Operative Results and Clinical Features of Chronic Stanford Type B Aortic Dissection: Examination of 234 Patients Over 6 Years

Fujikawa, Takuya; Yamamoto, Shin; Sekine, Yuji; Oshima, Satoshi; Kasai, Reo; Mochida, Yuki; Ozaki, Kensuke; Sasaguri, Shiro

doi:10.1016/j.ejvs.2015.07.012

Cited by 27 publications

(20 citation statements)

References 14 publications

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“…The OSR cohort comprised of 1081 patients, with a mean age of 58.2 ± 3.8 years [ 21 – 30 ]. The reported follow-up for these studies ranged between 34 months and 102 months.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies described the timing of OSR; elective interventions were performed between 53.2% and 95.7% [ 21 – 25 , 30 ], while urgent and emergent interventions were performed between 10.5% and 12.5% [ 21 , 24 ], and 3.1% to 7.7% [ 21 , 25 , 30 ], respectively. The exact interval between incident dissection and OSR was available in three studies, ranging between a mean of 32.4–61.0 months [ 29 , 30 ] and a median of 31.0 (thoraco-abdominal extent) to 43.0 months (limited to descending aorta) [ 21 ]. Mean time to intervention was 35.5 months.…”

Section: Resultsmentioning

confidence: 99%

“…Mean time to intervention was 35.5 months. For 37.4% of the patients the intervention was limited to the descending aorta [ 21 – 25 , 29 , 30 ], while for the remaining patients the intervention was thoraco-abdominal [ 21 – 25 , 27 , 29 , 30 ]. The operative details are reported in S1 Table .…”

Section: Resultsmentioning

confidence: 99%

“…Short-term mortality after OSR ranged between 5.6% and 21.0% [ 21 – 30 ]. One-, five- and ten-year survival was between 72.0% and 92.0% [ 21 , 23 , 24 , 27 , 28 , 30 ], 53.0% and 86.7% [ 22 – 25 , 27 , 29 ], and between 32.0% and 60.0% [ 23 , 25 , 27 ], respectively. One study reported a 15-year survival of 49.0% [ 25 ] ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

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Contemporary Management Strategies for Chronic Type B Aortic Dissections: A Systematic Review

et al. 2016

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BackgroundCurrently, the optimal management strategy for chronic type B aortic dissections (CBAD) is unknown. Therefore, we systematically reviewed the literature to compare results of open surgical repair (OSR), standard thoracic endovascular aortic repair (TEVAR) or branched and fenestrated TEVAR (BEVAR/FEVAR) for CBAD.MethodsEMBASE and MEDLINE databases were searched for eligible studies between January 2000 and October 2015. Studies describing outcomes of OSR, TEVAR, B/FEVAR, or all, for CBAD patients initially treated with medical therapy, were included. Primary endpoints were early mortality, and one-year and five-year survival. Secondary endpoints included occurrence of complications. Furthermore, a Time until Treatment Equipoise (TUTE) graph was constructed.ResultsThirty-five articles were selected for systematic review. A total of 1081 OSR patients, 1397 TEVAR patients and 61 B/FEVAR patients were identified. Early mortality ranged from 5.6% to 21.0% for OSR, 0.0% to 13.7% for TEVAR, and 0.0% to 9.7% for B/FEVAR. For OSR, one-year and five-year survival ranged 72.0%-92.0% and 53.0%-86.7%, respectively. For TEVAR, one-year survival was 82.9%-100.0% and five-year survival 70.0%-88.9%. For B/FEVAR only one-year survival was available, ranging between 76.4% and 100.0%. Most common postoperative complications included stroke (OSR 0.0%-13.3%, TEVAR 0.0%-11.8%), spinal cord ischemia (OSR 0.0%-16.4%, TEVAR 0.0%-12.5%, B/FEVAR 0.0%-12.9%) and acute renal failure (OSR 0.0%-33.3%, TEVAR 0.0%-34.4%, B/FEVAR 0.0%-3.2%). Most common long-term complications after OSR included aneurysm formation (5.8%-20.0%) and new type A dissection (1.7–2.2%). Early complications after TEVAR included retrograde dissection (0.0%-7.1%), malperfusion (1.3%–9.4%), cardiac complications (0.0%–5.9%) and rupture (0.5%–5.0%). Most common long-term complications after TEVAR were rupture (0.5%–7.1%), endoleaks (0.0%–15.8%) and cardiac complications (5.9%-7.1%). No short-term aortic rupture or malperfusion was observed after B/FEVAR. Long-term complications included malperfusion (6.5%) and endoleaks (0.0%-66.7%). Reintervention rates after OSR, TEVAR and B/FEVAR were 5.8%-29.0%, 4.3%-47.4% and 0.0%-53.3%, respectively. TUTE for OSR was 2.7 years, for TEVAR 9.9 months and for B/FEVAR 10.3 months.ConclusionWe found a limited early survival benefit of standard TEVAR over OSR for CBAD. Complication rates after TEVAR are higher, but complications after OSR are usually more serious. Initial experiences with B/FEVAR show its feasibility, but long-term results are needed to compare it to OSR and standard TEVAR. We conclude that optimal treatment of CBAD remains debatable and merits a patient specific decision. TUTE seems a feasible and useful tool to better understand management outcomes of CBAD.

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“…The OSR cohort comprised of 1081 patients, with a mean age of 58.2 ± 3.8 years [ 21 – 30 ]. The reported follow-up for these studies ranged between 34 months and 102 months.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Contemporary Management Strategies for Chronic Type B Aortic Dissections: A Systematic Review

et al. 2016

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“…Open descending thoracic aortic replacement involves complex preparations, such as one‐lung ventilation, left heart or partial cardiopulmonary bypass and cerebrospinal fluid drainage. Contemporary data have reported variable in‐hospital mortality rates of up to 21 per cent with open surgery; however, good and durable long‐term results can be achieved in high‐volume and experienced aortic centres . Thoracic endovascular aortic repair (TEVAR) is a minimally‐invasive alternative to open surgery.…”

Section: Type B Aortic Dissectionmentioning

confidence: 99%

Current management of acute aortic syndrome

Fujikawa

Underwood

et al. 2018

Surgical Practice

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Acute aortic dissection and intramural haematoma are the most common disease entities under the category of 'acute aortic syndromes'. High mortalities and morbidities remain clinical challenges in their management, even in the international arena. Continuous advancement and new evidence about open, endovascular and hybrid interventions offer new insights towards improvements in treatment outcomes. Careful planning and execution of operative management with attention to specific patient characteristics remain the prerequisites for a reduction in mortality and complications.

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Management of Chronic Dissection of the Descending Thoracic and Thoracoabdominal Aorta: Open Approach

Köksoy

Huu

Coselli

2021

Aortic Dissection and Acute Aortic Syndromes

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Operative Results and Clinical Features of Chronic Stanford Type B Aortic Dissection: Examination of 234 Patients Over 6 Years

Abstract: Enlargement of uncomplicated TBAD in the chronic phase was poorly related to FL status and the results of open repair have improved. However, further prospective study is necessary.

Cited by 27 publications

References 14 publications

Contemporary Management Strategies for Chronic Type B Aortic Dissections: A Systematic Review

Contemporary Management Strategies for Chronic Type B Aortic Dissections: A Systematic Review

Current management of acute aortic syndrome

Management of Chronic Dissection of the Descending Thoracic and Thoracoabdominal Aorta: Open Approach

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