Abstract 12150: Acute Type B Aortic Dissection a 15-Year, Single-Center Experience

Introduction: Treatment of acute type B aortic dissection (ATBAD) has evolved with the use of endovascular technology. This study evaluates the short and long-term outcomes of patients with ATBAD over a 15-year period. Methods: A retrospective review identified patients with ATBAD at our institution between 2006 and 2020. Patients were analyzed based on presentation status (complicated vs. uncomplicated) and treatment. Complicated ATBAD (cATBAD) included malperfusion of any vascular bed, intractable pain, rupture, or rapid expansion. Postoperative outcomes were evaluated within the initial 30 days after diagnosis when managed medically or within thirty days of surgical intervention. Descriptive statistics was performed to assess short-term outcomes. Kaplan-Meier survival was performed to assess long-term mortality. Results: A total of 296 patients presented with ATBAD in the study period. Out of those, 121 patients presented with cATBAD, while 175 patients presented with uncomplicated ATBAD (uATBAD). Out of the cATBAD group, 89 were treated with TEVAR, and 32 were treated with medication only. The cATBAD group was younger than the uCTBAD group (62.0 vs. 65.2, p=0.05). Early mortality was more common in cATBAD than uATBAD (9.9% vs 2.3%, p=0.013). When comparing cATBAD who underwent TEVAR vs conservative medical management, early mortality was higher in the medication only group (12.5% vs 9.0% p = 0.013). Permanent paraplegia occurred in 1.1% (1/89)of patients undergoing TEVAR. Kaplan-Meier survival analysis demonstrated no significant difference in long-term mortality between the cATBAD and uATBAD groups (Logrank p = 0.23). Among the uATBAD patients, 10.3% (18/175) required future intervention for type B dissection (12 TEVAR, 6 open). Among the TEVAR patients, 20.2% (18/89) required re-operations (11 endovascular repairs, 7 open). Conclusions: ATBAD is associated with significant morbidity and mortality, especially in the setting of a complicated presentation. While uATBAD is associated with better short-term outcomes, the diminishing difference in long-term outcome between cATBAD and uATBAD calls for reevaluation of our indications for intervention and may suggest that the remodeling associated with TEVAR could have long term benefit.