Management of Descending Thoracic Aortic Diseases: Similarities and Differences Among Cardiovascular Guidelines

Σπανός, Κωνσταντίνος; Nana, Petroula; Behrendt, Christian‐Alexander; Kouvelos, George; Panuccio, Giuseppe; Heidemann, Franziska; Matsagkas, Miltiadis; Debus, Eike Sebastian; Giannoukas, Athanasios D.; Kölbel, Tilo

doi:10.1177/1526602820987808

Cited by 21 publications

(19 citation statements)

References 34 publications

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“…Since 1999, endovascular stent–graft was introduced as a novel treatment option for patients with type B aortic dissection (TBAD) by Dake et al ( 1 ) and Nienaber et al ( 2 ), and it has now become the first choice for the treatment of acute complicated TBAD (cTBAD) according to recent guidelines ( 3 – 5 ). Uncomplicated TBAD (uTBAD) was historically managed medically with anti-impulse and anti-hypertensive therapy ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Acute or Subacute, the Optimal Timing for Uncomplicated Type B Aortic Dissection: A Systematic Review and Meta-Analysis

et al. 2022

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ObjectiveTo evaluate the optimal timing (acute or subacute) of thoracic endovascular aortic repair (TEVAR) for uncomplicated B aortic dissection (uTBAD) through a systematic review and meta-analysis.MethodA comprehensive literature search was undertaken across three major databases (EMBASE/Medline, PubMed, and Cochrane Library) and was assessed until November 2021 to identify studies reporting the outcomes of TEVAR utilized to treat patients with uTBAD. The continuous variables were compared between the two groups using t-test and the categorical variables were compared using the χ2-test. A meta-analysis was used to produce pooled odds ratios for early and follow-up outcomes. The random effects models were applied. A statistical analysis was performed using R software v.4.1.ResultA comprehensive literature search found 490 citations published within the predetermined time span of the analysis. Three studies including 1,193 patients (acute group 718, subacute group 475) were finally included for downstream meta-analysis. An acute uTBAD group presented with higher rates both in 30-day complications (20.5 vs. 13.7%; p = 0.014) and mortality (4.6 vs. 1.3%; p = 0.004) than subacute group. The respiratory complications were significantly higher in the acute group than in the subacute group (10.8 vs. 5.0%; p = 0.015). The procedure success rate (90.8 vs. 93.6%; p = 0.329), the follow-up mortality (7.7 vs. 7.6%; p = 1) and dissection-related late mortality (3.9 vs. 5.3%; p = 0.603) showed no significant difference.ConclusionOur meta-analysis suggested that despite significantly higher 30-day complications and 30-day mortality in the acute uTBAD group, there was no significant difference in the follow-up mortality between the two groups.Systematic Review RegistrationPROSPERO, identifier: CRD42021247609.

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Section: Introductionmentioning

confidence: 99%

Acute or Subacute, the Optimal Timing for Uncomplicated Type B Aortic Dissection: A Systematic Review and Meta-Analysis

et al. 2022

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“…Several studies have validated the surveillance of these morphologic characteristics as significant predictors of outcomes in TBAD 16,17,27,44 . Whilst there is evidence suggesting pre‐emptive TEVAR in patients with un‐TBAD, 5,45 assessment of aortic remodeling is vital in monitoring the postprocedural course of the dissection process and predicting outcomes 46,47 …”

Section: Late Outcomes (>30 Days)mentioning

confidence: 99%

Mid‐ and long‐term outcomes of thoracic endovascular aortic repair in acute and subacute uncomplicated type B aortic dissection

