What is the optimal timing for thoracic endovascular aortic repair in uncomplicated Type B aortic dissection?

Matti Jubouri, Mohamad Bashir, Sven Z.C.P. Tan, Damian Bailey, Richard Anderson, Christoph A. Nienaber, Joseph S. Coselli, Ian Williams

Allbwn ymchwil: Cyfraniad at gyfnodolynErthygl adolyguadolygiad gan gymheiriaid

Crynodeb

Background
Uncomplicated Stanford Type B aortic dissection (un-TBAD) is characterized by a tear in the aorta distal to the left subclavian artery without ascending aorta and arch involvement. Optimized 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 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 remodeling, 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.
Iaith wreiddiolSaesneg
Rhif yr erthygl16190
Tudalennau (o-i)993-1001
Nifer y tudalennau9
CyfnodolynJournal of Cardiac Surgery
Cyfrol37
Rhif cyhoeddi4
Dyddiad ar-lein cynnar30 Rhag 2021
Dynodwyr Gwrthrych Digidol (DOIs)
StatwsE-gyhoeddi cyn argraffu - 30 Rhag 2021

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