Interpretation of clinical practice guidelines for type B aortic dissection of the Society of Thoracic Surgeons and the American Association for Thoracic Surgery in 2022_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HAN Hui ¹ ,  LUO Mingyao ^1,2 , SHU Chang ^1,3

1. State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;
2. Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650032, P. R. China;
3. Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, P. R. China;

Corresponding author：

LUO Mingyao, Email: luomingyao@fuwai.com

Keywords：

Type B aortic dissection; classification; thoracic endovascular aortic repair; guideline interpretation

DOI：

10.7507/1007-4848.202204039

Video：

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In recent years, the diagnosis and management technology of type B aortic dissection (TBAD) has developed rapidly worldwide along with evidence-based medicine practice and clinical research data. But the standard clinical criteria are still limited. Based on this, the Society of Thoracic Surgeons (STS) and the American Association for Thoracic Surgery (AATS) established an expert group dominated by aortic surgeons to collate and analyze the comprehensive literature data of acute and chronic, complicated and uncomplicated TBAD. And then, the group formulated and officially released the clinical practice guidelines for TBAD in 2022. In this paper, we interpreted and analyzed the main contents of the guideline in combination with domestic research, in order to provide reference and help for the clinical diagnosis and treatment of TBAD at the present stage in China.

Citation： HAN Hui, LUO Mingyao, SHU Chang. Interpretation of clinical practice guidelines for type B aortic dissection of the Society of Thoracic Surgeons and the American Association for Thoracic Surgery in 2022. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(7): 820-827. doi: 10.7507/1007-4848.202204039 Copy

1.	Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA, 2000, 283(7): 897-903.
2.	Levinson Dc, Edmaedes Dt, Griffith Gc. Dissecting aneurysm of the aorta; its clinical, electrocardiographic and laboratory features; a report of 58 autopsied cases. Circulation, 1950, 1(3): 360-387.
3.	Xia L, Li JH, Zhao K, et al. Incidence and in-hospital mortality of acute aortic dissection in China: Analysis of China Health Insurance Research (CHIRA) Data 2011. J Geriatr Cardiol, 2015, 12(5): 502-506.
4.	Wang W, Duan W, Xue Y, et al. Clinical features of acute aortic dissection from the Registry of Aortic Dissection in China. J Thorac Cardiovasc Surg, 2014, 148(6): 2995-3000.
5.	Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
6.	MacGillivray TE, Gleason TG, Patel HJ, et al. The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection. J Thorac Cardiovasc Surg, 2022, 163(4): 1231-1249.
7.	Halperin JL, Levine GN, Al-Khatib SM, et al. Further evolution of the ACC/AHA Clinical Practice Guideline Recommendation Classification System: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2016, 133(14): 1426-1428.
8.	Weiss G, Wolner I, Folkmann S, et al. The location of the primary entry tear in acute type B aortic dissection affects early outcome. Eur J Cardiothorac Surg, 2012, 42(3): 571-576.
9.	Czerny M, Schmidli J, Adler S, et al. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: An expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg, 2019, 55(1): 133-162.
10.	孙立忠, 刘宁宁, 常谦, 等. 主动脉夹层的细化分型及其应用. 中华外科杂志, 2005, 43(18): 1171-1176.
11.	丘俊涛, 罗新锦, 常谦, 等. 主动脉夹层阜外分型的临床应用. 中华胸心血管外科杂志, 2020, 36(12): 709-715.
12.	Lombardi JV, Hughes GC, Appoo JJ, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. Ann Thorac Surg, 2020, 109(3): 959-981.
