The optimal timing for thoracic endovascular aortic repair (TEVAR) in patients with uncomplicated acute type B aortic dissection (UATBAD) remains a topic of debate. This analysis explores the relationship between TEVAR timing and postoperative outcomes using data from the Vascular Quality Initiative (VQI) registry.
This study analyzed data from the VQI TEVAR and complex endovascular aneurysm repair registry between 2010 and 2019. Patients with non-dissection related diseases or complicated ATBAD (with malperfusion or rupture) were excluded. Propensity score matching was used to compare two timing groups: acute (1-14 days from symptom onset to TEVAR) and subacute (15-90 days). Outcomes included postoperative mortality, in-hospital complications, and reintervention rates.
Initially, 688 cases met the inclusion criteria. After propensity matching, 187 patients remained in each group. No significant differences were found between groups regarding postoperative mortality or in-hospital complications.
However, the acute TEVAR group (1-14 days) showed a significantly higher rate of reintervention within 30 days (15.3% vs. 5.2%; P = .02). This difference persisted at one year (33.8% vs. 14.5%; P = .007). While multivariable analysis did not confirm statistical significance for long-term survival, complications, or reintervention, a trend (P = .08) suggested the acute group had 2.3 times higher odds of requiring in-hospital reintervention.
This analysis suggests that while TEVAR timing for UATBAD does not significantly impact mortality or overall complication rates, early repair (within 1-14 days) is strongly associated with a higher risk of reintervention. This may indicate that patients presenting for early repair have higher-risk anatomical or physiological characteristics not fully captured by propensity matching. Future TEVAR trials for UATBAD should prioritize research on optimal timing for intervention. This analysis highlights the need for careful patient selection and consideration of individual risk factors when determining the timing of TEVAR for UATBAD.
