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Outcomes of Patients with Acute Type B Aortic Dissection and High-Risk Features
Jonathan R Krebs1, Amanda C Filiberto1, Brian Fazzone1
1Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL.
Annals of Vascular Surgery
|April 4, 2024
Summary
High-risk features are common in acute type B aortic dissections (TBAD). Patients with high-risk TBAD managed with thoracic endovascular aortic repair (TEVAR) showed improved outcomes compared to those with complicated TBAD undergoing TEVAR.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Contemporary guidelines define complicated, uncomplicated, and high-risk acute type B aortic dissections (TBAD).
- Few studies have evaluated outcomes specifically for high-risk TBAD.
- This study assesses outcomes for high-risk TBAD managed with thoracic endovascular aortic repair (TEVAR) versus best medical management.
Purpose of the Study:
- To compare demographics, clinical presentation, and outcomes of high-risk TBAD patients treated with TEVAR or medical management.
- To compare these outcomes against patients with complicated and uncomplicated TBAD.
- To evaluate the impact of high-risk features on TBAD management and patient outcomes.
Main Methods:
- Analysis of 159 acute TBAD patients from October 2011 to March 2020.
- Classification into high-risk, complicated (C-TBAD), and uncomplicated TBAD groups based on STS/SVS 2020 guidelines.
- Primary endpoint: inpatient mortality; Secondary endpoints: complications, reintervention, and survival.
Main Results:
- 63% of patients met high-risk criteria; 40% had C-TBAD; 33 had uncomplicated TBAD.
- C-TBAD patients had longer hospital stays and shorter time to repair than HR-TEVAR.
- 3-year survival was worse for C-TBAD, but similar across groups excluding in-hospital mortality.
Conclusions:
- High-risk features are prevalent in acute TBAD, necessitating careful management.
- Both surgical (TEVAR) and medical management yielded acceptable outcomes for high-risk TBAD.
- TEVAR for high-risk TBAD demonstrated improved perioperative outcomes and mortality compared to TEVAR for C-TBAD.
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