Related Experiment Video
Updated: May 8, 2026
A New Murine Model of Endovascular Aortic Aneurysm Repair
Published on: July 7, 2013
Mid- and long-term results of open repair for chronic type B aortic dissection in endovascular era
Akitoshi Takazawa1, Toshihisa Asakura2, Osamu Kinoshita2
1Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama, Japan. a.takazawa.cvs@gmail.com.
Insights
Open surgical repair (OSR) offers better mid- and long-term outcomes for chronic type B aortic dissection (CTBAD) compared to thoracic endovascular repair (TEVAR). Despite OSR
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Medical management is standard for chronic type B aortic dissection (CTBAD).
- The comparative efficacy of open surgical repair (OSR) and thoracic endovascular repair (TEVAR) for CTBAD remains debated.
- This study evaluates mid- and long-term outcomes of OSR versus TEVAR in CTBAD patients.
Purpose of the Study:
- To compare the mid- and long-term clinical outcomes of OSR via left thoracotomy with TEVAR for CTBAD.
- To assess survival rates, aorta-related deaths, and re-intervention rates between the two surgical approaches.
Main Methods:
- Retrospective review of 85 consecutive CTBAD patients undergoing OSR (n=33) or TEVAR (n=52) from April 2007 to May 2021.
- Analysis of preoperative and postoperative computed tomography (CT) scans for maximum aortic and false lumen diameters.
- Mean follow-up duration of 5.8 years, evaluating complications, survival, aorta-related deaths, and re-interventions.
Main Results:
- No operative mortality; similar rates of stroke, paraplegia, and respiratory failure between groups.
- Significant differences in preoperative factors: OSR patients had longer intervals from onset to operation and larger aortic diameters.
- No significant differences in mid- to long-term survival, aorta-related deaths, or re-intervention rates overall; however, TEVAR group experienced severe postoperative complications (e.g., fistula, type A dissection), and outcomes reversed after seven years, favoring OSR.
Conclusions:
- While TEVAR is less invasive, its mid- and long-term re-intervention freedom was unsatisfactory, with fatal complications observed.
- OSR, despite being invasive, demonstrated safer perioperative outcomes and more favorable mid- and long-term results compared to TEVAR.
- OSR may be a more suitable option for achieving better long-term outcomes in select CTBAD patients.
Abstract:
Medical management is the standard treatment of chronic type B aortic dissection (CTBAD). However, the roles of open surgical repair (OSR) and thoracic endovascular repair (TEVAR) in patients with CTBAD remain controversial. Thus, this study aimed to assess and compare the mid- and long-term clinical outcomes of OSR via left thoracotomy with that of TEVAR for CTBAD. The data of 85 consecutive patients who underwent surgery for CTBAD from April 2007 to May 2021 were retrospectively reviewed. The patients were divided into two groups: Group G, which included patients who underwent OSR, and Group E, which included patients who underwent TEVAR. Groups G and E comprised 33 and 52 patients, respectively. Preoperative and postoperative computed tomography (CT) studies were retrospectively analyzed for the maximum diameter. The mean duration of the follow-up period was 5.8 years. Operative mortality did not occur. There was no difference in complications, such as stroke (G: 2 vs. E: 0, p = 0.30), paraplegia (G: 1 vs. E: 1, p = 0.66), and respiratory failure (G: 2, vs. E: 0, p = 0.30). The difference in preoperative factors was observed, including the intervals between onset and operation (G; 4.9 years vs. E; 1.9 years, p < 0.01), maximum diameter in preoperative CT (G; 59.0 mm vs. E; 50.5 mm, p < 0.001), and maximum false lumen diameter (G; 35.5 mm vs. E; 29.0 mm, p < 0.01). There was no significant difference in the mid- and long-term survival rates (p = 0.49), aorta-related deaths (p = 0.33), and thoracic re-intervention rates (p = 0.34). Postoperative adverse events occurred in Group E: four cases of retrospective type A aortic dissection, two cases of aorto-bronchial fistula, and one case of aorto-esophagus fistula. Aorta-related death and re-intervention rates crossed over in both groups after seven years postoperatively. Although endovascular repair of CTBAD is less invasive, the rate of freedom from re-intervention was unsatisfactory. Some fatal complications were observed in the endovascular group, and the mid- and long-term outcomes were reversed compared with those in the OSR group. Although OSR is an invasive procedure, it could be performed safely without perioperative complications. OSR has more feasible mid- and long-term outcomes.
