False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta-Analysis

Background: 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.

Methods and results: Eleven cohort studies (2924 participants) exploring the association between the false lumen status and long-term outcomes (>1 year) in AAD were included. All studies reported multivariate-adjusted hazard ratios (HRs) with 95% CIs for long-term outcomes, according to false lumen status. Pooled HRs for mortality and aortic events were computed and weighted using generic inverse-variance and random-effect modeling. 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).

Conclusions: 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.