TY - JOUR
T1 - The Impact of Thoracic Endovascular Aortic Repair on Long-Term Survival in Type B Aortic Dissection
AU - Lou, Xiaoying
AU - Chen, Edward P.
AU - Duwayri, Yazan M.
AU - Veeraswamy, Ravi K.
AU - Jordan, William D.
AU - Zehner, Carl A.
AU - Leshnower, Bradley G.
N1 - Publisher Copyright:
© 2018 The Society of Thoracic Surgeons
PY - 2018/1
Y1 - 2018/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.athoracsur.2017.06.016
DO - 10.1016/j.athoracsur.2017.06.016
M3 - Article
C2 - 28811003
AN - SCOPUS:85028317117
SN - 0003-4975
VL - 105
SP - 31
EP - 38
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -