title: Thoracic endovascular aortic repair for acute complicated type B aortic dissection: superiority relative to conventional open surgical and medical therapy.
abstract: OBJECTIVE
  This study compared outcomes between thoracic endovascular aortic repair and conventional open surgical and medical therapies for acute complicated type B aortic dissection.
  
  
  METHODS
  From 2002 to 2010, a total of 170 patients with type B aortic dissections were retrospectively identified from the University of Pennsylvania aortic database. Of these 170 patients, 147 had acute type B aortic dissections (uncomplicated 70, complicated 77). For patients with acute complicated type B aortic dissections, management included thoracic endovascular aortic repair (group A) or conventional open surgical and medical therapies (group B).
  
  
  RESULTS
  In the 77 patients with acute complicated type B aortic dissections, thoracic endovascular aortic repair (group A) was performed in 45 patients (59%). In group B, 20 patients (26%) underwent open surgical repair and 12 (15%) had their conditions managed with medical therapy. Thoracic endovascular aortic repair was associated with lower in-hospital or 30-day mortality (n = 2, 4%) than conventional therapy (open surgical repair n = 8, 40%, medical therapy, n = 4, 33%, P = .006). Patients in group A (thoracic endovascular aortic repair) continued to show significantly improved survival at 1, 3, and 5 years (group A: 82%, 79%, and 79% vs group B: 58%, 52%, and 44%, P = .008).
  
  
  CONCLUSIONS
  Thoracic endovascular aortic repair for acute complicated type B dissection is associated with superior early outcome and improved midterm survival relative to conventional therapy. Longer follow-up demonstrating survival benefit is needed before definitive conclusion can be made.
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Zeeshan
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Woo
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Fairman
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D001027:Aortography / Q000379:methods; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
chemical_list: D002317:Cardiovascular Agents