Surgical Strategy for Chronic Type B Dissecting Aortic Aneurysm to Prevent Aorta-Related Events

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Chronic type B aortic dissection presents complex management challenges.
• Evaluating surgical outcomes for chronic type B dissecting aortic aneurysm is crucial.

Purpose of the Study:

• To compare the outcomes of open surgical repair versus thoracic endovascular aortic repair (TEVAR) for chronic type B dissecting aortic aneurysm.
• To identify predictors of adverse events in patients undergoing repair for chronic type B aortic dissection.

Main Methods:

• A retrospective study of 52 patients with chronic type B dissecting aortic aneurysm treated between July 2004 and February 2019.
• Patients underwent either open repair (n=32) or TEVAR (n=20).
• Aorta replacement was limited to the aneurysmal portion; TEVAR involved stent graft deployment in the true lumen to cover the primary entry.

Main Results:

• No significant differences in operative mortality, morbidity, or spinal cord ischemia incidence between open and endovascular repair groups.
• Endovascular repair was independently associated with increased all-cause death (HR 5.7) and aorta-related events (HR 30.9).
• In the open repair group, a residual aortic diameter >41 mm predicted late aorta-related events.

Conclusions:

• Open repair is a preferable option compared to standalone endovascular repair for DeBakey IIIb dissection.
• A distal un-resected aortic portion exceeding 41 mm is linked to late aortic events, emphasizing the importance of complete aneurysm exclusion.