Current management of acute type B dissection in 2021

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• The management of type B aortic dissection varies by disease phase: acute complicated, subacute/early chronic (requiring preemptive TEVAR), and chronic (preventing dilatation/rupture).
• Thoracic endovascular aortic repair (TEVAR) has demonstrated low operative mortality and morbidity in complicated acute type B aortic dissection, with improved midterm survival.
• A new reporting standard classifies retrograde type A dissection as type B0,X (X>3), a condition amenable to less invasive TEVAR.

Purpose of the Study:

• To evaluate the efficacy and expanding indications of TEVAR for type B aortic dissection.
• To assess the role of TEVAR in different disease phases and specific subtypes like retrograde type A dissection.

Main Methods:

• Review of existing literature and clinical data on TEVAR for type B aortic dissection.
• Analysis of outcomes, including mortality, morbidity, and survival, associated with TEVAR across disease phases.
• Evaluation of the application of TEVAR for type B0,X dissections.

Main Results:

• TEVAR shows low operative risks and improved midterm survival for complicated acute type B aortic dissection.
• TEVAR is considered a primary and potentially sole effective strategy for acute type B dissection.
• The use of TEVAR for type B0,X dissections has been validated, demonstrating less invasiveness.

Conclusions:

• TEVAR is a validated and effective treatment for type B aortic dissection, particularly in the acute phase.
• The indications for TEVAR are expanding, including its use in type B0,X dissections.
• TEVAR offers a less invasive approach with favorable outcomes for specific aortic dissection presentations.