Surgical treatment in the chronic phase for uncomplicated Stanford type B aortic dissection

• Published in: PloS one Vol. 19; no. 2; p. e0298644
• Main Authors: Matsushita, Akihito, Tabata, Minoru, Hattori, Takashi, Mihara, Wahei, Sato, Yasunori
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23-02-2024; Public Library of Science (PLoS)
• Subjects: Aortic Aneurysm, Thoracic - surgery; Aortic Dissection - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Care and treatment; Dissecting aneurysm; Endovascular Procedures - adverse effects; Heart; Humans; Patient outcomes; Retrospective Studies; Risk Factors; Surgery; Treatment Outcome; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0298644

The most appropriate surgical method for patients with uncomplicated type B aortic dissection (UTBAD) in the chronic phase remains controversial. This study evaluated the outcomes of patients with UTBAD who needed aortic treatment as well as the impact of the treatment method or indication criteria on their prognosis.
This retrospective review of 106 consecutive patients with aortic events in the chronic phase who underwent initial treatment for UTBAD between 2004 and 2021 comprised three groups: 19 patients who underwent endovascular repair (TEVAR), 38 who underwent open aortic repair and the medication group that included 49 patients. Aortic events were defined as a late operation or indication for operation for dissected aorta, aortic diameter (AD) ≥ 55 mm, rapid aortic enlargement (≥5 mm/6 months), and saccular aneurysmal change. The endpoint was all-cause death. We assessed the association between treatment methods or surgical indication criteria and mortality using a Cox regression analysis.
The 5-year actuarial mortality rates were 27.1% in the TEVAR group, 19.6% in the open aortic repair group, and 38.4% in the medication group (p = 0.86). Moreover, the 5-year actuarial mortality rates in patients who had AD ≥ 55 mm were significantly higher than those patients with other surgical indication criteria (41.2% vs. 18.7%, p < 0.01). Multivariable analysis revealed a significant difference in AD ≥ 55 mm (hazard ratio [HR]: 2.88, 95% confidence interval [CI] 1.38-6.02, p < 0.01) and age (HR: 1.09, 95% CI 1.05-1.13, p < 0.01).
Under the existing surgical indication criteria, there was no difference in mortality rates among patients with UTBAD based on their surgical treatment.