Surgical and endovascular repair for type B aortic dissections with mesenteric malperfusion syndrome: A systematic review of in-hospital mortality

• Authors: Vishnu M Chandra, University of Virginia; Elizabeth L Norton, Emory University; Minhaj S Khaja, University of Virginia; Daniel Giraldo Herrera, University of Virginia; David M Williams, University of Michigan Medical School; Bo Yang, University of Michigan, Ann Arbor
• Journal Title: JTCVS Open
• Volume: Volume 12
• Publisher: Elsevier Inc | 2022-12-01, Pages 37-50
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.xjon.2022.07.012
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Radiology
• Keywords: CT, computed tomography; IRAD, International Registry of Acute Aortic Dissection; MesMP, mesenteric malperfusion; SMA, superior mesenteric artery; TBAD, type B aortic dissection; TEVAR, thoracic endovascular aortic repair; aortic stenting; fenestration; mesenteric malperfusion; thoracic endovascular aortic repair; type B aortic dissection; visceral malperfusion

Abstract

Objectives: Mesenteric malperfusion is a feared complication of aortic dissection, with high mortality. The purpose of this study was to systematically review in-hospital mortality (IHM) of endovascular and surgical management of acute and chronic Stanford type B aortic dissections (TBAD) complicated by mesenteric malperfusion (MesMP). Methods: A systematic search of English language articles was conducted in relevant databases. Data on patient demographics, procedure details, and survival outcomes were collected. Reports were classified by type of intervention performed. Studies that failed to report patient-level outcomes based on specific intervention performed or IHM were excluded. Retrospective chart review of previously published data from a single institution was also performed to further identify cases of TBAD that were managed endovascularly. The Fisher exact test was performed to determine statistical significance. Results: In total, 37 articles were suitable for inclusion in this systematic review, which yielded 149 patients with a median age 55.0 years (interquartile range, 46.5-65 years) and 79% being male. Overall, in-hospital mortality was 12.8% (19/149) and was similar between endovascular and open surgical interventions (13% vs 11%, P = .99). Among endovascular strategies, IHM was greater, although not statistically significant in the thoracic endovascular aortic repair group compared with the fenestration/stenting without thoracic endovascular aortic repair group (24% vs 11%, P = .15). Conclusions: Multiple strategies exist for the management of TBAD with MesMP; however, a majority of cases were managed endovascularly. Despite advances in therapies, mortality remains high at 13%.