Kreibich, Maximilian; Siepe, Matthias; Berger, Tim; Beyersdorf, Friedhelm; Soschynski, Martin; Schlett, Christopher L; Czerny, Martin; Rylski, Bartosz (2023). Intervention rates and outcomes in medically managed uncomplicated descending thoracic aortic dissections. The journal of thoracic and cardiovascular surgery, 165(3), 958-965.e4. Elsevier 10.1016/j.jtcvs.2021.03.126
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Intervention_rates_and_outcomes_in_medically_managed_uncomplicated_descending_thoracic_aortic_dissections.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (1MB) |
OBJECTIVE
To evaluate the long-term incidence and outcome of aortic interventions for medically managed uncomplicated thoracic aortic dissections.
METHODS
Between January 2012 and December 2018, 91 patients were discharged home with an uncomplicated, medically treated aortic dissection (involving the descending aorta with or without aortic arch involvement, no ascending involvement). After a median period of 4 (first quartile: 2, third quartile: 11) months, 30 patients (33%) required an aortic intervention. Patient characteristics, radiographic, treatment, and follow-up data were compared for patients with and without aortic interventions. A competing risk regression model was analyzed to identify independent predictors of aortic intervention and to predict the risk for intervention.
RESULTS
Patients who underwent aortic interventions had significantly larger thoracic (P = .041) and abdominal (P = .015) aortic diameters, the dissection was significantly longer (P = .035), there were more communications between both lumina (P = .040), and the first communication was significantly closer to the left subclavian artery (P = .049). A descending thoracic aortic diameter exceeding 45 mm was predictive for an aortic intervention (P = .001; subdistribution hazard ratio: 3.51). The risk for aortic intervention was 27% ± 10% and 36% ± 11% after 1 and 3 years, respectively. Fourteen patients (47%) underwent thoracic endovascular aortic repair, 11 patients (37%) thoracic endovascular aortic repair and left carotid to subclavian bypass, 3 patients (10%) total arch replacement with the frozen elephant trunk technique, and 2 patients (7%) thoracoabdominal aortic replacement. We observed no in-hospital mortality.
CONCLUSIONS
The need for secondary aortic interventions in patients with initially medically managed, uncomplicated descending aortic dissections is substantial. The full spectrum of aortic treatment options (endovascular, hybrid, conventional open surgical) is required in these patients.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Heart Surgery |
UniBE Contributor: |
Siepe, Matthias |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1097-685X |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Vjollca Coli |
Date Deposited: |
03 Jan 2024 10:37 |
Last Modified: |
27 Feb 2024 14:27 |
Publisher DOI: |
10.1016/j.jtcvs.2021.03.126 |
PubMed ID: |
34001355 |
Uncontrolled Keywords: |
FET TEVAR aortic dissection frozen elephant trunk thoracic endovascular aortic repair thoracoabdominal aortic replacement |
BORIS DOI: |
10.48350/191024 |
URI: |
https://boris.unibe.ch/id/eprint/191024 |