• Akihito Matsushita, Takashi Hattori, Yu Tsunoda, Yasunori Sato, and Wahei Mihara.
• Department of Cardiovascular Surgery, Seikeikai Chiba Medical Center, Chiba, Japan.
• Interact Cardiovasc Thorac Surg. 2018 Feb 1; 26 (2): 176-182.

ObjectivesMedical treatment is the gold standard for uncomplicated acute Type B aortic dissection (ATBAD). Although endovascular treatment could become an alternative therapy, it is unclear which ATBAD patients should undergo endovascular intervention. We aimed to evaluate the outcomes of patients with uncomplicated ATBAD and identify the risk factors for major adverse events.MethodsWe retrospectively reviewed 134 consecutive patients who underwent initial treatment for uncomplicated ATBAD between 2004 and 2015. Follow-up rate was 98.5%, and the median follow-up period was 47 months. We evaluated the incidence of major adverse events (aortic-related death, aortic surgery and dilated aorta ≥ 55 mm) and identified the predictors of major adverse events using multivariable analysis.ResultsIn-hospital mortality rate was 0.7% (1/134). During follow-up, 46 patients had major adverse events. The 1-, 3-, and 5-year rates of freedom from major adverse events were 79.8%, 71.4%, and 63.6%, respectively. The independent risk factors for major adverse events were initial aortic diameter ≥40 mm (hazard ratio 3.735, 95% confidence interval 1.888-7.390; P < 0.001) and false-lumen diameter > true-lumen diameter (hazard ratio 3.411, 95% confidence interval 1.491-7.806; P = 0.004).ConclusionsInitial aortic diameter ≥40 mm and false-lumen diameter > true-lumen diameter are predictors of major adverse events after uncomplicated ATBAD. Patients with these risk factors may benefit from early endovascular intervention.Clinical Registration NumberUMIN 000025388, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029229.© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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