医学交流课件：NewIndicationofTEVARforUncomplicatedTypeBAorticDissection

1、New Indication of TEVAR for Uncomplicated Type B Aortic Dissection,Aortic dissection,Information Centre for Health Education and Social Care. Hospital epsiode statistics online. www.hesonline.nhs.uk,Current Indication,Acute Rupture Malperfusion Intractable pain Chronic Rupture or impending rupture R

2、apid enlargement (10mm/year) Aneurysmal(50mm,Open Surgery For Complicated TBAD,Current Indication,Acute Rupture Malperfusion Intractable pain Chronic Rupture or impending rupture Rapid enlargement (10mm/year) Aneurysmal(50mm,Open Surgery For Complicated TBAD,Uncomplicated TBAD treated medically,Cont

3、roversy,Early death, paraplegia, renal insufficiency, reoperation for bleeding, cardiac complications, and length of stay decreased*. Long-term outcome of medical therapy indicated a total death rate over 10%, and up to 30% with complications,Cheng, D., J. Martin, et al. (2010). Endovascular Aortic

4、Repair Versus Open Surgical Repair for Descending Thoracic Aortic Disease: A Systematic Review and Meta-Analysis of Comparative Studies. J Am Coll Cardiol 55(10): 986-1001. *Tsai, T.T., Fattori, R., et al. (2006) Long-term survival in patients presenting with type B acute aortic dissection: Insights

5、 from the international registry of acute aortic dissection. Circulation 114:2226-2231,Controversy,Early death, paraplegia, renal insufficiency, reoperation for bleeding, cardiac complications, and length of stay decreased*. Long-term outcome of medical therapy indicated a total death rate over 10%,

6、 and up to 30% with complications,Cheng, D., J. Martin, et al. (2010). Endovascular Aortic Repair Versus Open Surgical Repair for Descending Thoracic Aortic Disease: A Systematic Review and Meta-Analysis of Comparative Studies. J Am Coll Cardiol 55(10): 986-1001. *Tsai, T.T., Fattori, R., et al. (20

7、06) Long-term survival in patients presenting with type B acute aortic dissection: Insights from the international registry of acute aortic dissection. Circulation 114:2226-2231,Endovascular Repair: A Better Solution For Uncomplicated Type B Aortic Dissection ,INSTEAD-XL TRIAL,TEVAR in addition to o

8、ptimal medical treatment is associated with improved 5-year aorta-specific survival and delayed disease progression,C.A. Nienaber et al. (2013). “Endovascular Repair of Type B Aortic Dissection: Long-term Results of the Randomized Investigation of Stent Grafts in Aortic Dissection Trial.” Circ Cardi

9、ovasc Interv. 2013;6:407-416;,INSTEAD-XL TRIAL,TEVAR in addition to optimal medical treatment is associated with improved 5-year aorta-specific survival and delayed disease progression,C.A. Nienaber et al. (2013). “Endovascular Repair of Type B Aortic Dissection: Long-term Results of the Randomized

10、Investigation of Stent Grafts in Aortic Dissection Trial.” Circ Cardiovasc Interv. 2013;6:407-416;,Changhai experience,Retrospective Data from 1996 to 2016, Changhai hospital, Shanghai, China Of over 1400 patients with type B aortic dissection, 252 uncomplicated cases were elected Best Medical Thera

11、py(BMT) : 117 Endovascular Repair + BMT : 135,Changhai experience,Inclusion criteria No evidence of ongoing intractable chest pain at the time of admission; No evidence of rupture or impending rupture at the time of admission; No evidence of refractory hypertension at the time of admission; No evide

12、nce of unstable hemodynamics at the time of admission; No evidence of symptomatic distal organ ischemia (clinical symptoms or laboratory test) at the time of admission,Baseline characteristics,Changhai experience,Baseline characteristics,No significant difference,Changhai experience,Long-term outcom

13、e,Changhai experience,Long-term outcome,Changhai experience,Significant better long-term survival rate in TEVAR,Morphological improvement in TEVAR group,Changhai experience,Morphological deterioration in medical group,Changhai experience,Long-term outcome,Changhai experience,Who? When,Who,Medical gr

14、oup,TEVAR group,Hemodynamics,Who,False / True lumen ratio P1 （maximal aorta diameter） median value 0.713,Who,COX regression analysis,F/T LUMEN RATIO0.7,Who,Normal aorta,Visceral artery involved,Hemodynamics,Who,COX分析,Visceral arteries involvement,When,Long-term outcome Acute phase Subacute phase Chronic phase,When,No Differences Among 3 groups,Long-term outcome Acute phase Subacute phase Chronic phase,When,Intervention Time And Blood Loss Increased,Conclusion,TEVAR has