Optimal treatment for patients with chronic Stanford type B aortic dissection: endovascularly, surgically or both?†

Nozdrzykowski, Michal; Etz, Christian D.; Luehr, Maximilian; Garbade, Jens; Misfeld, Martín; Borger, Michael A.; Mohr, Friedrich–Wilhelm

doi:10.1093/ejcts/ezt291

Cited by 50 publications

(30 citation statements)

References 27 publications

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“…After excluding records based on abstract, 225 full-text articles were assessed according to the inclusion and exclusion criteria. Nineteen relevant studies were included in the present review (2,(14)(15)(16)(17)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36).…”

Section: Quantity and Quality Of Evidencementioning

confidence: 99%

“…Overall, 76.5% of patients were male, with a weighted mean age of 57.9 years. Eighty-six percent of patients were hypertensive (2,17,23,25,30,31,(33)(34)(35)(36), 0-24% of patients had a history of stroke, while 0-33% of patients had pulmonary disease and 11.0% had renal dysfunction (2,16,17,23,28,30,31,(33)(34)(35)(36). Marfan syndrome was present in 12.0% of patients (2,17,23,26,28,(30)(31)(32)(33)35,36).…”

Section: Demographic and Operative Techniquesmentioning

confidence: 99%

“…Surgical indication for the majority of cases included aneurysms ≥50 mm (27,34), >55 mm (30), >60 mm (26), unspecified growth rate or dilation limit (14,15,23,28,31,35), malperfusion (15,28,31,34,35), presence of symptoms (14,23,27,28,31,34,35), or rupture (26,31,35) (Table 3). Nine studies did not specify indications for surgery (2,16,17,24,25,29,32,33,36).…”

Section: Demographic and Operative Techniquesmentioning

confidence: 99%

“…Nine studies did not specify indications for surgery (2,16,17,24,25,29,32,33,36). In series from institutions that also reportedly performed TEVAR, indications for open repair included extensive involvement of the aorta (33,35) or connective tissue disease (35). Another study indicated that TEVAR was only a 'complication-specific' indication (28).…”

Section: Demographic and Operative Techniquesmentioning

confidence: 99%

“…Individual patient survival data of 458 patients was reconstructed from the Kaplan-Meier survival curves of 7 studies (26,(28)(29)(30)(31)33,35). Analysis of this data using Kaplan-Meier methods demonstrate 1-, 2-, 3-, 5-, and 10-year survival of 82.1%, 77.1%, 74.1%, 66.3%, 50.8%, respectively (Figure 1).…”

Section: Medium-term Outcomesmentioning

confidence: 99%

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Open surgical repair for chronic type B aortic dissection: A systematic review

Tian

Silva

Wang

et al. 2015

Heart, Lung and Circulation

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Background: The treatment of chronic type B aortic dissection (CBAD) remains complicated. Thoracic endovascular aortic repair (TEVAR) has supplanted open surgical repair (OSR) as the preferred surgical treatment for CBAD. Despite TEVAR's superior short-term results, much less is understood about its longterm outcomes. As much of the understanding of OSR originates from historical report, contemporary series, with modern surgical techniques and technologies, may present an alternative to TEVAR. The present systematic review will assess the short-and long-term outcomes of historic and contemporary series of OSR for CBAD.Methods: Electronic searches were performed using six databases from their inception to March 2014.Relevant studies with OSRs for chronic type B dissection were identified. Data were extracted by two independent reviewers and analyzed according to predefined clinical endpoints. Studies were sub-classified into the pre-endovascular (historic series) and endovascular era (contemporary series) depending on whether the majority of cases were performed after 1999.Results: Nineteen studies were identified for inclusion for quantitative analysis. Pooled short-term mortality was 11.1% overall, and 7.5% in the nine contemporary studies. Stroke, spinal cord ischemia, renal dysfunction, and reoperation for bleeding were 5.9%, 4.9%, 8.1%, and 8.1%, respectively, for the contemporary series. Absolute late reintervention was identified in 13.3% of patients overall, and in 11.3% of patients in the contemporary series. Aggregated survival at 1-, 3-, 5-, and 10-years of all patients were 82.1%, 74.1%, 66.3%, and 50.8%, respectively.Conclusions: OSR for chronic type B dissection in the contemporary era offers acceptable results.Management approaches should be considered carefully, taking into account both short-term and long-term complications. More research is required to clarify specific indications for OSR and TEVAR in chronic type B dissections.

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Section: Quantity and Quality Of Evidencementioning

confidence: 99%

Section: Demographic and Operative Techniquesmentioning

confidence: 99%

Section: Demographic and Operative Techniquesmentioning

confidence: 99%

Section: Demographic and Operative Techniquesmentioning

confidence: 99%

Section: Medium-term Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Open surgical repair for chronic type B aortic dissection: A systematic review

Tian

Silva

Wang

et al. 2015

Heart, Lung and Circulation

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Secondary Procedures After Primary Thoracic Endovascular Aortic Repair (TEVAR): Pathologies and Management

Nozdrzykowski

Mohr

Garbade

2019

Surgical Management of Aortic Pathology

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Long-term results of etiology-based thoracic endovascular aortic repair: a single-center experience

Takazawa,

Asakura,

Nakazawa

et al. 2024

Heart Vessels

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The use of thoracic endovascular aortic repair (TEVAR) for thoracic aortic aneurysm (TAA) and Stanford type B aortic dissection (TBAD) has been increasing; however, in terms of etiology, the differences of long term after TEVAR outcomes remain unexplored. Thus, we investigated etiology-specific long-term results of TEVAR for TAA and TBAD. A total of 421 TEVAR procedures were performed at our institution from July 2007 to December 2021; 249 TAA cases and 172 TBAD cases were included. Traumatic aortic dissection and aortic injury cases were excluded. The mean observation duration was 5.7 years. The overall 30-day mortality rate was 1.4% (n = 6), with 1.2% (n = 3) in the TAA group and 1.7% (n = 3) in the TBAD group. The overall incidence of postoperative stroke was 0.9% (n = 4), with 1.2% (n = 3) and 0.6% (n = 1) in the TAA and TBAD groups, respectively (p = 0.90). Paraplegia developed in 1.7% (n = 7) of patients, with 2.4% (n = 6) in the TAA group and 0.6% (n = 1) in the TBAD group. Freedom from aortic-related death was not significantly different between the two etiologies; however, thoracic reintervention was more common in the TBAD group (p = 0.003), with endoleak being the most common indication for reintervention. Additionally, retrograde type A aortic dissection occurred in four TBAD cases, while migration occurred in three TAA cases. The perioperative results of TEVAR for TAA and TBAD were satisfactory. The long-term results were unfavorable owing to the occurrence of etiology-specific and common complications. In terms of the high frequency of reintervention, the long-term complications associated with TEVAR are etiology specific.

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Optimal treatment for patients with chronic Stanford type B aortic dissection: endovascularly, surgically or both?†

Cited by 50 publications

References 27 publications

Open surgical repair for chronic type B aortic dissection: A systematic review

Open surgical repair for chronic type B aortic dissection: A systematic review

Secondary Procedures After Primary Thoracic Endovascular Aortic Repair (TEVAR): Pathologies and Management

Long-term results of etiology-based thoracic endovascular aortic repair: a single-center experience

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