title: Impact of timing on major complications after thoracic endovascular aortic repair for acute type B aortic dissection.
abstract: OBJECTIVE
  Thoracic endovascular aortic repair (TEVAR) has been shown to have survival benefit in patients with complicated type B dissection compared with open surgery or medical therapy. We analyze the impact of timing of intervention from the onset of symptoms to TEVAR, and its relation to complications.
  
  
  METHODS
  Between 2005 and 2012, we performed 132 TEVARs for acute and subacute (<6 weeks) type B dissection; 186 other patients were managed with medical therapy only. Patients were followed in a clinical registry. Standard univariate and survival methods were used.
  
  
  RESULTS
  Of the 132 TEVARs for type B dissection, 70 were performed within 48 hours of presentation (Acute-Early); 44 between 48 hours and 14 days from presentation (Acute-Delayed); and 18 between 14 days and 6 weeks of presentation (Subacute). Demographic characteristics were similar among groups. Severe complications were more common in the Early-Acute and Delayed-Acute patients than in the Subacute patients (P = .04) Retrograde type A dissection tended to be more common in the Acute-Early group. Overall survival was similar among groups.
  
  
  CONCLUSIONS
  Delayed intervention appears to lower the risk of complications of TEVAR for aortic dissection in patients who are stable enough to wait. Among patients initially managed medically, new TEVAR indications were not uncommon, and such patients must be followed closely.
authors.affiliation: Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa. Electronic address: Nimesh.Desai@uphs.upenn.edu.
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
authors.affiliation: Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Gottret
authors.affiliation: Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Fenton
authors.initials: F
authors.lastname: McCarthy
authors.affiliation: Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Patrick
authors.initials: P
authors.lastname: Moeller
authors.affiliation: Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Rohan
authors.initials: R
authors.lastname: Menon
authors.affiliation: Division of Vascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Jackson
authors.affiliation: Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vallabhajosyula
authors.affiliation: Division of Vascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Wang
authors.affiliation: Division of Vascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Ronald
authors.initials: R
authors.lastname: Fairman
authors.affiliation: Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
mesh_terms: 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 / Q000009:adverse effects* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome