1
|
Laio KM, Shen CW, Huang YH, Lu CH, Lai HL, Chen CY. Prescription pattern and effectiveness of antihypertensive drugs in patients with aortic dissection who underwent surgery. Front Pharmacol 2023; 14:1291900. [PMID: 38026966 PMCID: PMC10667675 DOI: 10.3389/fphar.2023.1291900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background: Surgical patients with aortic dissection often require multiple antihypertensive drugs to control blood pressure. However, the prescription pattern and effectiveness of antihypertensive drugs for these patients are unclear. We aimed to investigate the prescription pattern and effectiveness of different classes of antihypertensive drugs in surgical patients with aortic dissection. Methods: Newly diagnosed aortic dissection patients who underwent surgery, aged >20 years, from 1 January 2012 to 31 December 2017 were identified. Patients with missing data, in-hospital mortality, aortic aneurysms, or congenital connective tissue disorders, such as Marfan syndrome, were excluded. Prescription patterns of antihypertensive drugs were identified from medical records of outpatient visits within 90 days after discharge. Antihypertensive drugs were classified into four classes: 1) β-blockers, 2) calcium channel blockers (CCBs), 3) renin-angiotensin system, and 4) other antihypertensive drugs. Patients were classified according to the number of classes of antihypertensive drugs as follows: 1) class 0, no exposure to antihypertensive drugs; 2) class 1, antihypertensive drugs of the same class; 3) class 2, antihypertensive drugs of two classes; 4) class 3, antihypertensive drugs of three classes; or 5) class 4, antihypertensive drugs of four classes. The primary composite outcomes included rehospitalization associated with aortic dissection, death due to aortic dissection, and all-cause mortality. Results: Most patients were prescribed two (28.87%) or three classes (28.01%) of antihypertensive drugs. In class 1, β-blockers were most commonly used (8.79%), followed by CCBs (5.95%). In class 2, β-blockers+CCB (10.66%) and CCB+RAS (5.18%) were the most common drug combinations. In class 3, β-blockers + CCB+RAS (14.84%) was the most prescribed combination. Class 0 had a significantly higher hazard of the composite outcome (HR, 2.1; CI, 1.46-3.02; p < 0.001) and all-cause mortality (HR, 2.34; CI, 1.56-3.51; p < 0.001) than class 1. There were no significant differences in hazards for rehospitalization associated with aortic dissection among classes. Conclusion: Among operated patients with type A aortic dissection, no specific type of antihypertensive drug was associated with a better outcome, whereas among those with type B aortic dissection, the use of β-blockers and CCBs was related to a significantly lower risk of the composite outcome.
Collapse
Affiliation(s)
| | - Chuan-Wei Shen
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yun-Hui Huang
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chun-Hui Lu
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hsuan-Lin Lai
- Division of Pharmacy, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chung-Yu Chen
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
2
|
Nam SW, Song IA, Oh TK. Trends in Cardiovascular Surgery in South Korea: A Nationwide Cohort Study from 2010 to 2019. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00335-X. [PMID: 37296025 DOI: 10.1053/j.jvca.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 04/14/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES We aimed to investigate mortality and its associated factors in cardiovascular surgery-associated intensive care unit (ICU) admissions in South Korea from 2010 to 2019. DESIGN Population-based cohort study. SETTING Data from the National Health Insurance Service database in South Korea were used in this study. PARTICIPANTS All adult patients admitted to the ICU associated with cardiovascular surgery in South Korea between January 1, 2010 and December 31, 2019 were analyzed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 62,794 ICU admissions associated with cardiovascular surgery were included in the analysis (median value of age: 65 years; 58.0% men). This included patients who underwent coronary artery bypass grafting (CABG) only (n = 10,704), valve-only surgery (n = 35,812), CABG + valve surgery (n = 3,230), aortic procedures (n = 7,968), and others (n = 5,080). The number of cardiovascular surgeries associated with ICU admissions was 4,409 in 2010, which gradually increased to 10,366 in 2019. The aortic procedure group had the highest 1-year mortality rate after cardiovascular surgery (15.7%), followed by the CABG + valve (13.2%), others (11.5%), CABG-only (9.5%), and valve-only (8.7%) groups. Invasive life support procedures during the ICU stay and hospital admission through the emergency room were potential risk factors for 1-year mortality after cardiovascular surgery. CONCLUSIONS Cardiovascular surgery-associated intensive care admissions gradually increased from 2010 to 2019 in South Korea. Among these patients, the highest 1-year mortality rate was observed in the aortic procedures group, followed by the CABG + valve, others, CABG-only, and valve-only groups.
