Open and endovascular repair of type B aortic dissection in the Nationwide Inpatient Sample

Sachs, Teviah E.; Pomposelli, Frank B.; Hagberg, Robert; Hamdan, Allen D.; Wyers, Mark C.; Giles, Kristina A.; Schermerhorn, Marc L.

doi:10.1016/j.jvs.2010.05.008

Cited by 123 publications

(109 citation statements)

References 34 publications

Supporting

Mentioning

105

Contrasting

Order By: Relevance

“…4,7,8,24,27,30 Nevertheless, 19% (9% type A and 33% type B) of our patients required surgical or endovascular therapy during follow-up with interventional mortality similar to those reported in other series. 6,8,25,31 Overall mortality in our study was 5% at 3 years, 13% at 5 years, and 48% at 10 years (20% in type A and 36% in type B), similar to those of contemporary series from major aortic surgery institutions. 6,7,23,26 -29 …”

Section: Long-term Evolution In Type a And B Dissections With Patent supporting

confidence: 84%

Long-Term Outcome of Aortic Dissection With Patent False Lumen

Evangelista

Saldierna²,

Ribera³

et al. 2012

Circulation

341

View full text Add to dashboard Cite

Background— Patent false lumen in aortic dissection has been associated with poor prognosis. We aimed to assess the natural evolution of this condition and predictive factors. Methods and Results— One hundred eighty-four consecutive patients, 108 surgically treated type A and 76 medically treated type B, were discharged after an acute aortic dissection with patent false lumen. Transesophageal echocardiography was performed before discharge, and computed tomography was performed at 3 months and yearly thereafter. Median follow-up was 6.42 years (quartile 1 to quartile 3: 3.31–10.49). Forty-nine patients died during follow-up (22 type A, 27 type B), 31 suddenly. Surgical or endovascular treatment was indicated in 10 type A and 25 type B cases. Survival free from sudden death and surgical-endovascular treatment was 0.90, 0.81, and 0.46 (95% CI, 0.36–0.55) at 3, 5, and 10 years, respectively. Multivariate analysis identified baseline maximum descending aorta diameter (hazard ratio [HR]: 1.32 [1.10–1.59]; P =0.003), proximal location (HR: 1.84 [1.06–3.19]; P =0.03), and entry tear size (HR: 1.13 [1.08–1.2]; P <0.001) as predictors of dissection-related adverse events, whereas mortality was predicted by baseline maximum descending aorta diameter (HR: 1.36 [1.08–1.70]; P =0.008), entry tear size (HR: 1.1 [1.04–1.16]; P =0.001), and Marfan syndrome (HR: 3.66 [1.65–8.13]; P =0.001). Conclusions— Aortic dissection with persistent patent false lumen carries a high risk of complications. In addition to Marfan syndrome and aorta diameter, a large entry tear located in the proximal part of the dissection identifies a high-risk subgroup of patients who may benefit from earlier and more aggressive therapy.

show abstract

Section: Long-term Evolution In Type a And B Dissections With Patent supporting

confidence: 84%

Long-Term Outcome of Aortic Dissection With Patent False Lumen

Evangelista

Saldierna²,

Ribera³

et al. 2012

Circulation

341

View full text Add to dashboard Cite

show abstract

“…Thus, INSTEAD-XL corroborates recent observational evidence, suggesting longterm beneficial results of TEVAR in subacute and chronic dissection. 4,12,25 With safer procedures attributable to improved operator skills and better technology, TEVAR may emerge as first-line therapy of type B dissection; the attempt to heal and remodel dissected aorta may replace the current complicationspecific strategy. ) and Landmark analysis with a breakpoint at 24 months after randomization to the end of the trial are shown for optimal medical treatment (OMT) and OMT + thoracic endovascular aortic repair (TEVAR) groups.…”

Section: #15 (Nr-2421) Cancermentioning

confidence: 99%

Endovascular Repair of Type B Aortic Dissection

Nienaber

Kische

Rousseau

et al. 2013

Circ: Cardiovascular Interventions

896

View full text Add to dashboard Cite

Background-Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection.Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown. Methods and Results-A total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR (n=72) versus optimal medical treatment alone (n=68) were analyzed retrospectively for aortaspecific, all-cause outcomes, and disease progression using landmark statistical analysis of years 2 to 5 after index procedure. Cox regression was used to compare outcomes between groups; all analyses are based on intention to treat. From the University of Rostock, Heart Center and Institute for Biostatistics, Rostock, Germany (C.A.N., S.K., T.C.R., G.K., A.G., T.K., H.I.); CCB Heart Center Frankfurt, Frankfurt, Germany (H.E.); University Heart Center Leipzig, Leipzig, Germany (D.S.); German Heart Institute Berlin, Berlin, Germany (B.Z.); the Centre Hospitalière Universitaire, Hôpital de Rangueil, Toulouse, France (H.R.); the Universitá St. Orsola Malpighi, Bologna, Italy (R.F.); the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (M.C.); and Bordeaux Heart University Hospital, Bordeaux, France (L.L.).All members of the Investigation of Stent grafts in Aortic Dissection with extended length of follow-up (INSTEAD-XL) study group are listed in the Appendix in the online-only Data Supplement.The online-only Data Supplement is available at http://circinterventions.ahajournals.org/lookup/suppl

show abstract

“…Our team usually introduces a 150-mm long stent graft first, and, if needed, distal or proximal extension is performed in the second period. Results from treating complicated type B aortic dissection document the success of TE-VAR with only 10.6% mortality, as compared with 19.5% mortality for surgical treatment [22]. When TEVAR is used in complicated dissections, there is a documented decrease in the incidence of spinal ischemia to 2% versus 8% when surgery is used [18,23].…”

Section: Discussionmentioning

confidence: 98%

“…The patient gradually rehabilitated to a Rankin score of 3 and died of myocardial infarction (MI) in the 4th month after treatment. The published frequency of this complication in large cohorts of patients ranges from 0-10% [16,18,21,22].…”

Section: Discussionmentioning

confidence: 99%