Objective: The study objective was to analyze the outcomes of thoracic endovas-cular aortic repair performed for complicated and uncomplicated acute type B aortic dissections.Methods: Patients from WL Gore's Global Registry for Endovascular Aortic Treat-ment who underwent thoracic endovascular aortic repair for acute type B aortic dissections were included, and data were retrospectively analyzed.Results: Of 5014 patients enrolled in the Global Registry for Endovascular Aortic Treatment, 172 underwent thoracic endovascular aortic repair for acute type B aortic dissections. Of these repairs, 102 were for complicated acute type B aortic dis-sections and 70 were for uncomplicated acute type B aortic dissections. There were 46 (45.1%) procedures related to aortic branch vessels versus 15 (21.4%) in compli-cated type B aortic dissections and uncomplicated type B aortic dissections (P = .002). The mean length of stay was 14.3 + 10.6 days (median, 11; range, 2-75) versus 9.8 + 7.9 days (median, 8; range, 0-42) in those with complicated type B aortic dissections versus those with uncomplicated acute type B aortic dissections (P < .001). Thirty-day mortality was not different between groups (complicated type B aortic dissections 2.9% vs uncomplicated acute type B aortic dissections 1.4%, P = .647), as well as aortic complications (8.8% vs 5.7%, P = .449). Aortic event-free survival was 62.9% + 37.1% versus 70.6% + 29.3% at 3 years (P = .696).Conclusions: In the Global Registry for Endovascular Aortic Treatment, thoracic endovascular aortic repair results for complicated type B aortic dissections versus uncomplicated acute type B aortic dissections showed that 30-day mortality and perioperative complications were equally low for both. The midterm outcome was positive. These data confirm that thoracic endovascular aortic repair as the first-line strategy for treating complicated type B dissections is associated with a low risk of complications. Further studies with longer follow-up are necessary to define the role of thoracic endovascular aortic repair in uncomplicated acute type B dissections compared with medical therapy. However, in the absence of level A evidence from randomized trials, results of the uncomplicated acute type B aortic dissection patient cohort treated with thoracic endovascular aortic repair from reg-istries are important to understand the related risk and benefit.
Endovascular treatment of complicated versus uncomplicated acute type B aortic dissection / D. Spinelli, F.A. Weaver, A. Azizzadeh, G.A. Magee, G. Piffaretti, F. Benedetto, C.C. Miller, H.K. Sandhu, D.R. Gable, S. Trimarchi. - In: JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. - ISSN 0022-5223. - 165:1(2023 Jan), pp. 4-13.e1. [10.1016/j.jtcvs.2021.01.027]
Endovascular treatment of complicated versus uncomplicated acute type B aortic dissection
S. TrimarchiCo-ultimo
2023
Abstract
Objective: The study objective was to analyze the outcomes of thoracic endovas-cular aortic repair performed for complicated and uncomplicated acute type B aortic dissections.Methods: Patients from WL Gore's Global Registry for Endovascular Aortic Treat-ment who underwent thoracic endovascular aortic repair for acute type B aortic dissections were included, and data were retrospectively analyzed.Results: Of 5014 patients enrolled in the Global Registry for Endovascular Aortic Treatment, 172 underwent thoracic endovascular aortic repair for acute type B aortic dissections. Of these repairs, 102 were for complicated acute type B aortic dis-sections and 70 were for uncomplicated acute type B aortic dissections. There were 46 (45.1%) procedures related to aortic branch vessels versus 15 (21.4%) in compli-cated type B aortic dissections and uncomplicated type B aortic dissections (P = .002). The mean length of stay was 14.3 + 10.6 days (median, 11; range, 2-75) versus 9.8 + 7.9 days (median, 8; range, 0-42) in those with complicated type B aortic dissections versus those with uncomplicated acute type B aortic dissections (P < .001). Thirty-day mortality was not different between groups (complicated type B aortic dissections 2.9% vs uncomplicated acute type B aortic dissections 1.4%, P = .647), as well as aortic complications (8.8% vs 5.7%, P = .449). Aortic event-free survival was 62.9% + 37.1% versus 70.6% + 29.3% at 3 years (P = .696).Conclusions: In the Global Registry for Endovascular Aortic Treatment, thoracic endovascular aortic repair results for complicated type B aortic dissections versus uncomplicated acute type B aortic dissections showed that 30-day mortality and perioperative complications were equally low for both. The midterm outcome was positive. These data confirm that thoracic endovascular aortic repair as the first-line strategy for treating complicated type B dissections is associated with a low risk of complications. Further studies with longer follow-up are necessary to define the role of thoracic endovascular aortic repair in uncomplicated acute type B dissections compared with medical therapy. However, in the absence of level A evidence from randomized trials, results of the uncomplicated acute type B aortic dissection patient cohort treated with thoracic endovascular aortic repair from reg-istries are important to understand the related risk and benefit.File | Dimensione | Formato | |
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