Open surgical repair for chronic type B aortic dissection: a systematic review

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Chronic type B aortic dissection (CBAD) treatment is complex.
• Thoracic endovascular aortic repair (TEVAR) is now preferred over open surgical repair (OSR) for CBAD.
• Long-term outcomes of TEVAR are less understood than OSR, prompting a review of modern OSR techniques.

Purpose of the Study:

• To systematically review and assess the short- and long-term outcomes of OSR for CBAD.
• To compare outcomes between historic and contemporary OSR series.
• To evaluate OSR as a potential alternative to TEVAR for CBAD.

Main Methods:

• Systematic review of six databases from inception to March 2014.
• Included studies focused on OSR for chronic type B dissection.
• Studies were categorized into pre-endovascular (historic) and endovascular (contemporary) eras based on the year 1999.

Main Results:

• Nineteen studies were analyzed; pooled short-term mortality was 11.1% overall and 7.5% in contemporary series.
• Contemporary OSR showed complication rates including stroke (5.9%), spinal cord ischemia (4.9%), renal dysfunction (8.1%), and reoperation for bleeding (8.1%).
• Late reintervention occurred in 13.3% overall and 11.3% in contemporary series, with survival rates at 1, 3, 5, and 10 years at 82.1%, 74.1%, 66.3%, and 50.8% respectively.

Conclusions:

• Contemporary OSR for CBAD yields acceptable results.
• Management decisions require careful consideration of both short- and long-term complications.
• Further research is needed to define optimal indications for OSR versus TEVAR in CBAD.