Collapse
Affiliation(s)
- Sun Woo Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
| |
Collapse
|
3
|
Oberhuber A, Raddatz A, Betge S, Ploenes C, Ito W, Janosi RA, Ott C, Langheim E, Czerny M, Puls R, Maßmann A, Zeyer K, Schelzig H. Interdisciplinary German clinical practice guidelines on the management of type B aortic dissection. GEFASSCHIRURGIE 2023; 28:1-28. [PMCID: PMC10123596 DOI: 10.1007/s00772-023-00995-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 08/13/2023]
Affiliation(s)
- A. Oberhuber
- German Society of Vascular Surgery and Vascular Medicine (DGG); Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany
| | - A. Raddatz
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI); Department of Anaesthesiology, Critical Care and Pain Medicine, Saarland University Hospital, Homburg, Germany
| | - S. Betge
- German Society of Angiology and Vascular Medicine (DGG); Department of Internal Medicine and Angiology, Helios Hospital Salzgitter, Salzgitter, Germany
| | - C. Ploenes
- German Society of Geriatrics (DGG); Department of Angiology, Schön Klinik Düsseldorf, Düsseldorf, Germany
| | - W. Ito
- German Society of Internal Medicine (GSIM) (DGIM); cardiovascular center Oberallgäu Kempten, Hospital Kempten, Kempten, Germany
| | - R. A. Janosi
- German Cardiac Society (DGK); Department of Cardiology and Angiology, University Hospital Essen, Essen, Germany
| | - C. Ott
- German Society of Nephrology (DGfN); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Hypertension, Paracelsus Medical University, Nürnberg, Germany
| | - E. Langheim
- German Society of prevention and rehabilitation of cardiovascular diseaese (DGPR), Reha Center Seehof, Teltow, Germany
| | - M. Czerny
- German Society of Thoracic and Cardiovascular Surgery (DGTHG), Department University Heart Center Freiburg – Bad Krozingen, Freiburg, Germany
- Albert Ludwigs University Freiburg, Freiburg, Germany
| | - R. Puls
- German Radiologic Society (DRG); Institute of Diagnostic an Interventional Radiology and Neuroradiology, Helios Klinikum Erfurt, Erfurt, Germany
| | - A. Maßmann
- German Society of Interventional Radiology (DeGIR); Department of Diagnostic an Interventional Radiology, Saarland University Hospital, Homburg, Germany
| | - K. Zeyer
- Marfanhilfe e. V., Weiden, Germany
| | - H. Schelzig
- German Society of Surgery (DGCH); Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
4
|
Current status of adult cardiac surgery-part 2. Curr Probl Surg 2023; 60:101245. [PMID: 36642488 DOI: 10.1016/j.cpsurg.2022.101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/13/2022] [Indexed: 12/13/2022]
|
5
|
Jordan F, FitzGibbon B, Kavanagh EP, McHugh P, Veerasingam D, Sultan S, Hynes N. Endovascular versus open surgical repair for complicated chronic Type B aortic dissection. Cochrane Database Syst Rev 2021; 12:CD012992. [PMID: 34905228 PMCID: PMC8670553 DOI: 10.1002/14651858.cd012992.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Type B aortic dissection can lead to serious and life-threatening complications such as aortic rupture, stroke, renal failure, and paraplegia, all of which require intervention. Traditionally, these complications have been treated with open surgery. Recently however, endovascular repair has been proposed as an alternative. OBJECTIVES To assess the effectiveness and safety of thoracic aortic endovascular repair versus open surgical repair for treatment of complicated chronic Type B aortic dissection (CBAD). SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and AMED databases, as well as the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers, to 2 August 2021. We searched references of relevant articles retrieved through the electronic search for additional citations. SELECTION CRITERIA We considered all randomised controlled trials (RCTs) and controlled clinical trials (CCTs) assessing the effects of thoracic aortic endovascular repair (TEVAR) versus open surgical repair (OSR) for treatment of complicated chronic Type B aortic dissection (CBAD). Outcomes of interest were mortality (all-cause, dissection-related), neurological sequelae (stroke, spinal cord ischaemia/paresis-paralysis, vertebral insufficiency), morphological outcomes (false lumen thrombosis, progression of dissection, aortic diameters), acute renal failure, ischaemic symptoms (visceral