Clinical Outcomes of Emergency Surgery for Acute Type B Aortic Dissection with Rupture

Objectives: The purpose of this study was to evaluate the clinical outcomes of emergency surgery for acute type B aortic dissection with rupture and to compare results between open surgery and thoracic endovascular aortic repair (TEVAR).

Methods: Two hundred and ninety-four patients with acute type B aortic dissection were admitted to our hospital between January 2000 and March 2012. At presentation, 30 (10%) patients had rupture (20 men, 10 women; mean age, 71 ± 15 years), among whom 23 underwent emergency surgery: 9 underwent TEVAR and 14 underwent open surgery. The objective of TEVAR was closure of the primary entry site and the secondary tear site in the descending thoracic aorta.

Results: In the TEVAR group, technical success was achieved: the primary entry site was closed, and bleeding was controlled in all 9 patients. There was no operative death, and 1 (13%) patient had cerebral infarction. In the open surgery group, 2 (14%) patients died during hospitalization, and 4 (29%) had cerebral infarction in the acute phase. Hospitalization tended to be longer in the open surgery group than in the TEVAR group. The overall survival rate at 1 year was 71 ± 17% in the TEVAR group and 86 ± 9% in the open surgery group (P = 0.89).

Conclusions: TEVAR for acute type B aortic dissection with rupture could be performed with relatively low morbidity and mortality, with no significant difference when compared with open surgery. The main objective of TEVAR for acute type B aortic dissection with rupture is control of bleeding, which can be achieved by closing the primary entry site and the secondary tear site in the descending thoracic aorta. If anatomically feasible and performed immediately, TEVAR is the treatment of choice for acute type B aortic dissection with rupture because it is less invasive than open surgery.