Complicated acute type B dissection: is surgery still the best option?: a report from the International Registry of Acute Aortic Dissection.
OBJECTIVE
Impact on survival of different treatment strategies was analyzed in 571 patients with acute type B aortic dissection enrolled from 1996 to 2005 in the International Registry of Acute Aortic Dissection.


BACKGROUND
The optimal treatment for acute type B dissection is still a matter of debate.


METHODS
Information on 290 clinical variables were compared, including demographics; medical history; clinical presentation; physical findings; imaging studies; details of medical, surgical, and endovascular management; in-hospital clinical events; and in-hospital mortality.


RESULTS
Of the 571 patients with acute type B aortic dissection, 390 (68.3%) were treated medically, 59 (10.3%) with standard open surgery and 66 (11.6%) with an endovascular approach. Patients who underwent emergency endovascular or open surgery were younger (mean age 58.8 years, p < 0.001) than their counterparts treated conservatively, and had male preponderance and hypertension in 76.9%. Patients submitted to surgery presented with a wider aortic diameter than patients treated by interventional techniques or by medical therapy (5.36 +/- 1.7 cm vs. 4.62 +/- 1.4 cm vs. 4.47 +/- 1.4 cm, p = 0.003). In-hospital complications occurred in 20% of patients subjected to endovascular technique and in 40% of patients after open surgical repair. In-hospital mortality was significantly higher after open surgery (33.9%) than after endovascular treatment (10.6%, p = 0.002). After propensity and multivariable adjustment, open surgical repair was associated with an independent increased risk of in-hospital mortality (odds ratio: 3.41, 95% confidence interval: 1.00 to 11.67, p = 0.05).


CONCLUSIONS
In the International Registry of Acute Aortic Dissection, the less invasive nature of endovascular treatment seems to provide better in-hospital survival in patients with acute type B dissection; larger randomized trials or comprehensive registries are needed to access impact on outcomes.
Fattori
Rossella
R
University Hospital S. Orsola, Bologna, Italy. rossella.fattori@unibo.it
Tsai
Thomas T
TT
Myrmel
Truls
T
Evangelista
Arturo
A
Cooper
Jeanna V
JV
Trimarchi
Santi
S
Li
Jin
J
Lovato
Luigi
L
Kische
Stephan
S
Eagle
Kim A
KA
Isselbacher
Eric M
EM
Nienaber
Christoph A
CA
D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000401:mortality / Q000628:therapy*; D001014:Aortic Aneurysm / Q000150:complications / Q000401:mortality / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007391:International Cooperation; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D018579:Patient Selection; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality
D002317:Cardiovascular Agents