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Registry to Clarify Optimal Type B Aortic Dissection Treatment
The perfect storm of high prevalence, large volume and advanced technology make MedStar Heart & Vascular Institute (MHVI) an ideal setting to help define the optimal treatment for aortic dissection.
As a tertiary referral hub, MHVI at MedStar Washington Hospital Center treats between six to eight patients with aortic dissection every month. While ascending dissection (Type A) requires lifesaving surgical intervention, treatment for descending aortic dissection (Type B) is less clear.
Medical management has long been the treatment choice unless there is leaking or rupture. But endovascular procedures now are more frequently used. Still, questions remain: Who is at greater risk for future rupture? Which patients would benefit from the endovascular repair of the aortic tear—and when?
To help clarify the issue, cardiac surgeon Christian Shults, MD, and vascular surgeon Tareq M. Massimi, MD, RPVI, are collecting extensive data to develop a registry of patients from across the MedStar Health network—information about treatment, outcomes and follow-up care that may help inform future clinical trials.
“We see more aortic dissection cases than any other hospital in the region,” says Dr. Shults. “And area physicians are referring an increasing number of complex cases to us. In many instances, open surgical intervention is clearly the right choice. But in less complicated cases, we have to weigh the risks and benefits of endovascular surgery with drug management. We want to know when and how to intervene before a catastrophic event occurs.”
“Nationwide there is a paradigm shift in treatment toward endovascular repair for patients with Type B dissection,” Dr. Massimi says.
No matter the treatment option, all of these patients are followed very closely, and that care provides a great opportunity to collect data and compare results.
The registry will begin retrospectively with patients treated from January 2014 and move forward. “We think the information will help us develop a new treatment algorithm for these patients, and help to reduce mortality and morbidity,” Dr. Massimi adds.