Mid- and long-term outcomes of thoracic endovascular aortic repair in acute and subacute uncomplicated type B aortic dissection

Matti Jubouri, Mohammed Al-Tawil, Ho Cheung Anthony Yip, Ali Bashir, Sven Zhen Cian Patrick Tan, Mohamad Bashir, Richard Anderson, Damian Bailey, Christoph A. Nienaber, Joseph S. Coselli, Ian Williams

    Research output: Contribution to journalArticlepeer-review

    Abstract

    BACKGROUND: Uncomplicated type B aortic dissection (un-TBAD) has been managed conservatively with medical therapy to control the heart rate and blood pressure to limit disease progression, in addition to radiological follow-up. However, several trials and observational studies have investigated the use of thoracic endovascular aortic repair (TEVAR) in un-TBAD and suggested that TEVAR provides a survival benefit over medical therapy. Outcomes of TEVAR have also been linked with the timing of intervention.

    AIMS: The scope of this review is to collate and summarize all the evidence in the literature on the mid- and long-term outcomes of TEVAR in un-TBAD, confirming its superiority. We also aimed to investigate the relationship between the timing of TEVAR intervention and results.

    METHODS: We carried out a comprehensive literature search on multiple electronic databases including PubMed, Scopus, and EMBASE to collate and summarize all research evidence on the mid- and long-term outcomes of TEVAR in un-TBAD, as well as its relationship with intervention timing.

    RESULTS: TEVAR has proven to be a safe and effective tool in un-TBAD, offering superior mid- and long-term outcomes including all-cause and aorta-related mortality, aortic-specific adverse events, aortic remodeling, and need for reintervention. Additionally, performing TEVAR during the subacute phase of dissection seems to yield optimal results.

    CONCLUSION: The evidence demonstrating a survival advantage in favor TEVAR over medical therapy in un-TBAD means that with further research, particular trials and observational studies, TEVAR could become the gold-standard treatment option for un-TBAD patients.

    Original languageEnglish
    Article number16349
    Pages (from-to)1328-1339
    Number of pages12
    JournalJournal of Cardiac Surgery
    Volume37
    Issue number5
    Early online date21 Feb 2022
    DOIs
    Publication statusPublished - May 2022

    Keywords

    • aortic dissection
    • aortic surgery
    • TEVAR
    • Type B aortic dissection

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