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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.
Plos One
|February 23, 2024
Summary
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.
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