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Is There Any Role for Open Surgery Via Thoracotomy in Acute Type B Dissection?

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Controversies in Aortic Dissection and Aneurysmal Disease

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Abstract

Acute complicated type B aortic dissection is a life-threatening condition. During the last decade, the endovascular reconstruction of the true lumen by the use of stent grafts has gained increasing attention as the first line therapy in this disease entity. We summarized all published studies for TEVAR among patients with acute complicated type B aortic dissection (TBAD) with respect to clinical success, complications, and outcomes. Furthermore, we determined whether TEVAR reduces death and morbidity compared with open repair for TBAD. Studies were identified from a literature search using various databases, and included studies when three or more patients were reported and at least in-hospital mortality was reported. Data from comparative studies of TEVAR versus open repair of the descending aorta in TBAD were combined through meta-analysis. Ninety-four observational studies involving 5,982 patients were included in the present meta-analysis. In-hospital mortality was 10.6 % and other major complications (i.e, stroke (5.9 %), paraplegia (5.1 %), occurred less frequently. Long-term follow- up was limited to a mean of 23.3 months. During this time late aortic rupture was calculated for 4.3 % of cases. A complete false lumen thrombosis was estimated to occur in 77.4 % of cases. Late mortality reached 10.2 %. In comparative studies, 30-day/ in-hospital mortality and paraplegia/ paraparesis were significantly reduced for TEVAR versus open repair. There was no significant difference between TEVAR and open repair in patients with acute complicated TBAD for the following outcomes: late mortality, and stroke rate. This summary analysis suggests that endovascular treatment of complicated acute type B aortic dissection produces favourable initial outcomes and would seem to be a great addition to the treatment options for this condition. If the long term gains of TEVAR over open repair could be proven in the near future, unquestionable this technique will replace open surgery in the treatment of complicated type B aortic dissections.

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  1. Department of Vascular and Endovascular Surgery, University of Cologne, Kerpener Str. 62, Cologne, 50937, Germany

    Thomas Lübke MD, PD & Jan Brunkwall MD, PhD

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  1. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Robert S. Bonser

  2. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Domenico Pagano

  3. Thoracic and Cardiovascular Surgery Depts., Hannover Medical School, Hannover, Germany

    Axel Haverich

  4. University Hospitals Birmingham, Queen Elizabeth Hospital & Centre, Birmingham, United Kingdom

    Jorge Mascaro

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Lübke, T., Brunkwall, J. (2014). Is There Any Role for Open Surgery Via Thoracotomy in Acute Type B Dissection?. In: Bonser, R., Pagano, D., Haverich, A., Mascaro, J. (eds) Controversies in Aortic Dissection and Aneurysmal Disease. Springer, London. https://doi.org/10.1007/978-1-4471-5622-2_34

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