A fresh look at managing patients with type B aortic dissection
The Society of Thoracic Surgeons (STS) and the American Association for Thoracic Surgery (AATS) have shared a new guidance for the management of patients with type B aortic dissection (TBAD), recommending a “stepwise approach” followed by close clinical surveillance when patients present with uncomplicated TBAD.
The guideline, published in the The Annals of Thoracic Surgery and The Journal of Thoracic and Cardiovascular Surgery, emphasizes the importance of aggressive medical therapy when treating uncomplicated TBAD. For more complicated cases, when the patient's life is in immediate danger, open surgery may be the clinician's best option.
“There has been an explosion of information in the form of research reports of varying quality regarding the treatment of type B dissection over the past decade,” co-author G. Chad Hughes, MD, with the division of cardiovascular and thoracic surgery at Duke University Medical Center, said in a prepared statement. “This guideline is unique in providing surgeons with a comprehensive, up-to-date summary of the state of the evidence, while also serving as ‘guard rails’ that outline treatment options and best practices in certain scenarios. This is a first for any document in the field of type B dissection management.”
In the same statement, co-author Dawn S. Hui, MD, with the department of cardiothoracic surgery at University of Texas Health Science Center at San Antonio, noted that one of the key takeaways from the guidelines is the new role of earlier endovascular treatments such as thoracic endovascular aortic repair (TEVAR) in patients with uncomplicated TBAD.
Hui explained that surgery has typically been reserved for patients with complicated TBAD. Under these new recommendations, however, surgeons may be able to identify high-risk patients with uncomplicated TBAD and treat them earlier with TEVAR before progression develops.
“We expect this guideline to improve the quality of care of patients with TBAD by providing surgeons the most up-to-date summary of when and how to effectively use which therapies, whether open surgery, endovascular therapy, or a combination of the two over the lifetime of the patient,” Hui said.
With the updated guidelines, the writing group was able to see the evidence summarized in a manner that “reinforced how little we actually know about the best way to treat these patients," Hui added.
The group plans to update its recommendations in another five years.
Read the new guidelines here.