Midterm outcomes of thoracic endovascular aortic repair versus optimal medical therapy for uncomplicated acute type B dissectionCentral MessagePerspective
Objective: We sought to compare the early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) versus optimal medical therapy (OMT) for uncomplicated acute type B aortic dissection. Methods: Data were analyzed for 200 consecutive patients with uncomplicated acute type B aortic dissect...
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| Language: | English |
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Elsevier
2025-04-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273625000324 |
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| author | Kevin G. Hu, BS Wei-Guo Ma, MD Stevan Pupovac, MD Irbaz Hameed, MD Soraya Fereydooni, MD Eric S. Li, MD Haleigh Larson, MD Mohammad Zafar, MBBS Britt Tonnessen, MD Jonathan Cardella, MD Eduard Aboian, MD Raul Guzman, MD Cassius Ochoa Chaar, MD David Strosberg, MD Matthew Williams, MD Naiem Nassiri, MD Roland Assi, MD Prashanth Vallabhajosyula, MD, MS |
| author_facet | Kevin G. Hu, BS Wei-Guo Ma, MD Stevan Pupovac, MD Irbaz Hameed, MD Soraya Fereydooni, MD Eric S. Li, MD Haleigh Larson, MD Mohammad Zafar, MBBS Britt Tonnessen, MD Jonathan Cardella, MD Eduard Aboian, MD Raul Guzman, MD Cassius Ochoa Chaar, MD David Strosberg, MD Matthew Williams, MD Naiem Nassiri, MD Roland Assi, MD Prashanth Vallabhajosyula, MD, MS |
| author_sort | Kevin G. Hu, BS |
| collection | DOAJ |
| description | Objective: We sought to compare the early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) versus optimal medical therapy (OMT) for uncomplicated acute type B aortic dissection. Methods: Data were analyzed for 200 consecutive patients with uncomplicated acute type B aortic dissection from February 1992 to July 2022, including 147 with initial OMT and 53 undergoing TEVAR at index hospitalization. Baseline, intraoperative, and postoperative data, survival, and (re)intervention were compared between the two strategies. Results: In-hospital/30-day mortality was 7.5% (15/200) for the entire series, which was significantly lower in the TEVAR group compared with the OMT group (0 vs 10.2% [15/147]; P = .013). Thirty-day rates were 5.7% (3/53) for reintervention after TEVAR and 15.6% (23/147) for intervention after OMT (P = .064). Death within 30 days of (re)intervention was 0 (n = 0) in the TEVAR group and 18.4% (n = 14) in the OMT group (P = .063). There were no significant differences in the incidences of stroke, paraplegia, acute kidney injury, sepsis, or malperfusion syndrome after initial treatment. Kaplan–Meier survival in the TEVAR group was 92.3% (95% CI, 80.7-97.0) at 1 year and 3 years, significantly higher than in the OMT group (80.3% [95% CI, 72.8-85.8] and 71.4% [95% CI, 63.4-78.0]; P = .012). In patients aged 65 years or more, TEVAR also achieved a significantly higher survival, which was 93.7% (95% CI, 77.5-98.3 vs 69.7% [95% CI, 58.0-78.7]) at 1 year and 93.7% (95% CI, 77.3-98.3] vs 60.5% [95% CI, 48.7-70.5]) at 3 years (P < .001). Conclusions: In this single-institution experience, upfront TEVAR performed at index hospitalization for uncomplicated acute type B aortic dissection was associated with improved survival at early and midterm follow-up. |
| format | Article |
| id | doaj-art-acade5aedbca44cbac723402ea6289de |
| institution | OA Journals |
| issn | 2666-2736 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj-art-acade5aedbca44cbac723402ea6289de2025-08-20T02:12:08ZengElsevierJTCVS Open2666-27362025-04-0124677610.1016/j.xjon.2024.12.013Midterm outcomes of thoracic endovascular aortic repair versus optimal medical therapy for uncomplicated acute type B dissectionCentral MessagePerspectiveKevin G. Hu, BS0Wei-Guo Ma, MD1Stevan Pupovac, MD2Irbaz Hameed, MD3Soraya Fereydooni, MD4Eric S. Li, MD5Haleigh Larson, MD6Mohammad Zafar, MBBS7Britt Tonnessen, MD8Jonathan Cardella, MD9Eduard Aboian, MD10Raul Guzman, MD11Cassius Ochoa Chaar, MD12David Strosberg, MD13Matthew Williams, MD14Naiem Nassiri, MD15Roland Assi, MD16Prashanth