Thoracic Endovascular Aortic Repair for Type B Aortic Dissection

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Thoracic Endovascular Aortic Repair for Type B Aortic Dissection: 11-Year Results From a Top Chinese Hospital

Aortic dissection is a life-threatening condition where the inner layer of the aorta tears, but advances in minimally invasive surgery are transforming outcomes—especially for type B aortic dissection (TBAD), which affects the descending aorta. Most global research on TBAD and its leading treatment, thoracic endovascular aortic repair (TEVAR), comes from Western registries like the International Registry of Acute Aortic Dissection (IRAD). But these studies include few Asian patients—none from China—leaving critical gaps in how TEVAR works for this population.

To fill this void, researchers from the Department of Vascular Surgery at Zhongshan Hospital, Fudan University (Shanghai, China) analyzed 11 years of data (2009–2019) from 1,573 TBAD patients who underwent TEVAR. Their findings, published in the Chinese Medical Journal, offer rare insights into outcomes, risk factors, and trends in a large Chinese cohort—information that could improve care for Asian patients worldwide.

Who Were the Patients?

The study included adults with TBAD (acute: 1–14 days; subacute: 15–90 days; chronic: >90 days) who had TEVAR. Key demographics:

  • Age: Average 56.1 years (most were 50–70 years old).
  • Gender: 83.2% male (consistent with global trends, as men have higher TBAD risk).
  • Hypertension: 67.9% had a history of high blood pressure—a major risk factor for aortic dissection.
  • Insurance: Only 38.3% were covered by local medical insurance, highlighting healthcare access challenges in the region.

Key Findings: Outcomes and Trends

The research focused on aortic-related in-hospital mortality (death from aortic dissection or TEVAR complications) and post-operative complications. Here’s what they found:

1. Mortality and Complications

  • Aortic-related in-hospital mortality: 2.42% (38 of 1,573 patients). This aligns with recent global studies (0%–5%) but is lower than IRAD’s 20-year average (10.6%).
  • Top causes of death: Retrograde type A dissection (RTAD, where the tear spreads to the ascending aorta) was the leading cause (10 deaths), followed by aortic rupture and bowel ischemia.
  • Complications: 8.07% of patients had post-op issues, including:
    • RTAD (0.95%)
    • Acute kidney injury (3.24%)
    • Stroke (1.78%)
    • Bowel ischemia (0.89%)
    • Paraplegia (0.57%)—a lower rate than some Western studies, likely due to surgical experience or patient factors.

2. Trends Over Time

  • Mortality: While overall in-hospital mortality didn’t drop significantly, acute TBAD patients saw a 12.91% annual decrease in death rates—a sign that care for the most urgent cases is improving.
  • Length of stay (LOS): Average hospital stays fell 6.5% per year, thanks to better devices and surgical expertise. Shorter stays mean less risk of hospital-acquired infections and lower costs for patients.

3. Risk Factors for Death

Hypertension was a major red flag: Patients with a history of high blood pressure were 3.13 times more likely to die in the hospital from aortic-related causes (95% confidence interval: 1.23–7.93). This underscores a simple but critical message: Controlling blood pressure saves lives in TBAD patients.

4. Imported vs. Domestic Stent-Grafts

A key question for many patients: Are domestic stent-grafts (made in China) as safe as imported ones? The study found no difference in LOS or early outcomes between the two groups. This suggests domestic devices are effective for short-term care—though long-term follow-up is needed to confirm durability.

What Does This Mean for Patients and Doctors?

This study adds vital context to global TEVAR research, which has long focused on Western populations. For Chinese patients with TBAD, the takeaways are clear:

  • TEVAR is a reliable option: The low mortality and complication rates confirm that TEVAR is safe and effective.
  • Control hypertension: If you have TBAD and a history of high blood pressure, strict blood pressure management is non-negotiable—it could mean the difference between life and death.
  • Domestic devices work: For patients who can’t access imported stent-grafts, domestic options are a viable choice (at least in the short term).

For doctors, the study highlights the need to:

  • Prioritize blood pressure control in TBAD patients.
  • Continue tracking long-term outcomes of domestic stent-grafts.
  • Share data from Asian cohorts to fill gaps in global guidelines.

Why This Study Matters

Most aortic dissection research comes from Western registries, but TBAD affects millions of people in Asia—including China, where hypertension is widespread. This 11-year study from a top Chinese hospital is one of the largest to focus on Asian patients, offering insights that could tailor care for this population.

As the authors note, “Our preliminary results show a favorable early outcome of TEVAR over the past decade, including both imported and domestic stent-graft groups.” Long-term follow-up will help confirm these findings, but for now, this work is a step forward in making TEVAR accessible and safe for more people worldwide.

Kan YQ, Guo DQ, Si Y, Fu WG. Thoracic endovascular aortic repair for type B aortic dissection patients: 11-year experience from a Chinese Tertiary Center. Chinese Medical Journal. 2021;134(8):971–972. doi:10.1097/CM9.0000000000001420

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