ischaemia, limb ischaemia), re-intervention, and health-related quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently screened all titles and abstracts identified by the searches to identify those that met the inclusion criteria. From title and abstract screening, we did not identify any trials (RCTs or CCTs) that required full-text assessment. We planned to undertake data collection and analysis in accordance with recommendations described in the Cochrane Handbook for Systematic Reviews of Interventions. We planned to assess the certainty of evidence using GRADE. MAIN RESULTS We did not identify any trials (RCTs or CCTs) that met the inclusion criteria for this review. AUTHORS' CONCLUSIONS Due to lack of RCTs or CCTs investigating the effectiveness and safety of TEVAR compared to OSR for patients with complicated CBAD, we are unable to provide any evidence to inform decision-making on the optimal intervention for these patients. High-quality RCTs or CCTs addressing this objective are necessary. However, conducting such studies will be challenging for this life-threatening disease.
Collapse
Affiliation(s)
- Fionnuala Jordan
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Brian FitzGibbon
- Mechanical and Biomedical Engineering, National University of Ireland Galway, Galway, Ireland
| | - Edel P Kavanagh
- Department of Vascular and Endovascular Surgery, The Galway Clinic, Galway, Ireland
| | - Peter McHugh
- Mechanical and Biomedical Engineering, National University of Ireland Galway, Galway, Ireland
| | - Dave Veerasingam
- Cardiothoracic Surgery, Galway University Hospital, Galway, Ireland
| | - Sherif Sultan
- Vascular Surgery, Galway University Hospital, Galway, Ireland
| | - Niamh Hynes
- Department of Vascular and Endovascular Surgery, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
6
|
Nejim B, Mathlouthi A, Naazie I, Malas MB. The Effect of Intravenous and Oral Beta-Blocker Use in Patients with Type B Thoracic Aortic Dissection. Ann Vasc Surg 2021; 80:170-179. [PMID: 34656722 DOI: 10.1016/j.avsg.2021.07.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Beta-blockers have become the cornerstone for medical management in patients with chronic type B aortic dissection (TBAD). However, the effect of being on and/or receiving intravenous beta-blockers during hospitalization on outcomes of surgical repair of TBAD is not fully described. We sought to investigate this association during open surgical repair (OSR) and endovascular (Endo) intervention for nontraumatic TBAD. METHODS The Premier Healthcare Database was inquired (June/2009-March/2015). Patients with nontraumatic isolated TBAD were identified via ICD-9-CM diagnosis and procedural codes. Patients with codes that indicated TAAD were excluded. In-hospital mortality, cardiac complications (CHF, MI, arrythmia) and stroke were evaluated. Log binomial regression analyses with bootstrapping were performed to assess the relative risk of adverse outcomes. RESULTS A total of 1,752 were admitted for OSR (54.3%) and Endo (45.7%) TBAD repair. Use of oral beta blocker (BB) was 16.0% in OSR and 56.4% in Endo groups. In each arm, patients on BB were more likely to be diabetic, on aspirin or statin and more likely to receive additional IV BB than nonBB patients. There was no significant difference in age, sex, race, or prior history of CHF between BB and nonBB groups. Mortality was proportionally lower in patients on BB in OSR group (7.9% vs. 16.7%; P = 0.006) and Endo (3.3% vs. 9.2%; P < 0.001). The adjusted relative risk for mortality and stroke were significantly lower in oral BB recipients compared with none [aRR (95% CI): 0.53 (0.32-0.90) and 0.46 (0.25-0.87); both P ≤ 0.02]. IV metoprolol was the only IV BB that reduced mortality [aRR (95% CI): 0.62 (0.46-0.85); P = 0.003]. A dose of ≤10 mg was associated with significant mortality reduction: 6.3% (3.0-9.5%) compared with 8.1% (4.6-11.6%) in no IV BB group. Cardiac complications were not affected by BB use. CONCLUSIONS For patients with nontraumatic TBAD, use of oral BB was associated with significant protection against in-hospital mortality and stroke following repair. Metoprolol was the only Intravenous BB type associated with improved survival. Further research is warranted to elucidate the effect of beta-blockers on the long-term surgical outcomes of TBAD.
