PMID- 23761415
OWN - NLM
STAT- MEDLINE
DCOM- 20140509
LR  - 20221207
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 44
IP  - 3
DP  - 2013 Sep
TI  - Optimal treatment for patients with chronic Stanford type B aortic dissection: 
      endovascularly, surgically or both?
PG  - e165-74; discussion e174
LID - 10.1093/ejcts/ezt291 [doi]
AB  - OBJECTIVES: Patients with chronic Stanford type B aortic dissections (TBAD) are 
      traditionally treated medically, but some of the affected thoracic and 
      thoracoabdominal aortic segments progress to large aneurysms with a significant 
      risk of rupture. The purpose of this study is to retrospectively evaluate, with 
      an 'all-comers' approach, the survival and the outcome of patients following 
      thoracic endovascular aortic repair (TEVAR) or conventional open surgery for 
      chronic TBAD as a first-line therapy or a secondary option after failed medical 
      treatment. METHODS: Between January 2000 and May 2010, 80 consecutive patients 
      (59 males, median age 63, inter-quartile range (IQR) 55-69) suffering from 
      chronic TBAD were treated at our institution. Thirty-three were treated medically 
      (Group A, median age: 65, IQR: 58.5-71.5), 32 received TEVAR (Group B, median 
      age: 62, IQR: 54-67.5) and 15 patients underwent conventional open surgery (Group 
      C, median age: 61, IQR: 54-66). The median follow-up was 42 months (range: 
      0.1-124.7) and 100% complete. RESULTS: There were no significant differences with 
      regard to age, gender and associated comorbidities between the treatment groups. 
      The overall hospital mortality for chronic TBAD was 6.3% (n = 5); in-hospital 
      mortalities for Groups A, B and C were 3.0, 6.2 and 13.4%, respectively. The 
      incidence of major complications, such as paraplegia, malperfusion, renal failure 
      and cardiac arrhythmia, did not significantly differ between the three groups. 
      Postoperative stroke occurred more often after conventional open surgery (Group 
      C: 13.3%; P = 0.07). Reintervention for TBAD pathology was required in Groups A, 
      B and C in 12.1, 28.1 and 0%, respectively (P = 0.03). Secondary open surgery 
      post-TEVAR was required in 7 cases (21.8%) with no postoperative paraplegia. 
      CONCLUSIONS: Open surgery for extensive thoracic and thoracoabdominal repair in 
      chronic TBAD may be performed with acceptable early and mid-term outcomes. TEVAR 
      for aortic complications in patients with chronic dissection may be successfully 
      performed as a first-stage procedure in order to stabilize the patient and serve 
      as a 'bridge' to secondary open surgery. However, close surveillance is mandatory 
      for the timely detection of aneurysm enlargement, malperfusion or impending 
      rupture after TEVAR.
FAU - Nozdrzykowski, Michal
AU  - Nozdrzykowski M
AD  - Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, 
      Leipzig, Germany.
FAU - Etz, Christian D
AU  - Etz CD
FAU - Luehr, Maximilian
AU  - Luehr M
FAU - Garbade, Jens
AU  - Garbade J
FAU - Misfeld, Martin
AU  - Misfeld M
FAU - Borger, Michael A
AU  - Borger MA
FAU - Mohr, Friedrich-Wilhelm
AU  - Mohr FW
LA  - eng
PT  - Journal Article
DEP - 20130612
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Aged
MH  - Aortic Dissection/*surgery
MH  - Aortic Aneurysm/*surgery
MH  - Blood Vessel Prosthesis Implantation/adverse effects/methods
MH  - Endovascular Procedures/adverse effects/*methods
MH  - Female
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/etiology
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Aortic surgery
OT  - Chronic type B aortic dissection (complicated, uncomplicated)
OT  - Descending aorta
OT  - Thoracic endovascular aortic repair
OT  - Throacoabdominal aorta
EDAT- 2013/06/14 06:00
MHDA- 2014/05/10 06:00
CRDT- 2013/06/14 06:00
PHST- 2013/06/14 06:00 [entrez]
PHST- 2013/06/14 06:00 [pubmed]
PHST- 2014/05/10 06:00 [medline]
AID - ezt291 [pii]
AID - 10.1093/ejcts/ezt291 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2013 Sep;44(3):e165-74; discussion e174. doi: 
      10.1093/ejcts/ezt291. Epub 2013 Jun 12.