Initial Thoracic Endovascular Aortic Repair vs Medical Therapy for Acute Uncomplicated Type B Aortic Dissection

Area of Science:

• Cardiovascular Surgery
• Vascular Medicine
• Health Services Research

Background:

• Thoracic endovascular aortic repair (TEVAR) is increasingly used for uncomplicated type B aortic dissection (uTBAD).
• Limited data exist comparing TEVAR to medical therapy alone for uTBAD.

Purpose of the Study:

• To assess if initial TEVAR for uTBAD reduces mortality or morbidity compared to medical therapy.
• To evaluate outcomes including all-cause mortality, cardiovascular hospitalizations, and aorta-related events.

Main Methods:

• A cohort study using Centers for Medicare & Medicaid Services inpatient claims data (2011-2019).
• Included adults aged 65+ with acute uTBAD, comparing initial TEVAR (within 30 days) to medical therapy.
• Propensity score inverse probability weighting was used to adjust for confounders.

Main Results:

• 16.0% of 7105 patients underwent initial TEVAR.
• After weighting, no significant differences in mortality, aorta-related hospitalizations, or interventions were observed up to 5 years.
• A sensitivity analysis including early deaths showed lower mortality with initial TEVAR at 1, 2, and 5 years.

Conclusions:

• Initial TEVAR for uTBAD was not associated with improved long-term mortality or reduced hospitalizations in the primary analysis.
• A trend towards lower mortality with TEVAR was observed when early deaths were considered.
• Prospective trials are needed to confirm findings and assess cost-effectiveness and quality of life.