Outcome of open and endovascular repair in acute type B aortic dissection: a retrospective and observational study

Abstract

BackgroundThe aim of the study was to analyze surgical and endovascular results in the treatment of acute type B aortic dissection (B AAD).MethodsRetrospective and observational analysis with patient inclusion between January 2001-December 2008 and follow-up ranged from 2 to 96 months (median = 47.2) was performed. Out of 51 consecutive patients with B AAD, 11 (21.6%) had to undergo open surgery (OS) and 13 (25.5%) endovascular treatment (TEVAR).ResultsThere was a significantly difference in early mortality in the TEVAR group (0/13,0%) vs OS group (4/11,36.4%, P < 0.05) and in the incidence of paraplegia/paraparesis (OS 2,28.6% vs TEVAR 1,7.7%, P < 0.05), renal failure (OS 3, 42.8% vs TEVAR 1, 7.7%, P < 0.05), respiratory failure (OS 2,28.6% vs TEVAR 1,7.7%, P < 0.05) and cerebrovascular accident (OS 1,14.3% vs TEVAR 0,0%, P < 0.05). The late mortality at a follow-up was 30.8% (4/13) in the TEVAR group and 42.8% (3/7) in the OS group, respectively (P = not significant). The cumulative survival rate after 1, 3 and 8 years was 93%, 84%, and 69% in the TEVAR group and 86%, 71% and 57% in the OS group, respectively. Endoleaks were diagnosed in 2/13 endovascular patients (15.4%).ConclusionsTEVAR group had a significantly reduction in early mortality and postoperative complications. No significant differences were found in terms of cumulative survival at follow-up. On this basis TEVAR could be considered an option in the treatment of these complex cases with all proper reservation especially related to the small sample sizes examined.

Long-term efficacy of endovascular vs open surgical repair for complicated type-B aortic dissection: a single-center retrospective study and meta-analysis

“…A total of 2,695 abstracts were identified for screening, but only eight studies ( 11 , 12 , 17 - 22 ) met the inclusion criteria. Finally, these eight studies and the present study involving a total of 739 patients (436 for TEVAR and 303 for OSR) were included in the meta-analysis.…”

Association of race and socioeconomic status with the use of endovascular repair to treat thoracic aortic diseases

“…1-3 Compared with patients treated with open aortic reconstruction, patients undergoing TEVAR have decreased operative mortality, paralysis, renal insufficiency, cardiac and pulmonary complications, and length of stay. 3,4 The spectrum of aortic pathologies amenable to either open repair or TEVAR has evolved and includes thoracic aortic aneurysms, thoracic dissection, intramural hematomas, and aortic rupture.…”

Controversies in Aortic Dissection and Aneurysmal Disease

“…Some researchers focussed on the exploration of biomechanical triggers of aneurysmal rupture to enhance our knowledge for predicting the exact day and hour of aneurysmal rupture [101]. Some patterns of aneurysmal rupture have been identified [107] including preponderance of aortic events in winter [108][109][110][111], of the early morning hours [111][112][113][114], and an increased risk during instances of extreme exertion or emotion [115][116][117]. Although the exact biomechanical mechanisms remain to be identified, authors agree that these peaks of aortic events relate to the well-known peaks of blood pressure.…”

“…By contrast, Russo and colleagues found an unfavorable post-operative course in a cohort of 50 patients with BAV after isolated AVR, with eight late aortic events and seven sudden cardiac deaths. [ 110 ] More recently, Girdauskas and colleagues analyzed their institutional database of 153 patients with stenotic BAV and dilated aortic roots (between 4 and 5 cm in diameter) who underwent isolated AVR [ 113 ]. The freedom from adverse aortic events.…”