Is medical therapy still the optimal treatment strategy for patients with acute type B aortic dissections

Abstract Objective: The optimal treatment of patients with acute type B dissections continues to be debated. Methods: A 36-year clinical experience of medical and surgical treatments in 189 patients was retrospectively analyzed (multivariable Cox proportional hazards model) with respect to three outcome end points: all deaths, freedom from reoperation, and freedom from late aortic complications or death. Propensity score analysis identified 2 quintiles (quintiles I and II, consisting of 142 comparable patients) for further comparison of the effects of surgical versus medical treatment. Results: Shock (hazard ratio 14.5, 95% confidence interval 4.7-44.5, P P Conclusions: The prognosis for patients with acute type B aortic dissection is bleak and determined primarily by dissection-related and patient-specific risk factors, which do not appear to be readily modifiable. J Thorac Cardiovasc Surg 2002;124:896-910