Outcomes of open repairs of chronic distal aortic dissection anatomically amenable to endovascular repairs

Commentary: Like most shortcuts, it could be an ill-chosen route

“…Thoracic endovascular aortic repair (TEVAR) is a treatment modality that has been rapidly embraced for treating thoracic aortic disease due to its less invasiveness, its availability, and its relative easiness of application, but in some cases this can be just a shortcut to follow, and as Washington Irving wrote in the story ''The Devil and Tom Walker,'' 1 ''Like most shortcuts, it was an ill-chosen route.'' The present paper, by Tanaka and colleagues, 2 is clear evidence that sometimes, in very expert hands, selecting the right patients for surgery is still the high road to take rather than pursuing less invasiveness at all costs.…”

Open repair remains the gold standard

“…In contemporary studies of distal aortic repair due to chronic dissection, the early mortality rate is 6% to 8%, the stroke rate is 1% to 4%, the incidence of paraplegia is 1% to 3%, and the incidence of renal failure requiring dialysis is 4% to 5%. 8 , 14 , 28 , 29 , 30 , 31 , 32 , 33 , 34 Open repair is durable. Estrera and colleagues 30 reported 94% freedom from reoperation of the repaired distal aorta at 20 years, and we 34 reported 96% freedom from reoperation of the repaired distal aorta at 7 years.…”

Recent developments in thoracic endovascular aortic repair for chronic type B dissection

“…Another meta-analysis assessed the early-and midterm outcomes of TEVAR, which reported 7.0% overall in-hospital mortality, 4.2% stroke, 3.3% SCI, 8.9% midterm mortality, and 12.5% secondary intervention rate (31). In response, Tanaka et al reported the outcome of 427 patients with anatomy amenable to TEVAR who underwent open repair (32). Thirty-day mortality was 8.4%, and the rate of stroke and SCI was 4.0% and 5.2%, respectively.…”