Collapse
Affiliation(s)
- Besma Nejim
- Department of Vascular Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA
| | - Asma Mathlouthi
- Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, CA
| | - Isaac Naazie
- Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, CA
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, CA..
| |
Collapse
|
7
|
Howard C, Sheridan J, Picca L, Reza S, Smith T, Ponnapalli A, Calow R, Cross O, Iddawela S, George M, Livra Dias D, Srinivasan A, Munir W, Bashir M, Idhrees M. TEVAR for complicated and uncomplicated type B aortic dissection-Systematic review and meta-analysis. J Card Surg 2021; 36:3820-3830. [PMID: 34310731 DOI: 10.1111/jocs.15827] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Type B aortic dissection (TBAD), is defined as a dissection involving the aorta distal to left subclavian artery with the ascending aorta and the aortic arch not affected. TBAD is classified due to the time frame and presence of complications. Complicated TBAD (co-TBAD) patients have a greater mortality rate than uncomplicated TBAD (un-TBAD) and thoracic endovascular aortic repair (TEVAR) is considered the gold-standard intervention for these clinical challenges. METHODS We undertook a systematic review of the literature regarding TEVAR intervention in co-TBAD and un-TBAD. A comprehensive search was undertaken across four major databases and was evaluated and assessed until June 2020. RESULTS A total of 16,104 patients were included in the study (7772 patients co-TBAD and 8352 un-TBAD). A significantly higher proportion of comorbidities were seen in co-TBAD patients compared with un-TBAD. Acute dissection was more frequent in the co-TBAD group (73.55% vs. 66.91%), while chronic dissection was more common in un-TBAD patients (33.8% vs. 70.73%). Postprocedure stroke was higher in co-TBAD (5.85% vs. 3.92%; p < .01), while postprocedural renal failure was higher in un-TBAD patients (7.23 vs. 11.38%; p < .01). No difference was observed in in-hospital mortality however the 30 days mortality was higher in the co-TBAD group. One-year survival was higher in the uncomplicated group but this difference was not observed in the 5-year survival. CONCLUSION In our analysis we can appreciate that despite significantly higher comorbidities in the co-TBAD cohort, there was no difference in in-hospital mortality between the two groups and the 5-year survival did not have any difference.
Collapse
Affiliation(s)
- Callum Howard
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Jonathan Sheridan
- Academic Unit of Medical Education, The University of Sheffield, Sheffield, UK
| | - Leonardo Picca
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Sihab Reza
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Tristan Smith
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Anuradha Ponnapalli
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Rachel Calow
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Olivia Cross
- School of Medicine, Keele University, Staffordshire, UK
| | - Sashini Iddawela
- Department of Respiratory Medicine, University Hospitals Birmingham, Birmingham, UK
| | - Melvin George
- Clinical Pharmacology, SRM Medical College Hospital, Kancheepuram, Tamil Nadu, India
| | - Deidre Livra Dias
- Senior Medical Reviewer, Cognizant Technology Solutions, Pune, India
| | - Anand Srinivasan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Wahaj Munir
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mohammad Bashir
- Vascular and Endovascular Surgery, NHS Wales Health Education and Improvement, Cardiff, UK
| | - Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Vadapalani, Chennai, India
| |
Collapse
|
8
|
