Optimal Treatment of Uncomplicated Type B Aortic Dissection: JACC Review Topic of the Week

Rami O Tadros; Gilbert H L Tang; Hanna J Barnes; Idine Mousavi; Jason C Kovacic; Peter Faries; Jeffrey W Olin; Michael L Marin; David H Adams

doi:10.1016/j.jacc.2019.07.063

Optimal Treatment of Uncomplicated Type B Aortic Dissection: JACC Review Topic of the Week

J Am Coll Cardiol. 2019 Sep 17;74(11):1494-1504. doi: 10.1016/j.jacc.2019.07.063.

Authors

Rami O Tadros¹, Gilbert H L Tang², Hanna J Barnes³, Idine Mousavi³, Jason C Kovacic⁴, Peter Faries³, Jeffrey W Olin⁴, Michael L Marin³, David H Adams²

Affiliations

¹ Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: rami.tadros@mountsinai.org.
² Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York.
³ Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York.
⁴ Division of Cardiology, Department of Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York.

PMID: 31514953
DOI: 10.1016/j.jacc.2019.07.063

Abstract

Historically, the gold standard for treating acute uncomplicated type B aortic dissection (TBAD) has been aggressive medical therapy to achieve optimal heart rate and blood pressure control. However, recent data have demonstrated that a significant proportion of patients with medically managed acute uncomplicated TBAD have late aorta-related complications, such as aneurysmal degeneration, that increase mortality and often necessitate surgical intervention. In this review, the authors review existing literature on uncomplicated TBAD and highlight contemporary surgical and medical strategies to manage this condition. Looking ahead, efforts are underway to identify and characterize a high-risk subgroup of acute uncomplicated TBAD patients who may benefit from early intervention.

Keywords: TEVAR; aortic; dissection; endovascular; surgery; vascular.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Algorithms
Aortic Aneurysm, Thoracic / classification
Aortic Aneurysm, Thoracic / complications
Aortic Aneurysm, Thoracic / therapy*
Aortic Dissection / classification
Aortic Dissection / complications
Aortic Dissection / therapy*
Humans