Comparison of the results of thoracic endovascular aortic repair and optimal medical therapy in patients with uncomplicated type B aortic dissection
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https://orcid.org/0009-0004-8489-8280
Abstract
The aim – to characterize clinical events and compare outcomes between patients treated with thoracic endovascular aortic repair (TEVAR) in combination with optimal medical therapy versus optimal medical therapy alone.
Materials and methods. The retrospective study included adult patients (over 18 years old) who were hospitalized at the Heart Institute of the Ministry of Health of Ukraine between 2018 and 2024 due to dissection of the descending thoracic aorta. Depending on the method of treatment for uncomplicated type B aortic dissection. All patients were divided into two groups: group A – patients who were initially prescribed TEVAR with optimal medical therapy (OMT) and group B – patients who were initially prescribed OMT.
Results and discussion. The course of the hospital period was not significantly different between the study groups, except for the frequency of general surgical complications in patients of group A, which were 4 (10.00 %). The duration of hospitalization was significantly lower in patients of group A compared to patients of group B (10.5 (8.00; 12.0) days vs. 12.0 (10.25; 14.0) days, p=0.001). The values of systolic and diastolic blood pressure in group A and group B were characterized by a significant decrease compared to the initial values at all stages during the 3-year observation period. In patients of group A, a positive difference in the dynamics of the diameter of the true lumen was observed by 15.9±7.65 mm, while in patients of group B, a negative dynamic was determined by 3.80±3.43 mm, which was significantly different between the study groups (p=0.002). In group A, late aortic complications were significantly less frequent by 26.7 % (p=0.025) compared to group B. Analysis of three-year mortality showed that the mortality rate in patients of group A was 18.3 % (p=0.032) lower in compared with group B.
Conclusions. Performing TEVAR together with OMT was characterized by better rates of remodeling of the descending aorta and a lower rate of late aortic complications compared to isolated OMT. Further randomized trials are needed to analyze long-term outcomes.
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References
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