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What is the optimal timing for Thoracic Endovascular Aortic Repair in uncomplicated Type B aortic dissection? Facts, fallacies and the future
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  • Matti Jubouri,
  • Mohamad Bashir,
  • Sven Zhen Cian Patrick Tan,
  • Damian Bailey,
  • Richard Anderson,
  • Christoph Nienaber,
  • Joseph S. Coselli,
  • Ian Williams
Matti Jubouri
Hull York Medical School
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Mohamad Bashir
Velindre University NHS Trust
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Sven Zhen Cian Patrick Tan
Queen Mary University of London Barts and The London School of Medicine and Dentistry
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Damian Bailey
University of South Wales Faculty of Life Sciences and Education
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Richard Anderson
University Hospital of Wales
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Christoph Nienaber
Royal Brompton and Harefield NHS Foundation Trust
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Joseph S. Coselli
Baylor College of Medicine Michael E DeBakey Department of Surgery
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Ian Williams
University Hospital of Wales
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Abstract

Background: Uncomplicated Stanford Type B aortic dissection (un-TBAD) is characterised by a tear in the aorta distal to the left subclavian artery without ascending aorta and arch involvement. Optimised cardiovascular control (blood pressure and heart rate) is the current gold standard treatment according to current international guidelines. However, emerging evidence indicates that Thoracic Endovascular Aortic Repair (TEVAR) is both safe and effective in the treatment of un-TBAD with improved long-term survival outcomes in combination with optimal medical therapy (OMT) relative to OMT alone. However, the optimal timeframe for intervention is not entirely clarified. Aims: This review critically addresses current state-of-the-art comparing TEVAR with OMT and corresponding clinical outcomes for un-TBAD based on timing of intervention. Methods: We carried out a comprehensive literature search on multiple electronic databases including PUBMED and Scopus in order to collate all research evidence on timing of TEVAR in uncomplicated Type B aortic dissection. Results: TEVAR has proven to be a safe and effective treatment for un-TBAD in combination with OMT through comparable survival outcomes, improved aortic remodelling, and relatively low periprocedural added risks. Though the timing of intervention remains controversial, it is becoming clear that performing TEVAR during the subacute phase of un-TBAD yields better outcomes compared to earlier and delayed (>90 days) intervention. Conclusions: Further research is required into both short and long-term outcomes of TEVAR in addition to its optimal therapeutic window for un-TBAD. With stronger evidence, TEVAR is likely to be adopted as the gold-standard intervention for un-TBAD with definitive timeframe guidelines.

Peer review status:ACCEPTED

09 Nov 2021Submitted to Journal of Cardiac Surgery
10 Nov 2021Assigned to Editor
10 Nov 2021Submission Checks Completed
10 Nov 2021Reviewer(s) Assigned
16 Nov 2021Review(s) Completed, Editorial Evaluation Pending
16 Nov 2021Editorial Decision: Accept