HR, 2.24, 95% CI, 1.37-3.65; P = 0.001). This association was not observed in AAD type A patients (HR, 1.75; 95% CI, 0.88-3.45; P = 0.211).
The false lumen status influences late outcomes in AAD. Residual patent false lumen is independently associated with poor long-term survival in AAD. However, only type B AAD patients with partial false lumen thrombosis had an increased late mortality risk.