Midterm outcomes of thoracic endovascular aortic repair versus optimal medical therapy for uncomplicated acute type B dissectionCentral MessagePerspective
Kevin G. Hu, BS,
Wei-Guo Ma, MD,
Stevan Pupovac, MD,
Irbaz Hameed, MD,
Soraya Fereydooni, MD,
Eric S. Li, MD,
Haleigh Larson, MD,
Mohammad Zafar, MBBS,
Britt Tonnessen, MD,
Jonathan Cardella, MD,
Eduard Aboian, MD,
Raul Guzman, MD,
Cassius Ochoa Chaar, MD,
David Strosberg, MD,
Matthew Williams, MD,
Naiem Nassiri, MD,
Roland Assi, MD,
Prashanth Vallabhajosyula, MD, MS
Affiliations
Kevin G. Hu, BS
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Wei-Guo Ma, MD
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Stevan Pupovac, MD
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Irbaz Hameed, MD
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Soraya Fereydooni, MD
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Eric S. Li, MD
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Haleigh Larson, MD
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Mohammad Zafar, MBBS
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Britt Tonnessen, MD
Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Jonathan Cardella, MD
Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Eduard Aboian, MD
Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Raul Guzman, MD
Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Cassius Ochoa Chaar, MD
Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
David Strosberg, MD
Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Matthew Williams, MD
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Naiem Nassiri, MD
Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Roland Assi, MD
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Prashanth Vallabhajosyula, MD, MS
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn; Address for reprints: Prashanth Vallabhajosyula, MD, Director, Yale Aortic Institute, Director, Yale Pulmonary Thromboendarterectomy Program Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar St BB204, New Haven, CT 06520.
Objective: We sought to compare the early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) versus optimal medical therapy (OMT) for uncomplicated acute type B aortic dissection. Methods: Data were analyzed for 200 consecutive patients with uncomplicated acute type B aortic dissection from February 1992 to July 2022, including 147 with initial OMT and 53 undergoing TEVAR at index hospitalization. Baseline, intraoperative, and postoperative data, survival, and (re)intervention were compared between the two strategies. Results: In-hospital/30-day mortality was 7.5% (15/200) for the entire series, which was significantly lower in the TEVAR group compared with the OMT group (0 vs 10.2% [15/147]; P = .013). Thirty-day rates were 5.7% (3/53) for reintervention after TEVAR and 15.6% (23/147) for intervention after OMT (P = .064). Death within 30 days of (re)intervention was 0 (n = 0) in the TEVAR group and 18.4% (n = 14) in the OMT group (P = .063). There were no significant differences in the incidences of stroke, paraplegia, acute kidney injury, sepsis, or malperfusion syndrome after initial treatment. Kaplan–Meier survival in the TEVAR group was 92.3% (95% CI, 80.7-97.0) at 1 year and 3 years, significantly higher than in the OMT group (80.3% [95% CI, 72.8-85.8] and 71.4% [95% CI, 63.4-78.0]; P = .012). In patients aged 65 years or more, TEVAR also achieved a significantly higher survival, which was 93.7% (95% CI, 77.5-98.3 vs 69.7% [95% CI, 58.0-78.7]) at 1 year and 93.7% (95% CI, 77.3-98.3] vs 60.5% [95% CI, 48.7-70.5]) at 3 years (P < .001). Conclusions: In this single-institution experience, upfront TEVAR performed at index hospitalization for uncomplicated acute type B aortic dissection was associated with improved survival at early and midterm follow-up.
