Khawaja A Ammar, Matthew McDiarmid, Lauren Richards, Mark W Mewissen, M Fuad Jan, Eric S Weiss, Tanvir Bajwa
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We aimed to determine if TEVAR for uTBAD results in better outcomes compared with OMT.</p><p><strong>Methods: </strong> This was a retrospective chart review of all patients with uTBAD during the last 13 years, with 46 cases (TEVAR group) and 56 controls (OMT group).</p><p><strong>Results: </strong> In the TEVAR group, the procedure duration of 2.5 hours resulted in 100% procedural success for stent placement, with 63% undergoing protective left subclavian artery bypass, 0% mortality or stroke, and a lower readmission rate (1 vs. 2%; <i>p</i> = 0.04 in early TEVAR cases), but a longer length of stay (12.9 vs. 8.5 days: <i>p</i> = 0.006). The risk of all-cause long-term mortality was markedly reduced in the TEVAR group (RR = 0.38; <i>p</i> = 0.01), irrespective of early (<14 days) versus late intervention. On follow-up computed tomography imaging, the false lumen stabilized or decreased in 85% of cases, irrespective of intervention timing.</p><p><strong>Conclusion: </strong> TEVAR performed solely in the CCL is safe and effective, with lower all-cause mortality than OMT. These data, in collaboration with previous data on TEVAR in different settings, call for consideration of an update of practice guidelines.</p>","PeriodicalId":52392,"journal":{"name":"AORTA","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4f/f4/10-1055-s-0043-1768201.PMC10232024.pdf","citationCount":"0","resultStr":"{\"title\":\"Early Thoracic Endovascular Aortic Repair of Uncomplicated Type B Thoracic Aortic Dissection: An Aorta Team Approach.\",\"authors\":\"Khawaja A Ammar, Matthew McDiarmid, Lauren Richards, Mark W Mewissen, M Fuad Jan, Eric S Weiss, Tanvir Bajwa\",\"doi\":\"10.1055/s-0043-1768201\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong> Although uncomplicated Type B aortic dissection (uTBAD) is traditionally treated with optimal medical therapy (OMT) as per guidelines, recent studies, performed primarily in interventional radiology or surgical operating rooms, suggest superiority of thoracic endovascular aortic repair (TEVAR) over OMT due to recent advancements in endovascular technologies. We report a large, single-center, case control study of TEVAR versus OMT in this population, undertaken solely in a cardiac catheterization laboratory (CCL) with a cardiologist and surgeon. We aimed to determine if TEVAR for uTBAD results in better outcomes compared with OMT.</p><p><strong>Methods: </strong> This was a retrospective chart review of all patients with uTBAD during the last 13 years, with 46 cases (TEVAR group) and 56 controls (OMT group).</p><p><strong>Results: </strong> In the TEVAR group, the procedure duration of 2.5 hours resulted in 100% procedural success for stent placement, with 63% undergoing protective left subclavian artery bypass, 0% mortality or stroke, and a lower readmission rate (1 vs. 2%; <i>p</i> = 0.04 in early TEVAR cases), but a longer length of stay (12.9 vs. 8.5 days: <i>p</i> = 0.006). 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引用次数: 0
摘要
背景:尽管无并发症的B型主动脉夹层(uTBAD)传统上按照指南采用最佳药物治疗(OMT)治疗,但最近主要在介入放射学或外科手术室进行的研究表明,由于血管内技术的最新进展,胸廓血管内主动脉修复(TEVAR)优于OMT。我们报告了一项大型单中心病例对照研究,该研究仅在心导管实验室(CCL)与心脏病专家和外科医生进行TEVAR与OMT的比较。我们的目的是确定TEVAR治疗uTBAD的结果是否比OMT更好。方法:回顾性分析13年来所有uTBAD患者,其中TEVAR组46例,OMT组56例为对照。结果:在TEVAR组中,手术时间为2.5小时,支架置入术成功率为100%,63%的患者接受了保护性左锁骨下动脉搭桥术,死亡率或卒中为0%,再入院率较低(1比2%;早期TEVAR病例p = 0.04),但住院时间较长(12.9 vs. 8.5天:p = 0.006)。TEVAR组全因长期死亡风险显著降低(RR = 0.38;结论:仅在CCL中进行TEVAR是安全有效的,其全因死亡率低于OMT。这些数据与以前在不同环境下的TEVAR数据相结合,要求考虑更新实践指南。
Early Thoracic Endovascular Aortic Repair of Uncomplicated Type B Thoracic Aortic Dissection: An Aorta Team Approach.
Background: Although uncomplicated Type B aortic dissection (uTBAD) is traditionally treated with optimal medical therapy (OMT) as per guidelines, recent studies, performed primarily in interventional radiology or surgical operating rooms, suggest superiority of thoracic endovascular aortic repair (TEVAR) over OMT due to recent advancements in endovascular technologies. We report a large, single-center, case control study of TEVAR versus OMT in this population, undertaken solely in a cardiac catheterization laboratory (CCL) with a cardiologist and surgeon. We aimed to determine if TEVAR for uTBAD results in better outcomes compared with OMT.
Methods: This was a retrospective chart review of all patients with uTBAD during the last 13 years, with 46 cases (TEVAR group) and 56 controls (OMT group).
Results: In the TEVAR group, the procedure duration of 2.5 hours resulted in 100% procedural success for stent placement, with 63% undergoing protective left subclavian artery bypass, 0% mortality or stroke, and a lower readmission rate (1 vs. 2%; p = 0.04 in early TEVAR cases), but a longer length of stay (12.9 vs. 8.5 days: p = 0.006). The risk of all-cause long-term mortality was markedly reduced in the TEVAR group (RR = 0.38; p = 0.01), irrespective of early (<14 days) versus late intervention. On follow-up computed tomography imaging, the false lumen stabilized or decreased in 85% of cases, irrespective of intervention timing.
Conclusion: TEVAR performed solely in the CCL is safe and effective, with lower all-cause mortality than OMT. These data, in collaboration with previous data on TEVAR in different settings, call for consideration of an update of practice guidelines.