New Consensus for the Management of Type B Aortic Dissection
A new multidisciplinary expert consensus document on the management of acute, subacute and chronic type B aortic dissection was published on April 15 in the Journal of the American College of Cardiology. The document presented definitions of each category of type B aortic dissection, treatment algorithms for each and evidence-based rationales for choosing among medical therapy, thoracic endovascular repair (TEVAR) or open surgery.
The recommendations are based on an extensive literature review and were made by a multidisciplinary panel comprised of seven Western European thought leaders from the fields of cardiology, cardiothoracic surgery, vascular surgery, and interventional radiology, led by Rossella Fattori, MD, San Salvatore Hospital, Pesaro, Italy.
The panel analyzed 63 studies with a total of 6,711 patients who received medical therapy, TEVAR or open surgery. Pooled mortality rates were calculated and prognostic indicators identified. Indicators of complicated type B aortic dissection requiring urgent repair included hemodynamic instability, organ malperfusion and increasing periaortic hematoma, among others. Predictors of poor outcomes identified by the literature review included recurrent symptoms, aortic aneurysmal dilation >55 mm or a yearly increase of >4 mm after the acute phase. The panel recommended delayed aortic repair for these patients.
"A definition of different clinical patterns of type B aortic dissection and corresponding algorithms of treatment has been made possible for this consensus document with the analysis of the mortality and complications rates of more than 6,700 patients reported in the available literature. This may substantially help the operating physician in selecting different modalities of treatment for type B aortic dissection," wrote the panel. "Nevertheless, the strength of proposals provided by this consensus document is limited, especially for aortic dissections in the subacute phase, because of the large heterogeneity among studies and the lack of high-quality data; most results were from uncontrolled, nonrandomized retrospective trials or registries."
Keywords: Registries, Endovascular Procedures, Aortic Aneurysm, Thoracic, Radiology, Interventional, Hematoma, Hemodynamics, Vascular Surgical Procedures, United States, Italy
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