Systematic review and meta-analysis of acute type B thoracic aortic dissection, open, or endovascular repair

Harky, Amer; Chan, Jeffrey Shi Kai; Wong, Chris Ho Ming; Francis, Niroshan; Grafton-Clarke, Ciaran; Bashir, Mohamad

doi:10.1016/j.jvs.2018.08.187

Cited by 48 publications

(26 citation statements)

References 44 publications

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“…11 Another risk of TEVAR deployment is the Stent graft-induced new entry (SINE) which has been reported to be around 3% and it is potentially lethal and life threatening complication, when it occurs. 12,13,14 This case highlights the need for close imaging follow-up after deployment of a FET and strict control of BP. This clinical scenario should be considered a surgical emergency and further TEVAR intervention considered to seal off the FET and reduce malperfusion.…”

Section: Discussionmentioning

confidence: 89%

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Management of a Compromised Frozen Elephant Trunk Due to Acute Type B Aortic Dissection

Harky

Fisher

Field

2020

Vasc Endovascular Surg

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Purpose: To report a case who required a thoracic endovascular stenting (TEVAR) following the deployment of frozen elephant trunk due to false lumen expansion Case Report: A 47 years old male patient undergone emergency repair of acute type A aortic dissection in 2011 with bioprosthetic aortic root conduit. Seven years later he presented with moderate aortic valve disease and expanding chronic dissection of the aortic arch, therefore a redo operation with replacement of the prosthetic aortic valve, ascending aorta, total arch and deployment of frozen elephant trunk and he was discharged in good health. Several days post discharge he presented with new onset of chest pain and a new dissection involved the thoracoabdominal aorta was noted pressing on the true lumen and the frozen elephant trunk. Following a multi-disciplinary team meeting, TEVAR was deemed as a most appropriate approach and this was achieved successfully, and patient was discharged. At 1 year of follow up, he remains well and asymptomatic. Conclusion: Close imaging follow-up following deployment of a FET is mandatory. A new acute Type B aortic dissection distal to the FET, that causes false lumen propagation parallel to the stented portion, is a surgical emergency and further intervention mandated.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Management of a Compromised Frozen Elephant Trunk Due to Acute Type B Aortic Dissection

Harky

Fisher

Field

2020

Vasc Endovascular Surg

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“…Some have demonstrated excellent results in the literature for hemodynamically stable patients treated conservatively. 33,44,45 Others have extrapolated this to conclude that a reasonable course of action is delayed intervention, allowing patients to recover from associated injuries of the initial mechanism, despite a 4% risk of death due to delayed rupture of the aorta within a week of the injury while waiting for surgery. 8,10 The advent of endovascular intervention has undermined many of the arguments advocating for either delayed intervention or conservative management, inasmuch as patients are more likely to tolerate intervention that does not involve single-lung ventilation, large incisions, systemic heparinization, and cross-clamp application.…”

Section: Journal Of Vascular Surgerymentioning

confidence: 99%

A systematic review and meta-analysis of endovascular versus open surgical repair for the traumatic ruptured thoracic aorta

Harky

Bleetman

Chan

et al. 2020

Journal of Vascular Surgery

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Objective: The purpose of this study was to compare clinical outcomes between open repair and thoracic endovascular aortic repair (TEVAR) in traumatic ruptured thoracic aorta. Methods: A comprehensive search was undertaken of the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all published data comparing open vs endovascular repair. Databases were evaluated to July 2018. Odds ratios (ORs), weighted mean differences, or standardized mean differences and their 95% confidence intervals (CIs) were analyzed. The primary outcomes were stroke, paraplegia, and 30-day mortality rates; secondary outcomes were requirement for reintervention and 1-year and five-year mortality rates. Results: A total of 1968 patients were analyzed in 21 articles. TEVAR was performed in 29% (n ¼ 578) and open repair in 71% (n ¼ 1390). TEVAR and open repair did not differ in the mean age of patients (42.1 6 14 years vs 44.1 6 14 years; P ¼ .48). There was no difference in duration of intensive care and total hospital stay between TEVAR and open repair groups (12.7 6 11.1 days vs 12.6 6 8 days [P ¼ .35] and 27.5 6 14.6 days vs 25.9 6 11 days [P ¼ .80], respectively). Similarly, no statistically significant difference in postoperative paraplegia or stroke rate was noted between TEVAR and open repair (1.4% vs 2.3% [OR, 1.27; 95% CI, 0.59-2.70; P ¼ .54] and 1% vs 0.5% [OR, 0.63; 95% CI, 0.18-2.18; P ¼ .46]). Lower 30-day and 1-year mortality was noted in TEVAR (7.9% vs 20% [OR, 2.94; 95% CI, 1.92-4.49; P < .00001] and 8.7% vs 17% [OR, 2.11; 95% CI, 0.99-4.52; P ¼ .05]). There was no difference in 5-year mortality (23% vs 17%; OR, 0.07; 95% CI, À0.07 to 0.20; P ¼ .33). However, there was a higher rate of reintervention at 1 year in the endovascular group (0% vs 6%; OR, 0.17; 95% CI, 0.03-0.96; P ¼ .04). Conclusions: TEVAR carries lower in-hospital mortality and provides satisfactory perioperative outcomes compared with open repair in traumatic ruptured thoracic aorta. It also provides a favorable 1-year survival at the expense of higher reintervention rates.

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“…20,21 Mid-term results of complicated type B dissections based on several meta-analyses have demonstrated the morbidity and mortality benefit of TEVAR over open surgical repair. 22,23 Guidelines across US, European, and Japanese societies are consistent with these recommendations and TEVAR in the setting of acute, complicated type B dissection is considered the standard of care. [4][5][6]…”

Section: Acute Complicatedmentioning

confidence: 99%

Updates on Indications for TEVAR in Type B Aortic Dissection

Malaisrie

Mehta

2020

Innovations�(Phila)

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Systematic review and meta-analysis of acute type B thoracic aortic dissection, open, or endovascular repair

Cited by 48 publications

References 44 publications

Management of a Compromised Frozen Elephant Trunk Due to Acute Type B Aortic Dissection

Management of a Compromised Frozen Elephant Trunk Due to Acute Type B Aortic Dissection

A systematic review and meta-analysis of endovascular versus open surgical repair for the traumatic ruptured thoracic aorta

Updates on Indications for TEVAR in Type B Aortic Dissection

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