Gill Heart Institute and the Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
James L. Januzzi
Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
The long-term approach to patients with successful initial treatment of acute aortic dissection is based on the understanding that such patients have a systemic illness that predisposes their entire aorta and potentially its larger branches to dissection, aneurysm, and rupture and that assiduous long-term follow-up for these patients is crucial. Systemic hypertension, advanced age, baseline aortic size, and presence of a patent false lumen are all factors that identify higher risk, as does the entire spectrum of the Marfan's syndrome1'2. All patients merit extremely aggressive medical therapy, follow-up visits, and serial imaging. Data suggest that nearly a third of patients surviving initial treatment for acute dissection will experience dissection extension or aortic rupture or will require surgery for aortic aneurysm formation within five years of presentation2. Furthermore, this risk is highest in the first few months after initial therapy. The cornerstones of optimal long-term therapy include adequate beta-blockade and additional therapies to achieve optimal blood pressure control and lipid-lowering therapy.
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