Outcome of open and endovascular repair in acute type B aortic dissection: a retrospective and observational study.
BACKGROUND
The aim of the study was to analyze surgical and endovascular results in the treatment of acute type B aortic dissection (B AAD).


METHODS
Retrospective and observational analysis with patient inclusion between January 2001-December 2008 and follow-up ranged from 2 to 96 months (median = 47.2) was performed. Out of 51 consecutive patients with B AAD, 11 (21.6%) had to undergo open surgery (OS) and 13 (25.5%) endovascular treatment (TEVAR).


RESULTS
There was a significantly difference in early mortality in the TEVAR group (0/13,0%) vs OS group (4/11,36.4%, P < 0.05) and in the incidence of paraplegia/paraparesis (OS 2,28.6% vs TEVAR 1,7.7%, P < 0.05), renal failure (OS 3, 42.8% vs TEVAR 1, 7.7%, P < 0.05), respiratory failure (OS 2,28.6% vs TEVAR 1,7.7%, P < 0.05) and cerebrovascular accident (OS 1,14.3% vs TEVAR 0,0%, P < 0.05). The late mortality at a follow-up was 30.8% (4/13) in the TEVAR group and 42.8% (3/7) in the OS group, respectively (P = not significant). The cumulative survival rate after 1, 3 and 8 years was 93%, 84%, and 69% in the TEVAR group and 86%, 71% and 57% in the OS group, respectively. Endoleaks were diagnosed in 2/13 endovascular patients (15.4%).


CONCLUSIONS
TEVAR group had a significantly reduction in early mortality and postoperative complications. No significant differences were found in terms of cumulative survival at follow-up. On this basis TEVAR could be considered an option in the treatment of these complex cases with all proper reservation especially related to the small sample sizes examined.
Mastroroberto
Pasquale
P
Department of Experimental and Clinical Medicine, Cardiovascular Surgery Unit University Magna Graecia, viale Europa, 88100 Catanzaro, Italy. mastroroberto@unicz.it
Onorati
Francesco
F
Zofrea
Saverio
S
Renzulli
Attilio
A
Indolfi
Ciro
C
D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D019370:Observation; D011183:Postoperative Complications; D011506:Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
C472676:Bio-glue; D011506:Proteins