Early and Long-term Outcome after Thoracic Endovascular Aortic Repair (TEVAR) for Acute Complicated Type B Aortic Dissection

Background: Uncomplicated Stanford Type B aortic dissection (un-TBAD) is characterised by a tear in the aorta distal to the left subclavian artery without ascending aorta and arch involvement. Optimised cardiovascular control (blood pressure and heart rate) is the current gold standard treatment according to current international guidelines. However, emerging evidence indicates that Thoracic Endovascular Aortic Repair (TEVAR) is both safe and effective in the treatment of un-TBAD with improved long-term survival outcomes in combination with optimal medical therapy (OMT) relative to OMT alone. However, the optimal timeframe for intervention is not entirely clarified. Aims: This review critically addresses current state-of-the-art comparing TEVAR with OMT and corresponding clinical outcomes for un-TBAD based on timing of intervention. Methods: We carried out a comprehensive literature search on multiple electronic databases including PUBMED and Scopus in order to collate all research evidence on timing of TEVAR in uncomplicated Type B aortic dissection. Results: TEVAR has proven to be a safe and effective treatment for un-TBAD in combination with OMT through comparable survival outcomes, improved aortic remodelling, and relatively low periprocedural added risks. Though the timing of intervention remains controversial, it is becoming clear that performing TEVAR during the subacute phase of un-TBAD yields better outcomes compared to earlier and delayed (>90 days) intervention. Conclusions: Further research is required into both short and long-term outcomes of TEVAR in addition to its optimal therapeutic window for un-TBAD. With stronger evidence, TEVAR is likely to be adopted as the gold-standard intervention for un-TBAD with definitive timeframe guidelines.

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The Impact of Thoracic Endovascular Aortic Repair on Long-Term Survival in Type B Aortic Dissection

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2017.06.016 ◽

2018 ◽

Vol 105 (1) ◽

pp. 31-38 ◽

Cited By ~ 26

Author(s):

Xiaoying Lou ◽

Edward P. Chen ◽

Yazan M. Duwayri ◽

Ravi K. Veeraswamy ◽

William D. Jordan ◽

...

Keyword(s):

Aortic Dissection ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type B ◽

Type B Aortic Dissection ◽

Term Survival ◽

Long Term Survival ◽

Aortic Repair ◽

The Impact

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Thrombocytopenia as a preoperative risk assessment tool in patients with type B aortic dissection after thoracic endovascular aortic repair

European Heart Journal ◽

10.1093/ehjci/ehaa946.2325 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E.M Xie ◽

J.T Liu ◽

F Yang ◽

H.Y Ding ◽

B.Q Hu ◽

...

Keyword(s):

Aortic Dissection ◽

Assessment Tool ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type B ◽

Type B Aortic Dissection ◽

Preoperative Risk ◽

Preoperative Risk Assessment ◽

Aortic Repair

Abstract Background Postoperative thrombocytopenia has been reported to be correlated with adverse events, but the prognostic value of baseline thrombocytopenia is unclear. This study was undertaken to evaluate the relationship between preoperative thrombocytopenia and adverse outcomes in patients with type B aortic dissection who underwent thoracic endovascular aortic repair (TEVAR). Methods A total of 825 patients with acute and sub-acute type B aortic dissection undergoing were TEVAR at a multidisciplinary aortic center were enrolled between January 2010 and December 2017. Patients were stratified on the basis of presence (n=149) or absence (n=676) of thrombocytopenia (platelet count, <150x109/L), according to preprocedural platelet counts. The primary outcome of interest was in-hospital mortality. Secondary outcomes of interest was long-term death. Results In the enrolled cohort, thrombocytopenia occurred in 149 (18.1%) patients. Patients with thrombocytopenia were older, were more commonly acute stage of TBAD, higher D-dimer level and had higher rates of abdominal vessel involvement and pericardial effusion. During the hospitalization period, 26 patients (3.2%) died, which was significantly higher in the thrombocytopenic group (8.1% versus 2.1%; P=0.001) Multivariate analyses revealed that thrombocytopenia was independently associated with in-hospital mortality (Table). During long-term follow-up (median duration 44.2 months), A total of 62 deaths were reported after discharge, including 40 (64.5%) aortic-related and unknown deaths, of which 12 and 50 patients for thrombocytopenia and non-thrombocytopenia group, respectively. Kaplan-Meier estimated rates of long-term all-cause mortality were higher for thrombocytopenia (log-rank test, P=0.014). Similar results were observed in a subset of aortic-related death (P=0.004) as well as aortic-related and unknown death (P=0.006), not non-aortic related death (P=0.878) (Figure 1). Conclusion Platelet counts, as simple and inexpensive indexes, were reliable to be used as a preoperative risk assessment tool for patients with type B aortic dissection undergoing thoracic endovascular aortic repair. Figure 1. Long-term Mortality Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): This research was supported by grant DFJH201807 from High-level Hospital Construction Project of Guangdong Provincial People's Hospital.

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