Early Influence of Valve-Related Anticoagulation on False Lumen Thrombosis in Aortic Dissection Patients after Stented Elephant Trunk Surgery

BACKGROUND: Aim of the study was to assess the influence of anticoagulation on the false lumen after a stented elephant trunk procedure with mechanical valve replacement for aortic dissection patients. METHODS: Between 2003 and 2008, 181 out of 232 aortic dissection patients undergoing stented elephant trunk procedure concomitant with arch and/or proximal surgery were enrolled in this study. Fifty-five patients received an aortic valve replacement (AVR) with mechanical prosthesis. Patients were divided into two groups: with and without AVR. The aorta was evaluated by CT, and the diameter ratios between the true lumen and the aorta were calculated and the extent of thrombosis of the false lumen was quantified. RESULTS: Follow-up CT study at one year showed a significant difference between groups, mainly in the diameter ratios of the stent and aorta at the same level (P=0.003, at the stent end). Accordingly, CT data after hospital discharge differed significantly with regard to the extent of false lumen thrombosis at the carina level (P=0.020, at one year). Over one year after surgery, the residual false lumen around the stent-graft achieved complete thrombosis obliteration in 87.3% of patients with AVR and in 98.4% without AVR (P=0.005). CONCLUSIONS: Valve-related anticoagulation is associated with delay in false lumen thrombosis around the stent-graft.