Clinical Profiles and Outcomes of Acute Type B Aortic Dissection in the Current Era: Lessons From the International Registry of Aortic Dissection (IRAD)

Abstract

Background-Clinical profiles and outcomes of patients with acute type B aortic dissection have not been evaluated in the current era. Methods and Results-Accordingly, we analyzed 384 patients (65Ϯ13 years, males 71%) with acute type B aortic dissection enrolled in the International Registry of Acute Aortic Dissection (IRAD). A majority of patients had hypertension and presented with acute chest/back pain. Only one-half showed abnormal findings on chest radiograph, and almost all patients had computerized tomography (CT), transesophageal echocardiography, magnetic resonance imaging (MRI), and/or aortogram to confirm the diagnosis. In-hospital mortality was 13% with most deaths occurring within the first week. Factors associated with increased in-hospital mortality on univariate analysis were hypotension/ shock, widened mediastinum, periaortic hematoma, excessively dilated aorta (Ն6 cm), in-hospital complications of coma/altered consciousness, mesenteric/limb ischemia, acute renal failure, and surgical management (all PϽ0.05). A risk prediction model with control for age and gender showed hypotension/shock (odds ratio [OR] 23.8, PϽ0.0001), absence of chest/back pain on presentation (OR 3.5, Pϭ0.01), and branch vessel involvement (OR 2.9, Pϭ0.02), collectively named 'the deadly triad' to be independent predictors of in-hospital death. Conclusions-Our study provides insight into current-day profiles and outcomes of acute type B aortic dissection. Factors associated with increased in-hospital mortality ("the deadly triad") should be identified and taken into consideration for risk stratification and decision-making.

Prevention of Aortic Dissection Suggests a Diameter Shift to a Lower Aortic Size Threshold for Intervention

“…type B, AADB), if uncomplicated, are primarily treated medically. Despite good early outcomes under optimal medical therapy [23,24,25], only 3 out of 4 patients survive the first 5 years [26]. Hence, prevention of such a dissection is essential.…”

Dissecção aórtica de tipo B de Stanford: relato de caso e revisão de literatura

“…The most important examinations, in descending order, are: computed tomography angiography (CTA), magnetic resonance imaging (MRI), transesophageal echocardiogram (TEE), and arteriography. 15 Computed tomography angiography with contrast is a rapid method that is viable in the majority of emergency centers, offering sensitivity of up to 95% and specificity of 85-95%. 10 In turn, MRI offers approximately 100% sensitivity and specificity and does not need intravenous contrast or exposure to radiation, 16 while TEE is primarily used in relation to type A dissection cases, with the capacity to identify involvement of coronary arteries, cardiac tamponade, and aortic insufficiency.…”

“…It is preferable to delay surgery until the patient has been stabilized, since mortality is as high as 34% when surgical treatment is initiated during the acute phase. 15,18 Endovascular techniques are preferred to open methods because morbidity is lower 19 , and endovascular fenestrations can be used to provide communication between the false and true lumens, to depressurize the false lumen. Placement of a stent increases stability of the artery and facilitates blood flow through the true lumen, considerably reducing the complications caused by dissection.…”

New Paradigms in the Treatment of Acute Complicated and Uncomplicated Type B Aortic Dissection

“…Advocates of TEVAR for acute uncomplicated type B dissections cite a 25-50% risk of progression of aortic disease, 8,10,17,24 a still unacceptably high rate of short-and long-term mortality 25 and favorable aortic remodeling that can occur with TEVAR. [26][27][28] For this reason, several studies have been conducted examining this specific issue.…”