Xiaoying Lou1, Edward P Chen1, Yazan M Duwayri2, Ravi K Veeraswamy2, William D Jordan2, Carl A Zehner1, Bradley G Leshnower3. 1. Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. 2. Division of Vascular and Endovascular Therapy, Emory University School of Medicine, Atlanta, Georgia. 3. Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. Electronic address: bleshno@emory.edu.
Abstract
BACKGROUND: Currently, optimal medical therapy is first-line therapy for uncomplicated acute type B aortic dissection (aTBAD) despite poor long-term outcomes. This study examines the impact of thoracic endovascular aortic repair (TEVAR) in the acute and chronic phases on short-term and long-term survival of patients presenting with aTBAD. METHODS: A review of the Emory aortic database from 2000 to 2016 identified 398 patients diagnosed with aTBAD. At index hospitalization, complicated patients underwent TEVAR (aTEVAR [thoracic endovascular aortic repair in the acute phase], n = 80) and uncomplicated patients received optimal medical therapy (n = 318). Uncomplicated patients were divided into subgroups based on final treatment: (1) TEVAR (cTEVAR [thoracic endovascular aortic repair in the chronic phase], n = 87); (2) open aortic replacement (n = 59); and (3) optimal medical therapy (n = 172). Kaplan-Meier curves assessed long-term mortality. RESULTS: The mean age of patients was 57 ± 12 years. In the uncomplicated group, 146 patients (45.9%) patients failed optimal medical therapy and underwent open repair (n = 59) or endovascular repair (cTEVAR, n = 87) repair in the chronic phase. Inhospital mortality was 5% and equivalent between complicated and uncomplicated aTBAD groups at index hospitalization. For patients requiring intervention, mortality and renal failure were highest for open patients (16.9%, p < 0.01, and 10.2%, p = 0.05, respectively), and stroke was highest among aTEVAR patients (7.5%, p < 0.01). The incidence of paraparesis and paraplegia was low and equivalent among the three groups. Despite a higher mortality risk at presentation, there was a trend toward improved long-term survival among complicated aTBAD patients (complicated 84.1% versus uncomplicated 58.9%, p = 0.17). Intervention-free survival at 5 and 10 years for all uncomplicated patients was 50.4% and 32.9%, respectively. CONCLUSIONS: The treatment of uncomplicated aTBAD with optimal medical therapy results in a high incidence of surgical intervention and poor long-term survival. At the index hospitalization, TEVAR may confer a survival advantage and serve as optimal therapy for complicated and uncomplicated aTBAD patients.
BACKGROUND: Currently, optimal medical therapy is first-line therapy for uncomplicated acute type B aortic dissection (aTBAD) despite poor long-term outcomes. This study examines the impact of thoracic endovascular aortic repair (TEVAR) in the acute and chronic phases on short-term and long-term survival of patients presenting with aTBAD. METHODS: A review of the Emory aortic database from 2000 to 2016 identified 398 patients diagnosed with aTBAD. At index hospitalization, complicated patients underwent TEVAR (aTEVAR [thoracic endovascular aortic repair in the acute phase], n = 80) and uncomplicated patients received optimal medical therapy (n = 318). Uncomplicated patients were divided into subgroups based on final treatment: (1) TEVAR (cTEVAR [thoracic endovascular aortic repair in the chronic phase], n = 87); (2) open aortic replacement (n = 59); and (3) optimal medical therapy (n = 172). Kaplan-Meier curves assessed long-term mortality. RESULTS: The mean age of patients was 57 ± 12 years. In the uncomplicated group, 146 patients (45.9%) patients failed optimal medical therapy and underwent open repair (n = 59) or endovascular repair (cTEVAR, n = 87) repair in the chronic phase. Inhospital mortality was 5% and equivalent between complicated and uncomplicated aTBAD groups at index hospitalization. For patients requiring intervention, mortality and renal failure were highest for open patients (16.9%, p < 0.01, and 10.2%, p = 0.05, respectively), and stroke was highest among aTEVARpatients (7.5%, p < 0.01). The incidence of paraparesis and paraplegia was low and equivalent among the three groups. Despite a higher mortality risk at presentation, there was a trend toward improved long-term survival among complicated aTBAD patients (complicated 84.1% versus uncomplicated 58.9%, p = 0.17). Intervention-free survival at 5 and 10 years for all uncomplicated patients was 50.4% and 32.9%, respectively. CONCLUSIONS: The treatment of uncomplicated aTBAD with optimal medical therapy results in a high incidence of surgical intervention and poor long-term survival. At the index hospitalization, TEVAR may confer a survival advantage and serve as optimal therapy for complicated and uncomplicated aTBAD patients.
Authors: Xiaoying Lou; Yazan M Duwayri; Edward P Chen; William D Jordan; Jessica Forcillo; Carl A Zehner; Bradley G Leshnower Journal: Ann Thorac Surg Date: 2018-10-04 Impact factor: 4.330
Authors: Christian Mpody; Jerry Cui; Hamdy Awad; Sujatha Bhandary; Michael Essandoh; Ronald L Harter; Joseph D Tobias; Olubukola O Nafiu Journal: J Cardiothorac Vasc Anesth Date: 2020-12-02 Impact factor: 2.628