AUTHOR=Sachs Charlotte , Vecchini Fabien , Corniquet Marie , Bartoli Michel , Barral Pierre-Antoine , De Masi Mariangela , Omnes Virgile , Piquet Philippe , Alsac Jean-Marc , Gaudry Marine 

TITLE=Preemptive treatment in the acute and early subacute phase of uncomplicated type B aortic dissections with poor prognosis factors

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1362576

DOI=10.3389/fcvm.2024.1362576

ISSN=2297-055X

ABSTRACT=<sec><title>Objective</title><p>Due to its favorable outcome regarding late morbidity and mortality, thoracic endovascular repair (TEVAR) is becoming more popular for uncomplicated type B aortic dissection (TBAD). This study aimed to compare preemptive endovascular treatment and optimal medical treatment (OMT) and OMT alone in patients presenting uncomplicated TBAD with predictors of aortic progression.</p></sec><sec><title>Design</title><p>Retrospective multicenter study</p></sec><sec><title>Methods</title><p>We analyzed patients with uncomplicated TBAD and risk factors of progression in two French academic centers. Aortic events [defined as aortic-related (re)intervention or aortic-related death after initial hospitalization], postoperative complications, non-aortic events, and radiologic aortic progression and remodeling were recorded and analyzed. Analysis was performed on an intention-to-treat basis.</p></sec><sec><title>Results</title><p>Between 2011 and 2021, preemptive endovascular procedures at the acute and early subacute phase (&lt;30 days) were performed on 24 patients (group 1) and OMT alone on 26 patients (group 2). With a mean follow-up of 38.08 ± 24.53 months, aortic events occurred in 20.83% of patients from group 1 and 61.54% of patients from group 2 (<italic>p</italic> &lt; .001). No patient presented aortic-related death during follow-up. There were no differences in postoperative events (<italic>p</italic> = 1.00) and non-aortic events (<italic>p</italic> = 1.00). OMT patients had significantly more aneurysmal progression of the thoracic aorta (<italic>p</italic> &lt; .001) and maximal aortic diameter (<italic>p</italic> &lt; .001). Aortic remodeling was found in 91.67% of patients in group 1 and 42.31% of patients in group 2 (<italic>p</italic> &lt; .001). A subgroup analysis of patients in group 1 showed that patients treated with preemptive TEVAR and STABILISE had reduced maximum aortic diameters at the 1-year (<italic>p</italic> = .010) and last follow-up (<italic>p</italic> = .030) compared to those in patients treated with preemptive TEVAR alone.</p></sec><sec><title>Conclusion</title><p>Preemptive treatment of uncomplicated TBAD with risk factors of progression reduces the risk of long-term aortic events. Over 60% of medically treated patients will require intervention during follow-up, with no benefit in terms of postoperative events. Even after surgical treatment, patients in the OMT group had significantly more aneurysmal progression, along with poorer aortic remodeling.</p></sec>