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Contemporary outcomes of open repair of acute complicated type B aortic dissection

Christopher Lau1, Giovanni Jr Soletti1, Kendall M Lawrence2

  • 1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.

Journal of Vascular Surgery
|May 21, 2023
PubMed

Insights

Open repair for acute complicated type B aortic dissection (ACTBAD) is safe and effective, with outcomes comparable to elective repair. Transferring patients unsuitable for endovascular repair to experienced centers improves outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Aortic Disease
  • Aortic Dissection Repair

Background:

  • Open repair of acute complicated type B aortic dissection (ACTBAD) is historically a high-risk procedure.
  • Endovascular repair is not always feasible for ACTBAD, necessitating open surgical intervention.

Purpose of the Study:

  • To analyze the outcomes of open repair for ACTBAD.
  • To compare the high-risk ACTBAD cohort with a standard cohort undergoing thoracic or thoracoabdominal aortic aneurysm repair.
  • To identify factors associated with major adverse events (MAEs) in this patient population.

Main Methods:

  • Retrospective analysis of 926 patients undergoing descending thoracic or thoracoabdominal aortic aneurysm repair from 1997 to 2021.
  • Comparison of 75 patients with ACTBAD to 851 patients with other aortic conditions.
  • Logistic regression analysis for MAEs, with 5-year survival and reintervention rates calculated.

Main Results:

  • The incidence of MAEs (13.3% vs 13.7%) and operative mortality (5.3% vs 4.8%) were similar between ACTBAD and standard cohorts.
  • Complications included tracheostomy (8%), spinal cord ischemia (4%), and new dialysis (2.7%).
  • No significant difference in 5- and 10-year survival or 10-year reintervention rates between the groups.

Conclusions:

  • Open repair of ACTBAD at an experienced center can be performed with low mortality and morbidity.
  • Outcomes comparable to elective repair are achievable for high-risk ACTBAD patients.
  • Transfer to high-volume centers for open repair is recommended for patients unsuitable for endovascular treatment.
Abstract

Keywords:
Aortic dissectionAortic operationOutcomesType B dissection

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