The role of open-heart surgery in the treatment of type B aortic dissection

Aim: to conduct an analytical review of the literature to study the role and place of open surgery in the treatment of type B aortic dissections.

Material and methods: a review of the medical literature published between 2000 and 2022 was conducted using the information and analyti- cal systems MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar and Web of Science. The search strategy was carried out in accordance with the PICO (Patient-Intervention-Comparison-Outcome) criteria. The following keywords were used to search the medical literature: «aortic dissection», «type B aortic dissection», «type B acute aortic dissection», «open thoracic aortic surgery», «endovascular surgery». The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. As a result of the search, 95 scientific publications were selected. Inclusion criteria: original articles on type B aortic dissection; Full-text articles on the diagnosis, treatment, and treatment outcomes of patients with type B aortic dissection. Exclusion criteria: abstracts, review articles, editorial notes and comments, book chapters; experimental and laboratory studies on animals or cadavers. After screening for compliance with the inclusion criteria, 66 scientific publications were excluded, 29 studies were included in the detailed analysis

Results: as a result of the search and analysis of the literature data, it was found that the treatment tactics for patients with type A aortic dissection (AD) are currently well studied and defined, while the choice of the optimal treatment method for type B AD is the subject of ongoing discussions. Today, there are serious debates among surgeons regarding the optimal treatment for chronic type B aortic dissection. The modern paradigm for managing this group of patients has undergone significant changes due to the development of minimally invasive procedures, which have become especially popular over the past decade. Current evidence suggests that endovascular treatment of RA is an effective treatment for acute type B RA, which helps prevent malperfusion and promotes further aortic remodeling.

Conclusion: randomized clinical trials with long-term follow-up comparing open surgery and TEVAR are needed to determine the optimal treatment strategy for chronic type B RA. Therefore, the optimal treatment strategy for chronic type B RA needs to be precisely defined, and at present it is difficult to establish any convincing recommendations in favor of a specific technology.

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