Key result
TEVAR is linked to fewer aortic events and lower mortality versus medical management.
Why the study?
Outcomes of comparisons between thoracic endovascular aortic repair and best medical treatment in patients with uncomplicated type B acute aortic dissection are inconsistent in published reports.
Does thoracic endovascular aortic repair (TEVAR) improve outcomes compared to best medical treatment in patients with uncomplicated type B acute aortic dissection?
Cohort (n=338)
Yes
Does thoracic endovascular aortic repair (TEVAR) improve outcomes compared to best medical treatment in patients with uncomplicated type B acute aortic dissection?
In patients with uncomplicated type B acute aortic dissection, TEVAR is associated with lower long-term all-cause mortality and fewer aortic-related adverse events compared to medical management alone.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“TEVAR should be considered as a therapy for selective patients with uncomplicated type B acute aortic dissection who have long life expectancy.”
“Postponing TEVAR to the subacute phase could have avoided their one case of retrograde dissection while still allowing ample time for TEVAR-induced remodeling before the window of plasticity/opportunity starts closing about day 100. Why rush when the strategy allows for a fully elective TEVAR including neck vessel debranching, if necessary, for an optimal landing zone?”
TEVAR associated with lower mortality than BMT in uncomplicated type B dissection; leaves open need for randomized trials before practice change.
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has been used in patients with uncomplicated type B acute aortic dissection (B-AAD) to reduce late morbidity and mortality. The outcomes of comparisons between TEVAR and best medical treatment (BMT) on patients with uncomplicated type B-AAD are inconsistent in the published reports. OBJECTIVES: This study sought to further clarify the early and long-term (11-year) outcomes of TEVAR in patients with uncomplicated type B-AAD compared with those with BMT treatment. METHODS: Between February 2003 and August 2014, 338 patients with uncomplicated type B-AAD were retrospectively identified in 3 tertiary medical centers. Information about baseline characteristics was collected from medical records. Images were retrieved from the imaging archiving system, and the thrombosis status of the false lumen and extent of the dissection were evaluated via computed tomography angiography. Early and late outcomes were recorded and analyzed. RESULTS: TEVAR procedures were performed on 184 patients (TEVAR group) and BMT for 154 patients (BMT group). Early events and 30-day mortality were not significantly different between the 2 groups. Patients receiving BMT had significantly higher aortic-related adverse events compared with those in the TEVAR group (p = 0.025). All-cause mortality with TEVAR was significantly lower than that of BMT (p = 0.01). CONCLUSIONS: This study confirmed the feasibility of TEVAR for uncomplicated type B aortic dissection in the acute setting with fewer aortic-related adverse events and a lower mortality rate compared with BMT.
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Qin et al. (2016) conducted a cohort in Uncomplicated type B acute aortic dissection (B-AAD) (n=338). Thoracic endovascular aortic repair (TEVAR) vs. Best medical treatment (BMT) was evaluated on Aortic-related adverse events and all-cause mortality (p=0.025 for aortic-related adverse events; 0.01 for all-cause mortality). Thoracic endovascular aortic repair (TEVAR) was associated with significantly fewer aortic-related adverse events (p=0.025) and lower all-cause mortality (p=0.01) compared with medical management.
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