Mohsen Bannazadeh, Adewunmi Adeyemo, Yolanda Munoz Maldonado, Jeffrey Altshuler, Marc Sakwa, O. William Brown
William Beaumont Hospital, Royal Oak, MI.
OBJECTIVES: The optimal management of Type B Aortic Dissection (TBAD) remains controversial in the era of endovascular therapies. This study reports the outcomes of different treatment paradigms for TBAD.
METHODS: A retrospective review was undertaken of all patients with TBAD from June 2006 to June 2012. Demographics, hospital course and follow-up visits were analyzed. Patients who underwent surgical interventions were compared to those with medical therapy. Survival rates and predictors of outcome were determined using the Kaplan-Meier method with Cox proportional hazards.
RESULTS: Out of 276 consecutive patients who were hospitalized during this period with a confirmed thoracic dissection, 134 (48%) had TBAD. Sixty-two (46%) were women, and the mean age was 66.4±14.9. Median follow-up was 22.4 (0, 184) month. Thirty-five patients underwent surgical intervention with 20 Thoracic Endovascular Aortic Repair (TEVAR) and open surgery in 15. The overall 30-day mortality was 7% and cumulative survival rates at 1 year, 3 years and 5 years were 85% (79,91), 68% (59,78) and 57% (47,69) with no difference between medical vs surgical groups (p=0.8) and TEVAR vs. open surgery group (p=1). Sixty-six (50%) patients developed aneurysmal expansion, which required surgical intervention in 26 (hazard ratios [HR] 0.99, p=0.96). Malperfusion and rupture only occurred in 5 (HR 1.57, p=0.54) and 5 (HR 3.64, p=0.01) patients respectively. Multivariate analysis for overall survival found renal insufficiency (HR 2.6, p=0.004) and age (HR 1.06, p<0.0001) were associated with greatest mortality. Intramural hematoma was not a significant predictor of survival (HR 0.49, p=0.11).
CONCLUSIONS: Medical therapy remains the mainstay of treating TBAD with low morbidity and acceptable survival rates. Surgical interventions including TEVAR are indicated in selected patients with malperfusion or aneurysmal expansion.
AUTHOR DISCLOSURES: A. Adeyemo: Nothing to disclose; J. Altshuler: Nothing to disclose; M. Bannazadeh: Nothing to disclose; O. Brown: Nothing to disclose; Y. Munoz Maldonado: Nothing to disclose; M. Sakwa: Nothing to disclose.
Posted on April 2013