Surgical and endovascular repair for type B aortic dissections with mesenteric malperfusion syndrome: A systematic review of in-hospital mortalityCentral MessagePerspective

Vishnu M. Chandra, MD; Elizabeth L. Norton, MD; Minhaj S. Khaja, MD; Daniel Giraldo Herrera, MD; David M. Williams, MD; Bo Yang, MD, PhD

JTCVS Open (Dec 2022)

Surgical and endovascular repair for type B aortic dissections with mesenteric malperfusion syndrome: A systematic review of in-hospital mortalityCentral MessagePerspective

Vishnu M. Chandra, MD,
Elizabeth L. Norton, MD,
Minhaj S. Khaja, MD,
Daniel Giraldo Herrera, MD,
David M. Williams, MD,
Bo Yang, MD, PhD

Affiliations

Vishnu M. Chandra, MD: Division of Vascular and Interventional Radiology, Department of Radiology & Medical Imaging, University of Virginia Health, Charlottesville, Va
Elizabeth L. Norton, MD: Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, Ga
Minhaj S. Khaja, MD: Division of Vascular and Interventional Radiology, Department of Radiology & Medical Imaging, University of Virginia Health, Charlottesville, Va; Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan, Ann Arbor, Mich; Address for reprints: Minhaj S. Khaja, MD, University of Virginia Health, 1215 Lee St, Charlottesville, VA 22902.
Daniel Giraldo Herrera, MD: Division of Vascular and Interventional Radiology, Department of Radiology & Medical Imaging, University of Virginia Health, Charlottesville, Va
David M. Williams, MD: Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan, Ann Arbor, Mich
Bo Yang, MD, PhD: Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich

Journal volume & issue: Vol. 12
pp. 37 – 50

Abstract

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Objectives: Mesenteric malperfusion is a feared complication of aortic dissection, with high mortality. The purpose of this study was to systematically review in-hospital mortality (IHM) of endovascular and surgical management of acute and chronic Stanford type B aortic dissections (TBAD) complicated by mesenteric malperfusion (MesMP). Methods: A systematic search of English language articles was conducted in relevant databases. Data on patient demographics, procedure details, and survival outcomes were collected. Reports were classified by type of intervention performed. Studies that failed to report patient-level outcomes based on specific intervention performed or IHM were excluded. Retrospective chart review of previously published data from a single institution was also performed to further identify cases of TBAD that were managed endovascularly. The Fisher exact test was performed to determine statistical significance. Results: In total, 37 articles were suitable for inclusion in this systematic review, which yielded 149 patients with a median age 55.0 years (interquartile range, 46.5-65 years) and 79% being male. Overall, in-hospital mortality was 12.8% (19/149) and was similar between endovascular and open surgical interventions (13% vs 11%, P = .99). Among endovascular strategies, IHM was greater, although not statistically significant in the thoracic endovascular aortic repair group compared with the fenestration/stenting without thoracic endovascular aortic repair group (24% vs 11%, P = .15). Conclusions: Multiple strategies exist for the management of TBAD with MesMP; however, a majority of cases were managed endovascularly. Despite advances in therapies, mortality remains high at 13%.

Published in JTCVS Open

ISSN: 2666-2736 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Surgery
Website: https://www.journals.elsevier.com/jtcvs-open

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