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2014 ; 3
(3
): 234-46
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Management of complicated and uncomplicated acute type B dissection A systematic
review and meta-analysis
#MMPMID24967162
Moulakakis KG
; Mylonas SN
; Dalainas I
; Kakisis J
; Kotsis T
; Liapis CD
Ann Cardiothorac Surg
2014[May]; 3
(3
): 234-46
PMID24967162
show ga
BACKGROUND: The management of acute type B dissection represents a clinical
challenge. We undertook a systematic review of the available literature regarding
medical, surgical and endovascular treatments of acute type B aortic dissection
and combined the eligible studies into a meta-analysis. METHODS: An extensive
electronic health database search was performed on all articles published from
January 2006 up to November 2013 describing the management of acute type B aortic
dissection. Studies including less than 15 patients were excluded. RESULTS: ACUTE
COMPLICATED TYPE B DISSECTION: overall, 2,531 patients were treated with
endovascular repair (TEVAR) and the pooled rate for 30-day/in-hospital mortality
was 7.3%. The pooled estimates for cerebrovascular events, spinal cord ischemia
(SCI) and total neurologic events were 3.9%, 3.1% and 7.3%, respectively. A total
of 1,276 patients underwent open surgical repair and the pooled rate for
30-day/in-hospital mortality was 19.0%. The pooled rate for cerebrovascular
events was 6.8%, for SCI 3.3% and for total neurologic complications 9.8%. Acute
uncomplicated type B dissection: outcome of 2,347 patients who underwent
conservative medical management were analyzed. The pooled 30-day/in-hospital
mortality rate was 2.4%. The pooled rate for cerebrovascular events was 1%, for
SCI 0.8% and for overall neurologic complications 2%. CONCLUSIONS: Endovascular
repair provides a superior 30-day/in-hospital survival for acute complicated type
B aortic dissection compared to surgical aortic reconstruction. However, open
repair still has a significant role as endovascular repair is not applicable in
all patients and there remains concerns regarding the durability of this
technique. TEVAR seems to have a more favorable outcome regarding aortic
remodeling and the aortic-specific survival rate when compared with medical
therapy alone. Randomized controlled trials focusing on the prognostic factors of
early and late complications in uncomplicated type B dissections are needed.