Authors: Rami Tadros, MD, Associate Professor of Surgery at the Icahn School of Medicine at Mount Sinai
Gilbert Tang, MD, Associate Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai; Surgical Director of the Structural Heart Program at Mount Sinai Health System
Journal: Journal of the American College of Cardiology
Paper Title: “Optimal Treatment of Uncomplicated Type B Aortic Dissection: JACC Review Topic of the Week”
Abstract: Historically, the gold standard for treating acute uncomplicated Type B aortic dissection (TBAD) has been aggressive medical therapy to achieve optimal heart rate and blood pressure control. However, recent data have demonstrated that a significant proportion of patients with medically managed acute uncomplicated TBAD have late aorta-related complications, such as aneurysmal degeneration, that increase mortality and often necessitate surgical intervention. In this article, we review existing literature on uncomplicated TBAD and highlight contemporary surgical and medical strategies to manage this condition. Looking ahead, efforts are underway to identify and characterize a high-risk subgroup of acute uncomplicated TBAD patients who may benefit from early intervention.
Bottom Line: The new research shows that in patients who suffers from acute type B aortic dissection (tear in the aorta), certain features should prompt early intervention with a stent graft to repair the torn aorta. This topic is very important given once the tear of the aortic becomes chronic it becomes harder to treat successfully. Our review article has provided a concise summary of what one should do.
What this review article means for physicians: Doctors should refer patients with a tear in the descending aorta (type B dissection) to a center of excellence where a cardiac and vascular surgeon can jointly evaluate the patient in a timely manner.
What this means for patients: If you have a condition called "aortic dissection" you should be followed up by a vascular surgeon and cardiac surgeon at a center of excellence who can jointly manage your condition. Without treatment a portion of these patients can deteriorate and reduce their life expectancies.
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About Mount Sinai Health System
The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology and the South Nassau Communities Hospital is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and South Nassau Communities Hospital are ranked regionally.