How should we treat uncomplicated subacute type B aortic dissection in octogenarians?
Abstract Background Preemptive thoracic endovascular aortic repair (TEVAR) is an advanced treatment that has possibility to improve late outcomes in patients with subacute type B aortic dissection. However, it may not be the treatment of choice for elderly patients with uncomplicated subacute type B...
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | Journal of Cardiothoracic Surgery |
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| Online Access: | http://link.springer.com/article/10.1186/s13019-019-0869-z |
| _version_ | 1819092969563619328 |
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| author | Ken Nakamura Tetsuro Uchida Azumi Hamasaki Mitsuaki Sadahiro |
| author_facet | Ken Nakamura Tetsuro Uchida Azumi Hamasaki Mitsuaki Sadahiro |
| author_sort | Ken Nakamura |
| collection | DOAJ |
| description | Abstract Background Preemptive thoracic endovascular aortic repair (TEVAR) is an advanced treatment that has possibility to improve late outcomes in patients with subacute type B aortic dissection. However, it may not be the treatment of choice for elderly patients with uncomplicated subacute type B aortic dissection because of their inherent frailty and increased risk of periprocedural complications. Methods Data were collected between July 2004 and October 2017 in Yamagata university hospital and between February 2016 and May 2018 in Nihonkai General hospital. A total of 152 medically treated subacute type B aortic dissection patients were enrolled in this study. Patients were divided into two groups: age 80 year and older group (Group O, n = 33, 22%) and a group < 80 years of age (Group U, n = 119, 78%). Results During follow-up, the incidence of adverse events was 27% (n = 9) in Group O and 37% (n = 44) in Group U (P = 0.409). The incidence of aortic rupture was 3% (n = 1), and the incidence of acute type A dissection was 3% (n = 1) in Group O. In Group O, only one patient (3%) died of aorto-bronchial fistula. The Group O patients had less surgical intervention (3 patients [9%] in Group O and 30 patients [25%] in Group U, P = 0.047), but aortic related death did not differ between the two groups. The 1-, 2-, and 5-year freedom from aorta-related death rates of Group O were 97, 97, and 97%, respectively, compared with 99, 94, and 91%, respectively, in Group U (P = 0.880). Conclusions Patients aged 80 years and older who underwent medical treatment for acute and subacute type B dissection had excellent outcomes in chronic phase. The elderly patients had less surgical intervention, but aortic related death did not differ from younger patients. |
| first_indexed | 2024-12-21T23:04:04Z |
| format | Article |
| id | doaj.art-b2304ce2e230408c8bdc753382c2c02a |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-12-21T23:04:04Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-b2304ce2e230408c8bdc753382c2c02a2022-12-21T18:47:13ZengBMCJournal of Cardiothoracic Surgery1749-80902019-02-011411710.1186/s13019-019-0869-zHow should we treat uncomplicated subacute type B aortic dissection in octogenarians?Ken Nakamura0Tetsuro Uchida1Azumi Hamasaki2Mitsuaki Sadahiro3Division of Cardiovascular Surgery Nihonkai General HospitalSecond Department of Surgery, Yamagata University Faculty of MedicineSecond Department of Surgery, Yamagata University Faculty of MedicineSecond Department of Surgery, Yamagata University Faculty of MedicineAbstract Background Preemptive thoracic endovascular aortic repair (TEVAR) is an advanced treatment that has possibility to improve late outcomes in patients with subacute type B aortic dissection. However, it may not be the treatment of choice for elderly patients with uncomplicated subacute type B aortic dissection because of their inherent frailty and increased risk of periprocedural complications. Methods Data were collected between July 2004 and October 2017 in Yamagata university hospital and between February 2016 and May 2018 in Nihonkai General hospital. A total of 152 medically treated subacute type B aortic dissection patients were enrolled in this study. Patients were divided into two groups: age 80 year and older group (Group O, n = 33, 22%) and a group < 80 years of age (Group U, n = 119, 78%). Results During follow-up, the incidence of adverse events was 27% (n = 9) in Group O and 37% (n = 44) in Group U (P = 0.409). The incidence of aortic rupture was 3% (n = 1), and the incidence of acute type A dissection was 3% (n = 1) in Group O. In Group O, only one patient (3%) died of aorto-bronchial fistula. The Group O patients had less surgical intervention (3 patients [9%] in Group O and 30 patients [25%] in Group U, P = 0.047), but aortic related death did not differ between the two groups. The 1-, 2-, and 5-year freedom from aorta-related death rates of Group O were 97, 97, and 97%, respectively, compared with 99, 94, and 91%, respectively, in Group U (P = 0.880). Conclusions Patients aged 80 years and older who underwent medical treatment for acute and subacute type B dissection had excellent outcomes in chronic phase. The elderly patients had less surgical intervention, but aortic related death did not differ from younger patients.http://link.springer.com/article/10.1186/s13019-019-0869-zUncomplicated subacute type B aortic dissectionConservative treatmentOctogenarianTEVARChronic aortic dissection |
| spellingShingle | Ken Nakamura Tetsuro Uchida Azumi Hamasaki Mitsuaki Sadahiro How should we treat uncomplicated subacute type B aortic dissection in octogenarians? Journal of Cardiothoracic Surgery Uncomplicated subacute type B aortic dissection Conservative treatment Octogenarian TEVAR Chronic aortic dissection |
| title | How should we treat uncomplicated subacute type B aortic dissection in octogenarians? |
| title_full | How should we treat uncomplicated subacute type B aortic dissection in octogenarians? |
| title_fullStr | How should we treat uncomplicated subacute type B aortic dissection in octogenarians? |
| title_full_unstemmed | How should we treat uncomplicated subacute type B aortic dissection in octogenarians? |
| title_short | How should we treat uncomplicated subacute type B aortic dissection in octogenarians? |
| title_sort | how should we treat uncomplicated subacute type b aortic dissection in octogenarians |
| topic | Uncomplicated subacute type B aortic dissection Conservative treatment Octogenarian TEVAR Chronic aortic dissection |
| url | http://link.springer.com/article/10.1186/s13019-019-0869-z |
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