Current Experience With Acute Type B Aortic Dissection: Validity of the Complication- Specific Approach in the Present Era Paris Charilaou, MD, Bulat.

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Current Experience With Acute Type B Aortic Dissection: Validity of the Complication- Specific Approach in the Present Era Paris Charilaou, MD, Bulat A. Ziganshin, MD, Sven Peterss, MD, Bijoy G. Rajbanshi, MD, Cha Rajakaruna, MD, Khaled J. Zaza, Mohammad N. Salloum, Alexander Mukherjee, Maryann Tranquilli, RN, John A. Rizzo, PhD, John A. Elefteriades, MD The Annals of Thoracic Surgery Volume 101, Issue 3, Pages 936-943 (March 2016) DOI: 10.1016/j.athoracsur.2015.08.074 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The complication-specific approach to acute descending aortic dissection. (Reprinted with permission from Elefteriades JA, et al. Ann Thorac Surg 1999;67:2002–5 [4]). The Annals of Thoracic Surgery 2016 101, 936-943DOI: (10.1016/j.athoracsur.2015.08.074) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Flow diagram shows the patient population classified according to clinical presentation (complicated vs uncomplicated), subsequently by treatment received, and finally, hospital survival in each group. Patients were monitored after discharge for the need of late operations. (BMT = baseline medical treatment; Fen = fenestration; LE = lower extremities; TE = thromboexclusion; TEVAR = thoracic endovascular aortic repair; Tx = treatment.) *At presentation. **Rupture count includes impending ruptures. The Annals of Thoracic Surgery 2016 101, 936-943DOI: (10.1016/j.athoracsur.2015.08.074) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Kaplan-Meier survival curve shows long-term follow-up for up to 10 years since the date of admission of 103 patients with acute type B aortic dissection (TBAD) treated in a complication-specific approach. The survival at 1, 3, 5, and 10 years is 83%, 78%, 71%, and 47%, respectively. The zoomed-in portion depicts the first year of follow-up in month-by-month resolution. Median survival is 108.9 months. (B) Kaplan-Meier survival curve shows a 10-year long-term follow-up for the same 103 TBAD patients (solid line) compared with an age-matched and gender-matched control curve (dashed line), which was based on life-table data from 2006 (Appendix 2). The log-rank p value <0.001 infers a significant difference between the TBAD patients and their matched controls for a follow-up of 10 years. The thin, grey, dotted line represents the standard error. The Annals of Thoracic Surgery 2016 101, 936-943DOI: (10.1016/j.athoracsur.2015.08.074) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) Kaplan-Meier curves compare an 8-year follow-up between uncomplicated medically treated (MT) patients (solid line) and complicated surgically treated patients (complication-specific approach; dashed line). Log-rank comparison shows significantly lower (p = 0.027) long-term survival in the complicated patients. Survival at 1, 3, 5, and 8 years is 67%, 63%, 59%, and 49%, respectively, for complicated patients and is 91%, 87%, 78% and 55%, respectively, for uncomplicated patients. Median survival was 81.5 months for complicated patients and 122.4 months for uncomplicated patients. Mean age of complicated and uncomplicated patients was 65.4 and 64.6 years, respectively (p = 0.785). (B) Kaplan-Meier curves compare 6-year survival between 65 uncomplicated medically treated patients (solid line) and age-matched and gender-matched control curve (dashed line), which was based on life-table data from 2007 (Appendix 2). The log-rank p = 0.057 infers no significant difference between the uncomplicated medically treated patients and their matched controls, for a follow-up of 6 years. The thin, grey, dotted line represents the standard error. The Annals of Thoracic Surgery 2016 101, 936-943DOI: (10.1016/j.athoracsur.2015.08.074) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions