Outcomes of High Risk and Complicated Type B Aortic Dissections Treated with Thoracic Endovascular Aortic Repair

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Reporting standards for type B aortic dissection (TBAD) now define complicated (cTBAD) and high-risk (hrTBAD) features.
• Thoracic endovascular aortic repair (T-EVAR) is a treatment option for TBAD.

Purpose of the Study:

• To evaluate outcomes of T-EVAR for hrTBAD versus cTBAD using multi-institution data.
• To compare post-operative death, complications, and re-intervention rates between hrTBAD and cTBAD patients.

Main Methods:

• Retrospective review of 641 patients from the SVS VQI PAS data (2013-2023).
• Stratification into cTBAD (rupture, malperfusion) and hrTBAD (refractory pain/hypertension, large diameter).
• Uni- and multivariable analyses to compare outcomes.

Main Results:

• Demographics and comorbidities were similar; cTBAD patients had higher transfer rates and pre-op creatinine.
• Post-operative complications were more frequent in the cTBAD group.
• Kaplan-Meier analysis showed lower 30-day, 1-year, and 5-year survival in cTBAD patients, with no difference in re-intervention.

Conclusions:

• T-EVAR yields poorer peri-operative and long-term outcomes for cTBAD compared to hrTBAD.
• Additional research is required to clarify T-EVAR's long-term benefits for hrTBAD.