Charchyan ER, Breshenkov DG, Belov YV. [Hybrid aortic repair in patients with type III aortic dissection and concomitant proximal aortic lesion]. Khirurgiia (Mosk) 2020:28-37. [PMID: 33029999 DOI: 10.17116/hirurgia202009128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report our own experience of hybrid treatment using FET technique in patients with type A aortic dissection and concomitant lesion of aortic arch and ascending aorta. MATERIAL AND METHODS There were 90 (28,3%) FET procedures for the period from January 2010 to August 2019. Type B aortic dissection was diagnosed in 19 (45,2%) patients. Type B aortic dissection combined with aortic arch aneurysm occurred in 11 (58%) cases, ascending aorta aneurysm - 15 (79%) cases. Patients underwent total arch and ascending aorta replacement via median sternotomy (upper partial J-shaped sternotomy in 3 cases). Valve-sparing interventions were performed in 58% of cases (aortic root repair - 6 (32%) patients, David procedure - 5 (26%) cases). Intraoperative features, early postoperative morbidity and in-hospital mortality were retrospectively analyzed. In long-term period, distal aortic remodeling, survival rate and incidence of redo interventions were evaluated. RESULTS Mean CPB time was 166±27 min, aortic cross-clamping time - 93±23 min, duration of circulatory arrest - 43±11 min. Neurological complications and paraplegia were absent. In-hospital mortality was absent. Reversible acute renal failure without need for hemodialysis developed in 2 cases (11%). Two patients underwent repeated intervention (TEVAR) due to dSINE and negative aortic remodeling. Annual survival rate was 100%. Freedom from redo aortic surgery was 89,5%. CONCLUSION FET surgery is an adequate alternative treatment for type B aortic dissection combined with lesion of aortic arch and ascending aorta. This approach ensures a one-stage repair in patients with contraindications to TEVAR. Unlike thoracotomy, FET procedure is valuable for simultaneous correction of cardiac and proximal aortic lesion, stabilizing the distal segments of dissected aorta. This is obvious advantage of this technique.
Collapse
Affiliation(s)
- E R Charchyan
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - D G Breshenkov
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - Yu V Belov
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| |
Collapse
|
9
|
Berkarda Z, Kondov S, Kreibich M, Czerny M, Beyersdorf F, Rylski B. Landing Zone Remodelling after Endovascular Repair of Dissected Descending Aorta. Eur J Vasc Endovasc Surg 2020; 59:939-945. [PMID: 32143991 DOI: 10.1016/j.ejvs.2020.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 01/08/2020] [Accepted: 02/07/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to determine geometric changes in the proximal and distal aortic landing zones after thoracic endovascular aortic repair (TEVAR) for acute descending aortic dissection. METHODS This was a retrospective analysis of clinical and radiological data. Included are patients who underwent TEVAR for acute descending aortic dissection between 2004 and 2018. Analysed are the proximal and distal landing zones' initial geometries and their change at follow up. Median follow up time was 2.3 (first quartile 0.9, third quartile 4.5) years. RESULTS One hundred and one patients were included (93 type B and 8 non-A non-B dissections, aged 65 (57, 74) years old, and 29% female). Dissection extended down to the abdominal aorta in 69% patients. The proximal landing zone was non-dissected in 92 patients. The diameters of non-dissected proximal landing zones increased by 3 (-1, 5; p < .001) mm at follow up. The distal landing zone was dissected in 84% of patients. The diameters of dissected distal landing zones had increased at follow up by 7 (3, 12) mm and 4 (1, 10; both p < .001) mm measured in true lumen and total aorta, respectively, observed one year after TEVAR. Stent grafts reached their nominal diameter at follow up in 22% and 17% of proximal and distal landing zones, respectively. There were seven proximal and 10 distal stent graft induced new entries at follow up. Aortic re-intervention was necessary in 23 patients entailing 19 TEVAR extensions and four open aortic repairs. CONCLUSION The distal landing zone in patients undergoing TEVAR for descending aortic dissection is frequently dissected and is associated with the risk of d-SINE at follow up and the need for re-interventions after TEVAR - factors that emphasise the importance of long term follow up.
