loading page

Is TEVAR Really Needed for Uncomplicated Type B Aortic Dissection?
  • Sven Zhen Cian Patrick Tan,
  • Hazem Elsantawy,
  • Amr Abdelhaliem
Sven Zhen Cian Patrick Tan
Queen Mary University of London Barts and The London School of Medicine and Dentistry

Corresponding Author:[email protected]

Author Profile
Hazem Elsantawy
Royal Blackburn Hospital
Author Profile
Amr Abdelhaliem
East Lancashire Hospitals NHS Trust
Author Profile

Abstract

Thoracic endovascular aortic repair (TEVAR) has quickly become the mainstay of treatment for acute aortic dissection, in particular cases of acute complicated Stanford Type B dissection (co-TBAD). Necessarily, TEVAR carries with it the risk of postoperative complications, including stroke and renal failure. As a result, the management of patients with uncomplicated type B aortic dissection (un-TBAD), which is generally accepted as being less severe, are safely managed via optimal medical therapy (OMT) alone. However, despite OMT, patients with un-TBAD are at substantial risk of severe disease progression requiring delayed intervention. The cost-benefit ratio associated with TEVAR for un-TBAD is therefore of key interest. Howard and colleagues produced a fascinating systematic review and meta-analysis investigating the clinical outcomes of TEVAR for complicated and uncomplicated TBAD. Their data suggests that there is no significant difference in in-hospital mortality or 5-year survival between TEVAR for un-TBAD and co-TBAD, although the 30-day mortality rate appeared to be higher in the co-TBAD cohort. Patients with co-TBAD appeared to also be at a higher risk of postoperative stroke and TEVAR endoleak, while un-TBAD patients were at a higher risk of postoperative renal failure. Further prospective research into these relationships are recommended to fully elucidate the comparative efficacies of TEVAR for un-TBAD and co-TBAD.
07 Jul 2021Submitted to Journal of Cardiac Surgery
07 Jul 2021Submission Checks Completed
07 Jul 2021Assigned to Editor
08 Jul 2021Editorial Decision: Accept
Oct 2021Published in Journal of Cardiac Surgery volume 36 issue 10 on pages 3831-3833. 10.1111/jocs.15828