Background: Data on the best management option for type B aortic dissection are still insufficient. The general consensus is to treat stable, acute, uncomplicated TBAD medically followed by regular ambulatory visits and imaging while interventional therapy is recommended for acute complicated TBAD. However, most Filipino patients are treated medically due to the high cost and risk of surgery.This study was conducted to evaluate the outcomes of acute complicated type B aortic dissection undergoing medical therapy alone, minimally invasive therapy (TEVAR) plus medical management and surgical plus medical management.
Methods: This is a retrospective cohort study done at Philippine Heart Center involving 44 adult patients admitted from January 2010 - June 2015 with diagnosis of acute complicated TBAD. Of these patients, 32 were treated medically, 10 underwent surgery and only 2 patients had TEVAR. Outcomes of interest include persistent pain, vascular complications, re-intervention from the initial management strategy and death.
Results: Majority of the patients were male, hypertensive and smoker. Only 34% had concomitant CAD. 20% of patients had aneurysm prior to the occurrence of dissection. The overall mortality rate is 22.7%, higher for the interventional group in the first 30-days, but mortality is increased in the medical group in the long-term. Patients in the interventional group have longer time from onset of symptoms to initiation of therapy however patients in the medical group have bigger false lumen diameter. The 5-year survival is estimated at 75% for conservative therapy, 90% for open surgical repair and 50% for the endovascular approach. Major outcome occurred in 53% of patients in the medical and 33% of patients in the interventional group (p=0.318).
Conclusion: Open surgical repair is still the standard therapy in patients presenting with acute complicated TBAD. The suboptimal rates of morbidity and mortality of endovascular therapy cannot be concluded in the study because of the very small number of patients subjected this treatment strategy. Prospective studies are therefore recommended to empower the small cohort studies to arrive at more reliable conclusions.