Long-term results of the treatment of Stanford type B aortic dissection with medical and invasive therapy in Hungary

Abstract

Introduction and objective: Acute Stanford type B aortic dissection (ATBAD) is a potentially life-threatening condi-tion, which may require immediate intervention. This study aims to compare the short-and long-term results of medical, open surgical and endovascular management of ATBAD. Method: This is a retrospective, multi-centre cohort study, where patients admitted with acute and subacute TBAD between Jan. 2011 and Dec. 2020 were included. Results were compared between patients treated with medical, open surgical and thoracic endovascular aortic repair (TEVAR). 30-day mortality and major complications were registered. Survival and freedom from reintervention were noted. Results: A total number of 188 patients were included (69.7% man, mean age: 57 +/- 12.2 years). Hypertension was present in 88.8% of the patients. The 30-day mortality was more higher among patients who underwent open sur-gery, than among patients after TEVAR (26% and 16.7%, p = 0.12). Postoperative lung complication (22.6% and 19.4%) and vascular complication (25.9% and 16.7%) were common in both open and TEVAR groups. In the con-servatively treated group, three patients required intervention in the first 30 days (renal stent implantation: n = 2, TEVAR: n = 1). Median follow-up was 41 (IQR, 73.5) months. There was no significant difference in reoperations during follow-up between the three groups (p = 0.428). 6-year survival was significantly lower among patients with open surgery compared to the other two patient populations (54.8% vs. 79.3% and 75%, p = 0.017). Conclusion: In the invasive treatment of ATBAD, TEVAR is associated with superior short-and long-term compli-cation rate, and survival. There is no significant difference between the long-term results of medical therapy and TEVAR.