Intervention rates and outcomes in medically managed uncomplicated descending thoracic aortic dissections

Objective: To evaluate the long-term incidence and outcome of aortic interven-tions for medically managed uncomplicated thoracic aortic dissections.Methods: Between January 2012 and December 2018, 91 patients were discharged home with an uncomplicated, medically treated aortic dissection (involving the de-scending aorta with or without aortic arch involvement, no ascending involvement). After a median period of 4 (first quartile: 2, third quartile: 11) months, 30 patients (33%) required an aortic intervention. Patient characteristics, radiographic, treat-ment, and follow-up data were compared for patients with and without aortic inter-ventions. A competing risk regression model was analyzed to identify independent predictors of aortic intervention and to predict the risk for intervention.Results: Patients who underwent aortic interventions had significantly larger thoracic (P = .041) and abdominal (P = .015) aortic diameters, the dissection was significantly longer (P = .035), there were more communications between both lumina (P = .040), and the first communication was significantly closer to the left subclavian artery (P = .049). A descending thoracic aortic diameter exceeding 45 mm was predictive for an aortic intervention (P = .001; subdistribu-tion hazard ratio: 3.51). The risk for aortic intervention was 27% +/- 10% and 36% +/- 11% after 1 and 3 years, respectively. Fourteen patients (47%) underwent thoracic endovascular aortic repair, 11 patients (37%) thoracic endovascular aortic repair and left carotid to subclavian bypass, 3 patients (10%) total arch replace-ment with the frozen elephant trunk technique, and 2 patients (7%) thoracoabdo-minal aortic replacement. We observed no in-hospital mortality. Conclusions: The need for secondary aortic interventions in patients with initially medically managed, uncomplicated descending aortic dissections is substantial. The full spectrum of aortic treatment options (endovascular, hybrid, conventional open surgical) is required in these patients. (J Thorac Cardiovasc Surg 2023;165:958-65)