Jubouri

Al‐Tawil

Yip

et al. 2022

Journal of Cardiac Surgery

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Background Uncomplicated type B aortic dissection (un‐TBAD) has been managed conservatively with medical therapy to control the heart rate and blood pressure to limit disease progression, in addition to radiological follow‐up. However, several trials and observational studies have investigated the use of thoracic endovascular aortic repair (TEVAR) in un‐TBAD and suggested that TEVAR provides a survival benefit over medical therapy. Outcomes of TEVAR have also been linked with the timing of intervention. Aims The scope of this review is to collate and summarize all the evidence in the literature on the mid‐ and long‐term outcomes of TEVAR in un‐TBAD, confirming its superiority. We also aimed to investigate the relationship between the timing of TEVAR intervention and results. Methods We carried out a comprehensive literature search on multiple electronic databases including PubMed, Scopus, and EMBASE to collate and summarize all research evidence on the mid‐ and long‐term outcomes of TEVAR in un‐TBAD, as well as its relationship with intervention timing. Results TEVAR has proven to be a safe and effective tool in un‐TBAD, offering superior mid‐ and long‐term outcomes including all‐cause and aorta‐related mortality, aortic‐specific adverse events, aortic remodeling, and need for reintervention. Additionally, performing TEVAR during the subacute phase of dissection seems to yield optimal results. Conclusion The evidence demonstrating a survival advantage in favor TEVAR over medical therapy in un‐TBAD means that with further research, particular trials and observational studies, TEVAR could become the gold‐standard treatment option for un‐TBAD patients.

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“…Several studies have validated the surveillance of these morphologic characteristics as significant predictors of outcomes in TBAD [16,17,27,44]. Whilst there is evidence suggesting pre-emptive TEVAR in patients with un-TBAD [5,45], assessment of aortic remodelling is vital in monitoring the post-procedural course of the dissection process and predicting outcomes [46,47].…”

Section: Aortic Remodellingmentioning

confidence: 99%

Mid- and long-term outcomes of thoracic endovascular aortic repair in acute and subacute uncomplicated type B aortic dissection

Jubouri

Al-Tawil

Yip

et al. 2022

Preprint

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Background: Uncomplicated type B aortic dissection (un-TBAD) has been managed conservatively with medical therapy in order to control the heart rate and blood pressure to limit disease progression, in addition to radiological follow-up. However, several trials and observational studies have investigated the use of thoracic endovascular aortic repair (TEVAR) in un-TBAD and suggested that TEVAR provides a survival benefit over medical therapy. Outcomes of TEVAR have also been linked with the timing of intervention. Aims: The scope of this review is to collate and summarise all the evidence in the literature on the mid- and long-term outcomes of TEVAR in un-TBAD, confirming its superiority. We also aimed to investigate the relationship between timing of TEVAR intervention and results. Methods: We carried out a comprehensive literature search on multiple electronic databases including PubMed, Scopus and EMBASE in order to collate and summarise all research evidence on the mid- and long-term outcomes of TEVAR in un-TBAD, as well as its relationship with intervention timing. Results: TEVAR has proven to be a safe and effective tool in un-TBAD, offering superior mid- and long-term outcomes including all-cause and aorta-related mortality, aortic-specific adverse events, aortic remodelling, and need for reintervention. Additionally, performing TEVAR during the subacute phase of dissection seems to yield optimal results. Conclusion: The evidence demonstrating a survival advantage in favour TEVAR over medical therapy in un-TBAD means that with further research, particular trials and observational studies, TEVAR could become the gold-standard treatment option for un-TBAD patients.

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Management of Descending Thoracic Aortic Diseases: Similarities and Differences Among Cardiovascular Guidelines

Cited by 21 publications

References 34 publications

Acute or Subacute, the Optimal Timing for Uncomplicated Type B Aortic Dissection: A Systematic Review and Meta-Analysis

Acute or Subacute, the Optimal Timing for Uncomplicated Type B Aortic Dissection: A Systematic Review and Meta-Analysis

Mid‐ and long‐term outcomes of thoracic endovascular aortic repair in acute and subacute uncomplicated type B aortic dissection

Mid- and long-term outcomes of thoracic endovascular aortic repair in acute and subacute uncomplicated type B aortic dissection

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