ArticleFrontiers in cardiovascular medicine2025
Validity of current surgical strategies for aneurysmal progression in post-subacute Stanford type B aortic dissection: a propensity score-matched comparative analysis.
Article in Frontiers in cardiovascular medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: The use of preemptive thoracic endovascular aortic repair (TEVAR) has been expanding, especially in cases where aortic enlargement is an indication for surgical intervention. Current guidelines recommend treatment for chronic type B aortic dissection (TBAD) when aortic diameter increases by ≥5 mm over a 6-month period. However, the optimal window for preemptive TEVAR is the subacute phase (up to 3 months), creating a dilemma where intervention may be delayed beyond this window. This study investigates the short- and long-term outcomes of aggressive treatment for rapidly enlarging aneurysms. Subjects and methods: Between July 2004 and August 2024, 432 patients with acute Stanford type B aortic dissection were treated at two centers. Of these, 324 patients who completed acute best medical therapy (BMT) were included. Patients with rapid enlargement of aortic aneurysms who did not meet absolute surgical indications (aneurysm diameter <55 mm and <5 mm/month) were compared to those who continued BMT. Propensity score matching was performed between the BMT group (Group B, Results: Among the 324 eligible patients, 88 exhibited rapid aortic enlargement (≤5 mm in <6 months). Of these, 42 (48%) underwent surgical intervention: 12 (14%) received graft replacement, and 30 (34%) underwent TEVAR, with 28 (32%) receiving preemptive TEVAR. The BMT group continued without surgery, with 7 patients (3%) receiving graft replacement and 20 (8%) undergoing TEVAR. In Group E, aortic diameter significantly increased compared to Group B (0.4 ± 0.2 vs. 1.1 ± 0.2 mm, Conclusion: Selective preemptive TEVAR for patients with rapid aortic enlargement in the subacute and chronic phases of TBAD showed favorable outcomes. Although no significant difference in aorta-related mortality was found, the higher incidence of rupture in untreated patients suggests that preemptive TEVAR may offer a benefit. Further research is needed to identify the patients most likely to benefit from early surgical intervention.
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