Collapse
Affiliation(s)
- Zeynep Berkarda
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| |
Collapse
|
10
|
Charchyan E, Breshenkov D, Belov Y. Follow-up outcomes after the frozen elephant trunk technique in chronic type B dissection. Eur J Cardiothorac Surg 2020; 57:904-911. [DOI: 10.1093/ejcts/ezz348] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/17/2019] [Accepted: 11/20/2019] [Indexed: 01/09/2023] Open
Abstract
Abstract
OBJECTIVES
Our goal was to present our experience with a hybrid approach to the frozen elephant trunk (FET) technique for the treatment of patients with chronic type B aortic dissection.
METHODS
Between January 2013 and July 2019, 86 patients underwent the FET procedure at our centre. In 20 patients, the indication was chronic type B aortic dissection with a concomitant proximal aortic lesion. We evaluated the sites of proximal and distal entries, luminal communication and originating visceral branches in the computed tomography scan data. Primary end points were hospital deaths, complications and follow-up survival. Secondary end points included reintervention, thrombosis of the false lumen and aortic remodelling.
RESULTS
There were no deaths, neurological complications or paraplegia during hospitalization; however, a few patients (10%) had temporary acute renal failure or required secondary aortic reintervention during the follow-up period. We performed thoracic endovascular aortic repair with stable aortic remodelling during follow-up. The follow-up survival rate was 92.3%, and 87.5% of cases did not require aortic reintervention.
CONCLUSIONS
The FET technique is an effective method for treating chronic Stanford type B aortic dissection in patients at high risk of retrograde type A aortic dissection, concomitant disease of the proximal aorta and unsuitable anatomy for thoracic endovascular aortic repair, which allows for single-stage radical correction. Compared with thoracic endovascular aortic repair, the FET technique excludes the risk of type Ia endoleak, retrograde type A aortic dissection and possible stent graft migration. This technique provides comparable midterm follow-up outcomes and freedom from reintervention.
Collapse
Affiliation(s)
- Eduard Charchyan
- Department of Aortic Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Denis Breshenkov
- Department of Aortic Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Yuriy Belov
- Department of Aortic Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| |
Collapse
|
11
|
Hsieh RW, Hsu TC, Lee M, Hsu WT, Chen ST, Huang AH, Hsieh AL, Lee CC. Comparison of type B dissection by open, endovascular, and medical treatments. J Vasc Surg 2019; 70:1792-1800.e3. [DOI: 10.1016/j.jvs.2019.02.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/27/2019] [Indexed: 01/16/2023]
|
12
|
Liu J, Xia J, Yan G, Zhang Y, Ge J, Cao L. Thoracic endovascular aortic repair versus open chest surgical repair for patients with type B aortic dissection: a systematic review and meta-analysis. Ann Med 2019; 51:360-370. [PMID: 31599180 PMCID: PMC7877884 DOI: 10.1080/07853890.2019.1679874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Aim: This meta-analysis study aimed to compare the efficacy and safety of TEVAR versus OCSR for TBAD patients.Methods: We systematically searched PubMed, EmBase, and the Cochrane library to identify studies compared the effectiveness of TEVAR and OCSR in TBAD patients from the inception up to July 2019. The summary results were calculated using a random-effects model.Results: The electronic search identified 1,894 studies, and 18 studies with 9,664 TBAD patients were included. We noted patients received TEVAR were associated with a reduced risk of in-hospital mortality, acute renal failure, respiratory failure, and bleeding as compared with OCSR, whereas no significant differences between groups for the risk of stroke, myocardial infarction, paraplegia, mesenteric ischaemia/infarction, reinterventions, sepsis, and spinal cord ischaemia.Conclusions: The findings of this meta-analysis study suggested that TEVAR resulted in more short-term survival benefits. Moreover, the reduced risk of acute renal failure, respiratory failure and bleeding was detected in TEVAR group. The treatment effects of TEVAR versus OCSR on specific complications should be further verified by a study with high-level of evidence.Key messageComprehensive collected studies investigated the treatment effectiveness between TEVAR and OCSR for TBAD patientsTEVAR resulted in more survival benefits, in addition to lower risk of acute renal failure, respiratory failure and bleedingThe results of stratified analyses according to patients' characteristics were conducted.
