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Risk Profile Analysis of Uncomplicated Type B Aortic Dissection Patients Undergoing Thoracic Endovascular Aortic Repair: Laboratory & Radiographic Predictors
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  • Alexander Geragotellis,
  • Mohammed Al-Tawil,
  • Matti Jubouri,
  • Sven Zhen Cian Patrick Tan,
  • Ian Williams,
  • Mohamad Bashir
Alexander Geragotellis
University of Cape Town

Corresponding Author:[email protected]

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Mohammed Al-Tawil
Al Quds University Faculty of Medicine
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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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Ian Williams
University Hospital of Wales
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Mohamad Bashir
NHS Wales Health Education and Improvement Wales
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Background: There is emerging evidence to support pre-emptive thoracic endovascular aortic repair (TEVAR) intervention for uncomplicated type B aortic dissection (unTBAD). Pre-emptive intervention would be particularly beneficial in patients that have a higher baseline risk of progressing to complicated TBAD (coTBAD). There remains debate on the optimal clinical, laboratory, morphological and radiological parameters which would identify the highest-risk patients that would benefit most from pre-emptive TEVAR. Aim: This review summarises evidence on the clinical, laboratory, and morphological parameters that increase the risk profiles of unTBAD patients. Methods: A comprehensive literature search was carried out on multiple electronic databases including PubMed, EMBASE, Ovid and Scopus in order to collate all research evidence on the the clinical, laboratory, and morphological parameters that increase the risk profiles of unTBAD patients Results: At present, there are no clear clinical guidelines using risk-stratification to inform the selection of unTBAD patients for TEVAR. However, there are noticeable literature trends that can assist with the identification of the most at-risk unTBAD patients. Patients are at particular risk when they have refractory pain and/or hypertension, elevated C-reactive protein (CRP), larger aortic diameter and larger entry tears. These risks should be considered alongside factors that increase the procedural risk of TEVAR to create a well-balanced approach. Advances in biomarkers and imaging are likely to identify more pertinent parameters in future to optimise the development of balanced, risk-stratified treatment protocols. Conclusion: There are a variety of risk profiling parameters that can be used to identify the high-risk unTBAD patient, with novel biomarkers and imaging parameter emerging. Longer-term evidence verifying these parameters would be ideal. Further randomized controlled trials and multicentre registry analyses are also warranted to guide risk-stratified selection protocols.
17 Apr 2022Submitted to Journal of Cardiac Surgery
18 Apr 2022Assigned to Editor
18 Apr 2022Submission Checks Completed
18 Apr 2022Reviewer(s) Assigned
22 Apr 2022Review(s) Completed, Editorial Evaluation Pending
22 Apr 2022Editorial Decision: Accept
Sep 2022Published in Journal of Cardiac Surgery volume 37 issue 9 on pages 2811-2820. 10.1111/jocs.16655