Vallabhajosyula, MD, MS17Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnDivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn; Address for reprints: Prashanth Vallabhajosyula, MD, Director, Yale Aortic Institute, Director, Yale Pulmonary Thromboendarterectomy Program Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar St BB204, New Haven, CT 06520.Objective: We sought to compare the early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) versus optimal medical therapy (OMT) for uncomplicated acute type B aortic dissection. Methods: Data were analyzed for 200 consecutive patients with uncomplicated acute type B aortic dissection from February 1992 to July 2022, including 147 with initial OMT and 53 undergoing TEVAR at index hospitalization. Baseline, intraoperative, and postoperative data, survival, and (re)intervention were compared between the two strategies. Results: In-hospital/30-day mortality was 7.5% (15/200) for the entire series, which was significantly lower in the TEVAR group compared with the OMT group (0 vs 10.2% [15/147]; P = .013). Thirty-day rates were 5.7% (3/53) for reintervention after TEVAR and 15.6% (23/147) for intervention after OMT (P = .064). Death within 30 days of (re)intervention was 0 (n = 0) in the TEVAR group and 18.4% (n = 14) in the OMT group (P = .063). There were no significant differences in the incidences of stroke, paraplegia, acute kidney injury, sepsis, or malperfusion syndrome after initial treatment. Kaplan–Meier survival in the TEVAR group was 92.3% (95% CI, 80.7-97.0) at 1 year and 3 years, significantly higher than in the OMT group (80.3% [95% CI, 72.8-85.8] and 71.4% [95% CI, 63.4-78.0]; P = .012). In patients aged 65 years or more, TEVAR also achieved a significantly higher survival, which was 93.7% (95% CI, 77.5-98.3 vs 69.7% [95% CI, 58.0-78.7]) at 1 year and 93.7% (95% CI, 77.3-98.3] vs 60.5% [95% CI, 48.7-70.5]) at 3 years (P < .001). Conclusions: In this single-institution experience, upfront TEVAR performed at index hospitalization for uncomplicated acute type B aortic dissection was associated with improved survival at early and midterm follow-up.http://www.sciencedirect.com/science/article/pii/S2666273625000324outcomesTEVARtreatmenttype B aortic dissection/uncomplicated |
| spellingShingle | Kevin G. Hu, BS Wei-Guo Ma, MD Stevan Pupovac, MD Irbaz Hameed, MD Soraya Fereydooni, MD Eric S. Li, MD Haleigh Larson, MD Mohammad Zafar, MBBS Britt Tonnessen, MD Jonathan Cardella, MD Eduard Aboian, MD Raul Guzman, MD Cassius Ochoa Chaar, MD David Strosberg, MD Matthew Williams, MD Naiem Nassiri, MD Roland Assi, MD Prashanth Vallabhajosyula, MD, MS Midterm outcomes of thoracic endovascular aortic repair versus optimal medical therapy for uncomplicated acute type B dissectionCentral MessagePerspective JTCVS Open outcomes TEVAR treatment type B aortic dissection/uncomplicated |
| title | Midterm outcomes of thoracic endovascular aortic repair versus optimal medical therapy for uncomplicated acute type B dissectionCentral MessagePerspective |
| title_full | Midterm outcomes of thoracic endovascular aortic repair versus optimal medical therapy for uncomplicated acute type B dissectionCentral MessagePerspective |
| title_fullStr | Midterm outcomes of thoracic endovascular aortic repair versus optimal medical therapy for uncomplicated acute type B dissectionCentral MessagePerspective |
| title_full_unstemmed | Midterm outcomes of thoracic endovascular aortic repair versus optimal medical therapy for uncomplicated acute type B dissectionCentral MessagePerspective |
| title_short | Midterm outcomes of thoracic endovascular aortic repair versus optimal medical therapy for uncomplicated acute type B dissectionCentral MessagePerspective |
| title_sort | midterm outcomes of thoracic endovascular aortic repair versus optimal medical therapy for uncomplicated acute type b dissectioncentral messageperspective |
| topic | outcomes TEVAR treatment type B aortic dissection/uncomplicated |
| url | http://www.sciencedirect.com/science/article/pii/S2666273625000324 |
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