Follow Up of Patients after Endovascular Treatment of Type B Aortic Dissection Demonstrates Good Mid-term Survival

Abstract

Introduction: Thoracic endovascular aortic repair (TEVAR) is the mainstay of treatment for “complicated” type B aortic dissection and, although the subject of much debate, increasingly used to protect against late aortic sequelae in “uncomplicated” cases. Our aim was to collate a single centre experience of TEVAR for treatment of type B aortic dissection over an 12-year period. Methods: Data was collected from a prospectively maintained local registry and review of case notes. Treatment <14 days after the onset of symptoms was deemed as acute intervention, 14-30 days subacute, and >30 days chronic. Complicated dissection was defined as rapidly expanding dissection, aortic rupture, end-organ malperfusion, or uncontrollable hypertension or pain. Statistical analysis was performed using SPSS with analysis of long term survival by Kaplan-Meir. Results: 127 patients (74% men) underwent endovascular repair for type B aortic dissection between January 2006 and December 2017. Mean age of patients was 65.4 (SD 11.4) years. 53 repairs were carried out in the acute setting, 20 in subacute, and 54 in chronic. 41 (32.3%) were for uncomplicated dissection. The proportion of repairs performed for uncomplicated dissection decreased during the study period; 26/57 in 2006-2011 compared with 15/70 in 2012-2017. In-hospital mortality was 9.4% (11.3% for acute, 10.0% for subacute, and 7.4% for chronic). In-hospital mortality for uncomplicated dissection was 4.9% compared with 11.6% for complicated. None of the differences in mortality reached statistical significance. After a median follow-up of 2.3 years (IQR 0.7-5.1), one year survival was 83.8% and 3-year survival 70.1%. Conclusion: The present series demonstrates comparable in hospital mortality rates in patients treated for type B aortic dissection, regardless of the timing of the intervention, and good longer term survival after the index aortic intervention. This highlights the importance of planning an index repair strategy that “future proofs” the aorta, facilitating subsequent interventions that are likely to be required over the patient’s lifetime.