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Complicated acute type B aortic dissection: update on management and results
Eric Y Pruitt1, Salvatore T Scali2, Dean J Arnaoutakis1
1Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA.
The Journal of Cardiovascular Surgery
|September 23, 2020
Summary
Outcomes for thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection (acTBAD) have improved over time, showing decreased mortality and complications. Survival rates significantly increased, underscoring advancements in TEVAR management.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Thoracic endovascular aortic repair (TEVAR) is a primary treatment for acute complicated type B aortic dissection (acTBAD).
- Unresolved issues include optimal timing, graft selection, and adjunctive therapies for TEVAR in acTBAD.
- A contemporary perspective on TEVAR management and outcomes for acTBAD is needed.
Purpose of the Study:
- To provide a contemporary perspective on the management and results of TEVAR for acTBAD.
- To analyze outcomes based on time-dependent cohorts.
- To highlight evolving practices and outcomes in TEVAR for acTBAD.
Main Methods:
- Analysis of 159 patients with acTBAD who underwent TEVAR at a high-volume academic medical center.
- Comparative analysis across three time-dependent cohorts: 2005-2009 (n=43), 2010-2014 (n=56), and 2015-2020 (n=60).
Main Results:
- 30-day mortality showed a trend towards improvement (18% vs. 12%; P=0.1), and postoperative complications decreased significantly (70% vs. 36%; P-trend=0.08).
- One and 5-year survival significantly improved over time (P<0.001), while freedom from aorta-related reintervention and mortality remained stable.
- One-year survival was 75±3% and 5-year survival was 64±7%.
Conclusions:
- Outcomes for TEVAR in acTBAD patients have progressively improved.
- Increased experience, technological advancements, and evidence maturation contribute to better results.
- This study updates the understanding of TEVAR for acTBAD, addressing persistent clinical challenges.
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