RR1. A Propensity Adjusted Analysis of Open and Endovascular Thoracic Aortic Repair for Chronic Type B Dissection: A 20-Year Evaluation

Abstract

Background. Optimal treatment of chronic type B aortic dissection (CBAD), whether open (open descending aortic repair, OAR) or endovascular (thoracic endovascular aortic repair, TEVAR), is controversial, suggesting a comparative analysis is warranted. Methods. One hundred twenty-two of 1,049 patients (1993 to 2013) undergoing descending aortic repair required intervention for CBAD 29.2 ± 34.9 months after the initial acute event and formed the study cohort (mean age 59.7 years). Those with degenerated residual type A dissection were excluded (n[ 65). Eighty-eight had extent IIIB CBAD; 11 had intramural hematoma. Indications for surgery included aneurysmal degeneration (n [ 105), rupture (n [ 8), acute or chronic dissection (n [ 8), and extension of dissection (n [ 1). Open strategy included descending (n [ 71) and thoracoabdominal repair (n [ 19), with hypothermic circulatory arrest used in 70 patients. The TEVAR was performed with (n [ 2) or without (n [ 30) visceral debranching. A treatment strategy propensity score incorporating time since initial acute event, CBAD extent, year of intervention, age, and selected comorbidities was constructed for multivariable analysis. Results. Early outcome included the following: 30-day mortality 4% (n [ 5); stroke 2% (n [ 2); permanent