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Selective management of acute type B aortic dissection: long-term follow-up
J S Schor1, M E Yerlioglu, J D Galla
1Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York, USA.
Insights
Selective management of acute type B aortic dissection shows good survival rates. Early surgery is not necessary and does not impact long-term outcomes for these aortic dissections.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Selective management of acute type B aortic dissections since 1985.
- Initial treatment focused on lowering blood pressure and heart rate.
- Diagnosis and follow-up utilized transesophageal echocardiography and CT scans.
Purpose of the Study:
- To evaluate the outcomes of selective management for acute type B aortic dissections.
- To compare the results of early surgical intervention versus nonoperative treatment.
- To assess the impact of management strategy on short-term and long-term survival.
Main Methods:
- Retrospective review of consecutive patients admitted over a 10-year period (August 1985 - May 1995).
- Patients were categorized into operative (group 1) and nonoperative (group 2) groups.
- Data analysis included survival rates, mortality, paraplegia, and need for late intervention.
Main Results:
- 68 patients were evaluated; 3 died during initial assessment.
- 17 patients underwent surgery (group 1) with no mortality or paraplegia.
- 47 of 48 nonoperatively treated patients (group 2) were discharged; 1 died of rupture.
- Actuarial survival at 1 and 5 years was 92% and 82% for all patients.
- Survival rates and need for late intervention showed no significant differences between groups.
Conclusions:
- Selective management of acute type B aortic dissection yields acceptable short-term and long-term survival.
- Avoiding early operation does not negatively affect late results.
- This approach offers a viable alternative to immediate surgical intervention.
Background:
Since 1985, we have selectively treated acute type B aortic dissections. Initial treatment lowered blood pressure and heart rate. Transesophageal echocardiography and computed tomographic scans were used to diagnose and follow up the patients. Patients were operated on for organ ischemia, pain, hypertension, or increasing subpleural fluid on computed tomographic scan.
Methods:
We retrospectively reviewed consecutive patients admitted over a 10-year period to the Mt. Sinai Hospital.
Results:
From August 1985 to May 1995, 68 patients were seen. Three died soon after admission during initial diagnostic evaluation. Seventeen patients underwent operation without mortality or paraplegia (group 1). Forty-seven of 48 patients treated nonoperatively were discharged; 1 patient died of rupture on day 7 (group 2). Actuarial survival for all 68 patients at 1 and 5 years was 92% +/- 4% and 82% +/- 8%. Group 1 survival was 93% +/- 4% and 68% +/- 5%, and group 2 survival was 90% +/- 6% and 87% +/-14%. There were no differences between groups. Late intervention was required in 2 group 1 patients (12%) and in 12 of 48 group 2 patients (25%), again without mortality or paraplegia.
Conclusions:
This experience suggests that selective management of acute type B aortic dissection results in acceptable short-term and long-term survival. Avoiding early operation did not compromise late results.