How should we treat uncomplicated subacute type B aortic dissection in octogenarians?

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.