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J Thorac Cardiovasc Surg. 2010 Dec;140(6 Suppl):S109-15; discussion S142-S146. doi: 10.1016/j.jtcvs.2010.06.024.

Thoracic endovascular aortic repair for acute complicated type B aortic dissection: superiority relative to conventional open surgical and medical therapy.

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1
Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, PA, USA.

Abstract

OBJECTIVE:

This study compared outcomes between thoracic endovascular aortic repair and conventional open surgical and medical therapies for acute complicated type B aortic dissection.

METHODS:

From 2002 to 2010, a total of 170 patients with type B aortic dissections were retrospectively identified from the University of Pennsylvania aortic database. Of these 170 patients, 147 had acute type B aortic dissections (uncomplicated 70, complicated 77). For patients with acute complicated type B aortic dissections, management included thoracic endovascular aortic repair (group A) or conventional open surgical and medical therapies (group B).

RESULTS:

In the 77 patients with acute complicated type B aortic dissections, thoracic endovascular aortic repair (group A) was performed in 45 patients (59%). In group B, 20 patients (26%) underwent open surgical repair and 12 (15%) had their conditions managed with medical therapy. Thoracic endovascular aortic repair was associated with lower in-hospital or 30-day mortality (n = 2, 4%) than conventional therapy (open surgical repair n = 8, 40%, medical therapy, n = 4, 33%, P = .006). Patients in group A (thoracic endovascular aortic repair) continued to show significantly improved survival at 1, 3, and 5 years (group A: 82%, 79%, and 79% vs group B: 58%, 52%, and 44%, P = .008).

CONCLUSIONS:

Thoracic endovascular aortic repair for acute complicated type B dissection is associated with superior early outcome and improved midterm survival relative to conventional therapy. Longer follow-up demonstrating survival benefit is needed before definitive conclusion can be made.

PMID:
21092775
DOI:
10.1016/j.jtcvs.2010.06.024
[Indexed for MEDLINE]
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