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Surgical treatment in the chronic phase for uncomplicated Stanford type B aortic dissection
Akihito Matsushita1,2, Minoru Tabata3, Takashi Hattori2
1Department of Cardiovascular Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
Insights
For chronic uncomplicated type B aortic dissection, surgical approach (TEVAR, open repair, or medication) did not impact mortality. However, aortic diameter ≥ 55 mm was a significant predictor of increased mortality.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Disease
Background:
- The optimal management strategy for chronic uncomplicated type B aortic dissection (UTBAD) requiring intervention is debated.
- This study investigates outcomes in UTBAD patients undergoing aortic treatment, considering treatment modality and indication criteria.
Purpose of the Study:
- To evaluate the impact of treatment methods (TEVAR, open repair, medication) on mortality in chronic UTBAD patients.
- To assess the influence of specific indication criteria on prognosis in UTBAD.
Main Methods:
- Retrospective review of 106 UTBAD patients (2004-2021) divided into TEVAR, open repair, and medication groups.
- Aortic events defined by late operation, diameter ≥ 55 mm, rapid enlargement, or saccular aneurysm.
- Cox regression analysis used to assess mortality predictors.
Main Results:
- Five-year mortality rates were 27.1% (TEVAR), 19.6% (open repair), and 38.4% (medication), with no significant difference (p=0.86).
- Patients with aortic diameter ≥ 55 mm had significantly higher 5-year mortality (41.2% vs. 18.7%, p<0.01).
- Multivariable analysis identified aortic diameter ≥ 55 mm (HR 2.88) and age (HR 1.09) as significant mortality predictors.
Conclusions:
- Current surgical indication criteria for UTBAD do not differentiate mortality risk between TEVAR, open repair, and medication management.
- Aortic diameter ≥ 55 mm is a critical factor associated with increased mortality in UTBAD patients.
Background:
The most appropriate surgical method for patients with uncomplicated type B aortic dissection (UTBAD) in the chronic phase remains controversial. This study evaluated the outcomes of patients with UTBAD who needed aortic treatment as well as the impact of the treatment method or indication criteria on their prognosis.
Methods:
This retrospective review of 106 consecutive patients with aortic events in the chronic phase who underwent initial treatment for UTBAD between 2004 and 2021 comprised three groups: 19 patients who underwent endovascular repair (TEVAR), 38 who underwent open aortic repair and the medication group that included 49 patients. Aortic events were defined as a late operation or indication for operation for dissected aorta, aortic diameter (AD) ≥ 55 mm, rapid aortic enlargement (≥5 mm/6 months), and saccular aneurysmal change. The endpoint was all-cause death. We assessed the association between treatment methods or surgical indication criteria and mortality using a Cox regression analysis.
Results:
The 5-year actuarial mortality rates were 27.1% in the TEVAR group, 19.6% in the open aortic repair group, and 38.4% in the medication group (p = 0.86). Moreover, the 5-year actuarial mortality rates in patients who had AD ≥ 55 mm were significantly higher than those patients with other surgical indication criteria (41.2% vs. 18.7%, p < 0.01). Multivariable analysis revealed a significant difference in AD ≥ 55 mm (hazard ratio [HR]: 2.88, 95% confidence interval [CI] 1.38-6.02, p < 0.01) and age (HR: 1.09, 95% CI 1.05-1.13, p < 0.01).
Conclusions:
Under the existing surgical indication criteria, there was no difference in mortality rates among patients with UTBAD based on their surgical treatment.
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