Complicated acute type B dissection: is surgery still the best option?: a report from the International Registry of Acute Aortic Dissection

JACC Cardiovasc Interv. 2008 Aug;1(4):395-402. doi: 10.1016/j.jcin.2008.04.009.

Abstract

Objectives: Impact on survival of different treatment strategies was analyzed in 571 patients with acute type B aortic dissection enrolled from 1996 to 2005 in the International Registry of Acute Aortic Dissection.

Background: The optimal treatment for acute type B dissection is still a matter of debate.

Methods: Information on 290 clinical variables were compared, including demographics; medical history; clinical presentation; physical findings; imaging studies; details of medical, surgical, and endovascular management; in-hospital clinical events; and in-hospital mortality.

Results: Of the 571 patients with acute type B aortic dissection, 390 (68.3%) were treated medically, 59 (10.3%) with standard open surgery and 66 (11.6%) with an endovascular approach. Patients who underwent emergency endovascular or open surgery were younger (mean age 58.8 years, p < 0.001) than their counterparts treated conservatively, and had male preponderance and hypertension in 76.9%. Patients submitted to surgery presented with a wider aortic diameter than patients treated by interventional techniques or by medical therapy (5.36 +/- 1.7 cm vs. 4.62 +/- 1.4 cm vs. 4.47 +/- 1.4 cm, p = 0.003). In-hospital complications occurred in 20% of patients subjected to endovascular technique and in 40% of patients after open surgical repair. In-hospital mortality was significantly higher after open surgery (33.9%) than after endovascular treatment (10.6%, p = 0.002). After propensity and multivariable adjustment, open surgical repair was associated with an independent increased risk of in-hospital mortality (odds ratio: 3.41, 95% confidence interval: 1.00 to 11.67, p = 0.05).

Conclusions: In the International Registry of Acute Aortic Dissection, the less invasive nature of endovascular treatment seems to provide better in-hospital survival in patients with acute type B dissection; larger randomized trials or comprehensive registries are needed to access impact on outcomes.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aortic Aneurysm / complications
  • Aortic Aneurysm / mortality
  • Aortic Aneurysm / therapy*
  • Aortic Dissection / complications
  • Aortic Dissection / mortality
  • Aortic Dissection / therapy*
  • Blood Vessel Prosthesis
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Blood Vessel Prosthesis Implantation* / instrumentation
  • Blood Vessel Prosthesis Implantation* / mortality
  • Cardiovascular Agents / therapeutic use*
  • Female
  • Hospital Mortality
  • Humans
  • International Cooperation
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Outcome and Process Assessment, Health Care* / statistics & numerical data
  • Patient Selection
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Stents
  • Treatment Outcome
  • Vascular Surgical Procedures* / adverse effects
  • Vascular Surgical Procedures* / instrumentation
  • Vascular Surgical Procedures* / mortality

Substances

  • Cardiovascular Agents