Collapse
Affiliation(s)
- Jianping Liu
- Department of Cardiothoracic Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Juan Xia
- Department of Pathology, Suining Central Hospital, Suining, Sichuan, China
| | - Gaowu Yan
- Department of Radiology, Suining Central Hospital, Suining, Sichuan, China
| | - Yongheng Zhang
- Department of Cardiothoracic Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Jing Ge
- Department of Cardiothoracic Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Lin Cao
- Department of Intensive Care Unit, Suining Central Hospital, Suining, Sichuan, China
| |
Collapse
|
13
|
Midterm prognosis of type B aortic dissection with and without dissecting aneurysm of descending thoracic aorta after endovascular repair. Sci Rep 2019; 9:8870. [PMID: 31222164 PMCID: PMC6586898 DOI: 10.1038/s41598-019-45472-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 06/06/2019] [Indexed: 02/05/2023] Open
Abstract
Few studies support guidelines for the use of thoracic endovascular aortic repair (TEVAR) to address type B aortic dissection (TBAD) coexisting with descending thoracic aortic dissection and aneurysm (dTADA). This cohort study investigated midterm outcomes of TBAD with dTADA (dTADA group, n = 31) and without dTADA (non-dTADA group, n = 98) after TEVAR. Compared with the non-dTADA group, the dTADA group exhibited higher incidences of type Ia endoleak (29.0% vs. 3.1%, P < 0.001) and reintervention (16.1% vs. 5.1%, P = 0.045). The completely thrombosed rate of the thoracic false lumen was significantly lower in the dTADA group than in the non-dTADA group (45.2% vs. 80.6%, P < 0.001). Although the two groups exhibited similar mortality rates, TBAD coexisting with no regressive dTADA after TEVAR was an independent predictor of mortality (HR: 15.52, 95% CI: 1.614-149.233, P = 0.018). Moreover, the change percentages of false lumen retraction and true lumen re-expansion in the dTADA group were significantly inferior to those of the non-dTADA group at levels of 4th, 6th, 8th and 10th thoracic vertebra throughout follow-up. In conclusion, in the presence of preexisting dTADA, the failure of the dTADA to regress after TEVAR is associated with lower survival and a higher risk of reintervention.
Collapse
|
14
|
Systematic review and meta-analysis of acute type B thoracic aortic dissection, open, or endovascular repair. J Vasc Surg 2018; 69:1599-1609.e2. [PMID: 30598351 DOI: 10.1016/j.jvs.2018.08.187] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/07/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to compare perioperative and mortality outcomes of endovascular aortic repair against open repair in acute type B thoracic aortic dissection. METHODS A comprehensive search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all published data comparing open vs endovascular repair in management of acute type B aortic dissection. Databases where evaluated and assessed to July 2017. The 95% confidence intervals were analyzed from the extracted data using relevant statistical methods. RESULTS Overall, 18,193 patients were found in a combination of nine studies. Patients undergoing open repair were younger (mean, 61.3 ± 9.3 years vs 66.6 ± 12.5 years; P < .00001). Postoperative stroke and paraplegia were similar in both groups (P = .71 and P = .81 respectively); however, the rate of all neurologic complications were more common in the traditional open repair group (6.9% vs 4.8%; P = .006). The all-cause operative and 1-year death was reported as higher in the open repair group (18.6% vs 7.4% [P < .0001] and 24.3% vs 14.3% [P < .0001], respectively); however, at 5 years this rate is almost similar between both groups (46.7% vs 49.7%; P = .21). At 1 year, the rate of reintervention was reported to be higher in endovascular repair group of patients (15.4% vs 5.5%; P = .004). CONCLUSIONS This study concludes that endovascular repair, in the setting of acute type B thoracic aortic dissection, provides an early surgical benefit; however, this finding has not yet been supported by long-term data. There seems to be a benefit with respect to all-neurologic events in favor of endovascular repair. Long-term comparative data and studies are required to give a better understanding of these two approaches.