13.	van Bakel TMJ, Grassi V, Patel HJ, et al. Commentary: Dynamic mesenteric malperfusion in aortic dissection. J Endovasc Ther, 2019, 26(1): 88-89.
14.	Jonker FH, Patel HJ, Upchurch GR, et al. Acute type B aortic dissection complicated by visceral ischemia. J Thorac Cardiovasc Surg, 2015, 149(4): 1081-1086.
15.	Shu C, Fan B, Luo M, et al. Endovascular treatment for aortic arch pathologies: Chimney, on-the-table fenestration, and in-situ fenestration techniques. J Thorac Dis, 2020, 12(4): 1437-1448.
16.	Luo M, Fang K, Fan B, et al. Midterm results of retrograde in situ needle fenestration during thoracic endovascular aortic repair of aortic arch pathologies. J Endovasc Ther, 2021, 28(1): 36-43.
17.	Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
18.	Nienaber CA, Rousseau H, Eggebrecht H, et al. Randomized comparison of strategies for type B aortic dissection: The investigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial. Circulation, 2009, 120(25): 2519-2528.
19.	Nienaber CA, Kische S, Rousseau H, et al. Endovascular repair of type B aortic dissection: Long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv, 2013, 6(4): 407-416.
20.	Brunkwall J, Kasprzak P, Verhoeven E, et al. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg, 2014, 48(3): 285-291.
21.	Qin YL, Wang F, Li TX, et al. Endovascular repair compared with medical management of patients with uncomplicated type B acute aortic dissection. J Am Coll Cardiol, 2016, 67(24): 2835-2842.
22.	Xiang D, Kan X, Liang H, et al. Comparison of mid-term outcomes of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(1): 26-36.
23.	Li DL, Zhang HK, Chen XD, et al. Thoracic endovascular aortic repair for type B aortic dissection: Analysis among acute, subacute, and chronic patients. J Am Coll Cardiol, 2016, 67(10): 1255-1257.
24.	Fattori R, Cao P, De Rango P, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol, 2013, 61(16): 1661-1678.
25.	Yammine H, Briggs CS, Stanley GA, et al. Retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2019, 69(1): 24-33.
26.	李树春, 周庆, 潘俊, 等. Stanford B型主动脉夹层腔内修复术后并发A型夹层的外科治疗. 中国胸心血管外科临床杂志, 2019, 26(8): 826-828.
27.	Pujara AC, Roselli EE, Hernandez AV, et al. Open repair of chronic distal aortic dissection in the endovascular era: Implications for disease management. J Thorac Cardiovasc Surg, 2012, 144(4): 866-873.
28.	舒畅, 王暾. 慢性主动脉夹层动脉瘤的诊治. 中国血管外科杂志(电子版), 2021, 13(1): 1-3.
29.	Faure EM, Canaud L, Agostini C, et al. Reintervention after thoracic endovascular aortic repair of complicated aortic dissection. J Vasc Surg, 2014, 59(2): 327-333.
30.	Leshnower BG, Szeto WY, Pochettino A, et al. Thoracic endografting reduces morbidity and remodels the thoracic aorta in DeBakey Ⅲ aneurysms. Ann Thorac Surg, 2013, 95(3): 914-921.
31.	Hughes GC. Commentary: Left subclavian artery revascularization during zone 2 thoracic endovascular aortic repair: Bypass versus transposition? Just do it! J Thorac Cardiovasc Surg, 2020, 159(4): 1228-1230.
32.	苏奕明, 魏立春, 侯培勇, 等. 脑脊液引流防治胸腹主动脉瘤腔内修复术后脊髓损伤疗效及安全性的系统评价和Meta分析. 中国普通外科杂志, 2019, 28(6): 687-695.
33.	Bartos O, Mustafi M, Andic M, et al. Carotid-axillary bypass as an alternative revascularization method for zone Ⅱ thoracic endovascular aortic repair. J Vasc Surg, 2020, 72(4): 1229-1236.
34.	罗明尧, 舒畅, 方坤, 等. “HENDO”技术体系治疗主动脉弓部疾病. 中国胸心血管外科临床杂志, 2020, 27(9): 987-991.
35.	王冕, 常光其, 殷恒讳, 等. 杂交技术治疗主动脉弓部病变的经验分析. 中华外科杂志, 2015, 53(11): 826-830.
36.	李树春, 周庆, 金珉, 等. 分期杂交手术治疗胸腹主动脉夹层. 中国胸心血管外科临床杂志, 2020, 27(9): 1099-1102.
37.	舒畅, 施俊哲, 葛建军, 等. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 2020, 35(2): 124-129.
38.	Zhang L, Yu C, Yang X, et al. Hybrid and frozen elephant trunk for total arch replacement in DeBakey typeⅠdissection. J Thorac Cardiovasc Surg, 2019, 158(5): 1285-1292.

1. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA, 2000, 283(7): 897-903.
2. Levinson Dc, Edmaedes Dt, Griffith Gc. Dissecting aneurysm of the aorta; its clinical, electrocardiographic and laboratory features; a report of 58 autopsied cases. Circulation, 1950, 1(3): 360-387.
3. Xia L, Li JH, Zhao K, et al. Incidence and in-hospital mortality of acute aortic dissection in China: Analysis of China Health Insurance Research (CHIRA) Data 2011. J Geriatr Cardiol, 2015, 12(5): 502-506.
4. Wang W, Duan W, Xue Y, et al. Clinical features of acute aortic dissection from the Registry of Aortic Dissection in China. J Thorac Cardiovasc Surg, 2014, 148(6): 2995-3000.
5. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
6. MacGillivray TE, Gleason TG, Patel HJ, et al. The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection. J Thorac Cardiovasc Surg, 2022, 163(4): 1231-1249.
7. Halperin JL, Levine GN, Al-Khatib SM, et al. Further evolution of the ACC/AHA Clinical Practice Guideline Recommendation Classification System: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2016, 133(14): 1426-1428.
8. Weiss G, Wolner I, Folkmann S, et al. The location of the primary entry tear in acute type B aortic dissection affects early outcome. Eur J Cardiothorac Surg, 2012, 42(3): 571-576.
9. Czerny M, Schmidli J, Adler S, et al. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: An expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg, 2019, 55(1): 133-162.
10. 孙立忠, 刘宁宁, 常谦, 等. 主动脉夹层的细化分型及其应用. 中华外科杂志, 2005, 43(18): 1171-1176.
11. 丘俊涛, 罗新锦, 常谦, 等. 主动脉夹层阜外分型的临床应用. 中华胸心血管外科杂志, 2020, 36(12): 709-715.
12. Lombardi JV, Hughes GC, Appoo JJ, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. Ann Thorac Surg, 2020, 109(3): 959-981.
13. van Bakel TMJ, Grassi V, Patel HJ, et al. Commentary: Dynamic mesenteric malperfusion in aortic dissection. J Endovasc Ther, 2019, 26(1): 88-89.
14. Jonker FH, Patel HJ, Upchurch GR, et al. Acute type B aortic dissection complicated by visceral ischemia. J Thorac Cardiovasc Surg, 2015, 149(4): 1081-1086.
15. Shu C, Fan B, Luo M, et al. Endovascular treatment for aortic arch pathologies: Chimney, on-the-table fenestration, and in-situ fenestration techniques. J Thorac Dis, 2020, 12(4): 1437-1448.
16. Luo M, Fang K, Fan B, et al. Midterm results of retrograde in situ needle fenestration during thoracic endovascular aortic repair of aortic arch pathologies. J Endovasc Ther, 2021, 28(1): 36-43.
17. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
18. Nienaber CA, Rousseau H, Eggebrecht H, et al. Randomized comparison of strategies for type B aortic dissection: The investigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial. Circulation, 2009, 120(25): 2519-2528.
19. Nienaber CA, Kische S, Rousseau H, et al. Endovascular repair of type B aortic dissection: Long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv, 2013, 6(4): 407-416.
20. Brunkwall J, Kasprzak P, Verhoeven E, et al. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg, 2014, 48(3): 285-291.
21. Qin YL, Wang F, Li TX, et al. Endovascular repair compared with medical management of patients with uncomplicated type B acute aortic dissection. J Am Coll Cardiol, 2016, 67(24): 2835-2842.
22. Xiang D, Kan X, Liang H, et al. Comparison of mid-term outcomes of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(1): 26-36.
23. Li DL, Zhang HK, Chen XD, et al. Thoracic endovascular aortic repair for type B aortic dissection: Analysis among acute, subacute, and chronic patients. J Am Coll Cardiol, 2016, 67(10): 1255-1257.
24. Fattori R, Cao P, De Rango P, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol, 2013, 61(16): 1661-1678.
25. Yammine H, Briggs CS, Stanley GA, et al. Retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2019, 69(1): 24-33.
26. 李树春, 周庆, 潘俊, 等. Stanford B型主动脉夹层腔内修复术后并发A型夹层的外科治疗. 中国胸心血管外科临床杂志, 2019, 26(8): 826-828.
27. Pujara AC, Roselli EE, Hernandez AV, et al. Open repair of chronic distal aortic dissection in the endovascular era: Implications for disease management. J Thorac Cardiovasc Surg, 2012, 144(4): 866-873.
28. 舒畅, 王暾. 慢性主动脉夹层动脉瘤的诊治. 中国血管外科杂志(电子版), 2021, 13(1): 1-3.
29. Faure EM, Canaud L, Agostini C, et al. Reintervention after thoracic endovascular aortic repair of complicated aortic dissection. J Vasc Surg, 2014, 59(2): 327-333.
30. Leshnower BG, Szeto WY, Pochettino A, et al. Thoracic endografting reduces morbidity and remodels the thoracic aorta in DeBakey Ⅲ aneurysms. Ann Thorac Surg, 2013, 95(3): 914-921.
31. Hughes GC. Commentary: Left subclavian artery revascularization during zone 2 thoracic endovascular aortic repair: Bypass versus transposition? Just do it! J Thorac Cardiovasc Surg, 2020, 159(4): 1228-1230.
32. 苏奕明, 魏立春, 侯培勇, 等. 脑脊液引流防治胸腹主动脉瘤腔内修复术后脊髓损伤疗效及安全性的系统评价和Meta分析. 中国普通外科杂志, 2019, 28(6): 687-695.
33. Bartos O, Mustafi M, Andic M, et al. Carotid-axillary bypass as an alternative revascularization method for zone Ⅱ thoracic endovascular aortic repair. J Vasc Surg, 2020, 72(4): 1229-1236.
34. 罗明尧, 舒畅, 方坤, 等. “HENDO”技术体系治疗主动脉弓部疾病. 中国胸心血管外科临床杂志, 2020, 27(9): 987-991.
35. 王冕, 常光其, 殷恒讳, 等. 杂交技术治疗主动脉弓部病变的经验分析. 中华外科杂志, 2015, 53(11): 826-830.
36. 李树春, 周庆, 金珉, 等. 分期杂交手术治疗胸腹主动脉夹层. 中国胸心血管外科临床杂志, 2020, 27(9): 1099-1102.
37. 舒畅, 施俊哲, 葛建军, 等. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 2020, 35(2): 124-129.
38. Zhang L, Yu C, Yang X, et al. Hybrid and frozen elephant trunk for total arch replacement in DeBakey typeⅠdissection. J Thorac Cardiovasc Surg, 2019, 158(5): 1285-1292.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interpretation of clinical practice guidelines for type B aortic dissection of the Society of Thoracic Surgeons and the American Association for Thoracic Surgery in 2022

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