Outcome of patients suffering from acute type B aortic dissection: a retrospective single-centre analysis of 135 consecutive patients.

OBJECTIVES: Acute uncomplicated Stanford type B aortic dissection (TBAD) is optimally managed with medical treatment. However, surgery and thoracic endovascular aortic repair (TEVAR) are occasionally indicated, particularly when end-organ ischaemia develops. This study assesses the perioperative and long-term outcomes of medical, interventional and surgical management of acute TBAD.
METHODS: A total of 135 consecutive patients with acute TBAD treated at our institution between 2000 and 2008 were analysed. Of these patients, 84 were treated medically (group A, median age: 65 years, interquartile range (IQR): 34-90), 46 patients received TEVAR (group B, median age: 65, IQR: 23-83) and five patients underwent open surgical management (group C, median age: 60 years, IQR: 44-69). Clinical data and information on complications, re-intervention and acute and long-term mortality were retrospectively collected and examined. Follow-up was made on 98% of patients with a median time span of 1107 days (IQR: 870-1343).
RESULTS: There were no significant differences in age, gender, body mass index or co-morbidities among the three treatment groups. Group B patients had the highest rate of ruptures (n=7) and impending ruptures (n=19). Indications for surgery in group C were impending rupture with malperfusion (n=1), rupture (n=2) and refractory pain (n=2). The maximal diameter of dissection was significantly higher in group C (mean: 52.6mm, IQR: 36-82, p<0.05) than in group B (mean: 42.0mm, IQR: 20-74) and group A (mean: 40.6, IQR: 23-66). The 30-day and 5-year mortality rates, respectively, were 8.5% and 27.9% for group A, 20.0% and 43.7% for group B (p=0.018 for group A) and 20.0% for both time points for group C patients. The rate of re-intervention was significantly higher in group A (A: 22/84, 26.2% vs B: 8/46, 17.4%; p=0.049, and group C: 1/5, 20%). The rate of major complications (e.g., stroke, paraplegia and/or vascular problems) did not differ among groups.
CONCLUSIONS: Medical, interventional and surgical management for acute TBAD result in acceptable survival rates. Although stent implantation and surgery were reserved for patients with complications of TBAD in the current study, results were good for both treatment modalities. Randomised prospective trials should be performed to determine whether conservative, TEVAR or surgical management is most advantageous for complicated acute TBAD patients. Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.