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

Peer review status:ACCEPTED

07 Jul 2021Submitted to Journal of Cardiac Surgery
07 Jul 2021Assigned to Editor
07 Jul 2021Submission Checks Completed
08 Jul 2021Editorial Decision: Accept