Collapse
|
15
|
Tan GJS, Khoo PLZ, Chan KMJ. A review of endovascular treatment of thoracic aorta disease. Ann R Coll Surg Engl 2018; 100:1-6. [PMID: 30286634 PMCID: PMC6204499 DOI: 10.1308/rcsann.2018.0143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2018] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The development of thoracic endovascular aortic repair has altered the approach and reduced the risk of treating the majority of descending thoracic aortic conditions. Primarily developed for the exclusion of thoracic aortic aneurysms, it is now used in place of open repair surgery for most descending thoracic aortic diseases, and has also been used to treat aortic arch diseases in selected cases. METHODS A literature search was conducted of Medline and Embase databases from January 2007 to February 2017, using the key words 'aortic disease', 'thoracic aorta' and 'endovascular repair'; 205 articles were identified, of which 25 studies were selected for review based on their relevance. FINDINGS The key findings of the indications, techniques, outcomes, complications and comparisons with open surgical repair were extracted from the published studies and are summarised in this review. Thoracic endovascular aortic repair is the preferred choice of intervention for patients with descending thoracic aortic disease. With time, it has improved to be safer and has the potential to expand aortic treatment choices in future.
Collapse
Affiliation(s)
- GJS Tan
- Faculty of Medical Sciences, Newcastle University Medical School, Newcastle Upon Tyne, UK
| | - PLZ Khoo
- Faculty of Medical Sciences, Newcastle University Medical School, Newcastle Upon Tyne, UK
| | - KMJ Chan
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiac Vascular Sentral Kuala Lumpur (CVSKL) Hospital, Kuala Lumpur, Malaysia
| |
Collapse
|
16
|
Talaie T, Werter C, Drucker C, Aicher BO, Crawford R, Toursavadkohi S. Laser Fenestration for Treatment of a Complicated Chronic Type B Aortic Dissection. Vasc Endovascular Surg 2018; 52:212-217. [PMID: 29554863 DOI: 10.1177/1538574417749401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of a complex chronic type B aortic dissection treated by thoracic endovascular aortic repair and laser fenestration of the false septum to preserve flow to branch vessels originating from both the true and false lumen. Dissections complicated by thoracoabdominal aneurysmal degeneration with critical organs being perfused by branches arising from both true and false lumens are rare and leave limited options for repair. Despite advancements in endovascular techniques, fenestration remains one of the only means of preserving flow to both the true and false lumens and thus was necessary in the management of our patient. This novel procedure allows complex aortic dissections to be addressed endovascularly, which increases the flexibility and management of this challenging problem that previously required an open repair with significant morbidity.
Collapse
Affiliation(s)
- Tara Talaie
- 1 University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher Werter
- 2 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Charles Drucker
- 2 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brittany O Aicher
- 2 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert Crawford
- 2 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shahab Toursavadkohi
- 2 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
17
|
Qin YL, Wang F, Li TX, Ding W, Deng G, Xie B, Teng GJ. Endovascular Repair Compared With Medical Management of Patients With Uncomplicated Type B Acute Aortic Dissection. J Am Coll Cardiol 2016; 67:2835-42. [DOI: 10.1016/j.jacc.2016.03.578] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/29/2016] [Indexed: 01/21/2023]
|
18
|
San Norberto E, Vaquero C. La disección aórtica tipo B: tratamiento endovascular. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2015.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
19
|
Debus ES, Kölbel T, Manzoni D, Behrendt CA, Heidemann F, Grundmann RT. [Endovascular versus conventional vascular surgery - old-fashioned thinking? Part 1: interventions on the aorta]. Chirurg 2016; 87:195-201. [PMID: 26801752 DOI: 10.1007/s00104-015-0146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Endovascular therapy has widely replaced conventional open vascular surgical reconstruction. For this reason both techniques were widely considered to be competing approaches. Evidence-based data from randomized prospective trials, meta-analyses and clinical registries, however, demonstrated that both techniques should be used to complement each other. It became increasingly more evident that the use of either procedure depends on the underlying disease and the anatomical conditions, whereby a combination of both (hybrid approach) may be the preferred option in certain situations. This review focuses on the treatment of complicated acute type B aortic dissection, descending thoracic aortic aneurysms, thoracoabdominal aortic aneurysms as well as asymptomatic and ruptured abdominal aortic aneurysms.
Collapse
Affiliation(s)
- E S Debus
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - T Kölbel
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - D Manzoni
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - C-A Behrendt
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - F Heidemann
- Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | | |
Collapse
|