HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Anthony L. Estrera Eyal E. Porat Paul E. Achouh Jayesh Dhareshwar Riad Meada Hazim J. Safi Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Estrera, A. L. Articles by Safi, H. J. Search for Related Content PubMed PubMed Citation Articles by Estrera, A. L. Articles by Safi, H. J. Related Collections Great vessels

Ann Thorac Surg 2007;83:S842-S845
© 2007 The Society of Thoracic Surgeons

---

Supplement

Update on Outcomes of Acute Type B Aortic Dissection

^a Department of Cardiothoracic and Vascular Surgery, The University of Texas-Houston Medical School, Houston, Texas
^b Memorial Hermann Heart and Vascular Institute, Houston, Texas

Accepted for publication October 17, 2006.

^_* Address correspondence to Dr Estrera, Department of Cardiothoracic and Vascular Surgery, The University of Texas-Houston Medical School, 6410 Fannin St, Suite 450, Houston, TX 77030 (Email: anthony.l.estrera{at}uth.tmc.edu).

Presented at Aortic Surgery Symposium X, New York, NY, April 27–28, 2006.

BACKGROUND: The optimal treatment of acute type B aortic dissection remains controversial. This study reports early clinical outcomes of medical management for acute type B aortic dissection.

METHODS: Between January 2001 and April 2006, data on 159 consecutive patients (55 women [35%]) with the confirmed diagnosis of acute type B aortic dissection were prospectively collected and analyzed. Mean age was 62 years (range, 29 to 94). On admission, all patients were initiated on an acute type B aortic dissection protocol with the intent to manage all patients medically. Indications for surgical intervention included rupture, aortic expansion, retrograde dissection, malperfusion (visceral, peripheral), and intractable pain. All patients were followed up after discharge with serial clinical and radiographic examinations.

RESULTS: Overall hospital mortality was 8.8% (14/159): 17% (4/23) with procedural intervention, and 7.4% (10/136) when medical management was maintained. Early intervention was required in 23 patients (14.5%), of which 21 (13.2%) were open vascular/aortic procedures, and two (1.3%) were percutaneous aortic interventions. Morbidity included rupture (5.0%), stroke (5.0%), paraplegia (8.2%), bowel ischemia (5.7%), acute renal failure (20.1%), dialysis requirement (13.8%), and peripheral ischemia (3.8%). Mortality associated with complicated dissection (74/159) was 17%, and mortality associated with uncomplicated dissection (85/159) was 1.2% (p < 0.0003). Late vascular related procedures were performed in 11 (7.6%) of 144 cases (9 aortic, 2 peripheral vascular). The only independent risk factors for hospital mortality by multiple logistic regression analysis was rupture (p < 0.0009). Independent risk factors for mid-term death were history of chronic obstructive pulmonary disease (p < 0.002) and glomerular filtration rate at admission (p < 0.0001).

CONCLUSIONS: Medical management, especially for uncomplicated acute type B aortic dissection, is associated acceptable outcomes. This study provides current data for initial medical management of acute type B aortic dissection. Alternative strategies for the treatment of acute Type B aortic dissection should be compared with these results.

This article has been cited by other articles:

				L. Botta, V. Russo, C. La Palombara, M. Rosati, R. Di Bartolomeo, and R. Fattori Stent graft repair of descending aortic dissection in patients with Marfan syndrome: An effective alternative to open reoperation? J. Thorac. Cardiovasc. Surg., November 1, 2009; 138(5): 1108 - 1114. [Abstract] [Full Text] [PDF]

				J. Xiong, B. Jiang, W. Guo, S.-M. Wang, and X.-Y. Tong Endovascular stent graft placement in patients with type B aortic dissection: A meta-analysis in China J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 865 - 872. [Abstract] [Full Text] [PDF]

				K. J. Blount and K. D. Hagspiel Aortic Diameter, True Lumen, and False Lumen Growth Rates in Chronic Type B Aortic Dissection Am. J. Roentgenol., May 1, 2009; 192(5): W222 - W229. [Abstract] [Full Text] [PDF]

				V. S. Ramanath, J. K. Oh, T. M. Sundt III, and K. A. Eagle Acute Aortic Syndromes and Thoracic Aortic Aneurysm Mayo Clin. Proc., May 1, 2009; 84(5): 465 - 481. [Abstract] [Full Text] [PDF]

				R. Fattori, T. T. Tsai, T. Myrmel, A. Evangelista, J. V. Cooper, S. Trimarchi, J. Li, L. Lovato, S. Kische, K. A. Eagle, et al. Complicated Acute Type B Dissection: Is Surgery Still the Best Option?: A Report From the International Registry of Acute Aortic Dissection J. Am. Coll. Cardiol. Intv., August 1, 2008; 1(4): 395 - 402. [Abstract] [Full Text] [PDF]

				Y. Miyamoto, T. Ohata, M. Mitsuno, M. Yamamura, H. Tanaka, Y. Kobayashi, M. Ryomoto, and S. Fukui Long-term outcomes after entry closure and aneurysmal wall plication for type B aortic dissection Eur. J. Cardiothorac. Surg., February 1, 2008; 33(2): 152 - 156. [Abstract] [Full Text] [PDF]