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The Misnomer of Uncomplicated Type B Aortic Dissection
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  • Mohamad Bashir,
  • Matti Jubouri,
  • Sven Zhen Cian Patrick Tan,
  • Damian Bailey,
  • Bashi Velayudhan,
  • Mohammed Idhrees,
  • Randolph Wong,
  • Martin Czerny,
  • Edward P. Chen,
  • Leonard Girardi,
  • Joseph Coselli,
  • Ian Williams
Mohamad Bashir
NHS Wales Health Education and Improvement Wales

Corresponding Author:[email protected]

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Matti Jubouri
Hull York Medical School
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Sven Zhen Cian Patrick Tan
Queen Mary University of London Barts and The London School of Medicine and Dentistry
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Damian Bailey
University of South Wales Faculty of Life Sciences and Education
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Bashi Velayudhan
SRM Institutes for Medical Science Vadapalani
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Mohammed Idhrees
SRM Institutes for Medical Science Vadapalani
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Randolph Wong
The Chinese University of Hong Kong Department of Surgery
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Martin Czerny
Albert-Ludwigs-Universitat Freiburg Universitatsbibliothek Freiburg
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Edward P. Chen
Duke University Hospital
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Leonard Girardi
Weill Cornell Medicine Department of Cardiothoracic Surgery
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Joseph Coselli
Baylor College of Medicine Michael E DeBakey Department of Surgery
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Ian Williams
University Hospital of Wales
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Background: Acute type B aortic dissection (TBAD) is a rare condition that can be divided into complicated (CoTBAD) and uncomplicated (UnCoTBAD) based on certain presenting clinical and radiological features, with UnCoTBAD constituting the majority of TBAD cases. The classification of TBAD directly affects the treatment pathway taken, however, there remains confusion as to exactly what differentiates complicated from uncomplicated TBAD. Aims: The scope of this review is to delineate the literature defining the intervention parameters for UnCoTBAD. Methods: A comprehensive literature search was conducted using multiple electronic databases including PubMed, Scopus, and EMBASE to collate and summarize all research evidence on intervention parameters and protocols for UnCoTBAD. Results: A TBAD without evidence of malperfusion or rupture might be classified as uncomplicated but there remains a subgroup who might exhibit high-risk features. Two clinical features representative of “high risk” are refractory pain and persistent hypertension. First line treatment for CoTBAD is TEVAR, and whilst this has also proven its safety and effectiveness in UnCoTBAD, it is still being managed conservatively. However, TBAD is a dynamic pathology and a significant proportion of UnCoTBADs can progress to become complicated, thus necessitating more complex intervention. While the “high risk” UnCoTBAD do benefit the most from TEVAR, yet, the defining parameters are still debatable as this benefit can be extended to a wider UnCoTBAD population. Conclusion: Uncomplicated TBAD remains a misnomer as it is frequently representative of a complex ongoing disease process requiring very close monitoring in a critical care setting. A clear diagnostic pathway may improve decision making following a diagnosis of UnCoTBAD. Choice of treatment still predominantly depends on when an equilibrium might be reached where the risks of TEVAR outweigh the natural history of the dissection in both the short- and long-term.
23 Mar 2022Submitted to Journal of Cardiac Surgery
28 Mar 2022Assigned to Editor
28 Mar 2022Submission Checks Completed
28 Mar 2022Reviewer(s) Assigned
29 Mar 2022Review(s) Completed, Editorial Evaluation Pending
01 Apr 2022Editorial Decision: Accept
Sep 2022Published in Journal of Cardiac Surgery volume 37 issue 9 on pages 2761-2765. 10.1111/jocs.16728