Editor's Choice - Trends in Management and Outcomes of Type B Aortic Dissection: A Report From the International Registry of Aortic Dissection

Abstract

Objective: To describe the trends in management and outcomes of patients with acute type B aortic dissection in the International Registry of Acute Aortic Dissection.

Methods: From 1996 - 2022, 3 908 patients were divided into similar sized quartiles (T1, T2, T3, and T4). In hospital outcomes were analysed for each quartile. Survival rates following admission were compared using Kaplan-Meier analyses with Mantel-Cox Log rank tests.

Results: Endovascular treatment increased from 19.1% in T1 to 37.2% in T4 (p_trend < .001). Correspondingly, medical therapy decreased from 65.7% in T1 to 54.0% in T4 (p_trend < .001), and open surgery from 14.8% in T1 to 7.0% in T4 (p_trend < .001). In hospital mortality decreased in the overall cohort from 10.7% in T1 to 6.1% in T4 (p_trend < .001), as well as in medically, endovascularly and surgically treated patients (p_trend = .017, .033, and .011, respectively). Overall post-admission survival at three years increased (T1: 74.8% vs. T4: 77.3%; p = .006).

Conclusion: Considerable changes in the management of acute type B aortic dissection were observed over time, with a significant increase in the use of endovascular treatment and a corresponding reduction in open surgery and medical management. These changes were associated with a decreased overall in hospital and three year post-admission mortality rate among quartiles.

Keywords: Aortic disease; Aortic dissection; International Registry of Acute Aortic Dissection; Survival.