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Eur J Cardiothorac Surg 2001;19:606-610
© 2001 Elsevier Science NL

Chronic ß-blocker therapy improves outcome and reduces treatment costs in chronic type B aortic dissection

^a Division of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland,
^b Division of Echocardiography, University Hospital Zürich, Zurich, Switzerland
^c Department of Biostatistics ISPM, University of Zürich, Zurich, Switzerland

Received 10 October 2000; received in revised form 27 February 2001; accepted 1 March 2001.

Corresponding author. Department of Heart Surgery, Triemli City Hospital, Birmensdorferstr 397, 8063 Zurich, Switzerland. Tel.: +41-1-466-1185; fax: +41-1-466-2745
e-mail: michele.genoni{at}triemli.stzh.ch

Objectives: To compare the medical treatment of chronic type B aortic dissection with ß-blockers versus other antihypertensive treatments in terms of their requirement for surgical intervention and treatment costs. Methods: Case records of the 130 patients treated for aortic dissection type B in this unit between 1988 and 1997 were reviewed. Seventy-eight of 130 patients with chronic dissection have received isolated medical treatment. Seventy-one of 78 patients were discharged alive. Fifty-one of 71 received ß-blocker treatment, 20/71 were treated with other antihypertensive drugs. Results: Surgery for aortic dissection became necessary in 20/71 patients (28%) during follow-up (mean, 4.2 years): 10/51 in the ß-blocker group and 9/20 in the other antihypertensive drug group. The freedom from subsequent aortic operation was 80 and 47%, respectively (P=0.001). Indications for emergency surgery were increased aortic diameter (79%), symptomatic aortic aneurysm (11%), and renal artery hypoperfusion (5%). The median hospitalization time during follow-up (dissection-related) was 2 days for patients who received ß-blockers and 16 days for patients who received other antihypertensive drug treatments (P=0.001). The cost of treatment/patient per year amounted to 644 and 12 748 euros, respectively. Conclusions: A substantial proportion of patients with chronic type B dissection who receive initial medical management will later need surgery. Long-term treatment with ß-blockers reduces the progression of aortic dilatation, the incidence of subsequent hospital admissions, as well as the incidence of late dissection-related aortic procedures and the cost of treatment. Patients with chronic type B dissection need, in addition to frequent follow-up of aortic diameter, continuous treatment with ß-blocking agents.

Key Words: Aortic dissection • Antihypertensive agent • Beta-blocker • Cost of treatment

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