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Midterm outcomes of thoracic endovascular repair for uncomplicated type B aortic dissection with double-barrel type

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Abstract

Objective

The midterm outcomes and aortic remodeling after thoracic endovascular aortic repair (TEVAR) for uncomplicated type B aortic dissection (TBAD) were evaluated.

Methods

Forty-seven patients (mean age 66 ± 12 years) who underwent TEVAR for uncomplicated TBAD with double-barrel type from January 2012 to December 2017 were retrospectively analyzed. The indication for TEVAR for entry closure was a maximum aortic diameter > 40 mm with a patent false lumen. Twenty-six patients (55.3%) had TEVAR in chronic phase, over 6 months after the onset of aortic dissection.

Results

There was no hospital death or serious complication. During follow-up (mean 35 ± 16 months), overall 3-year survival was 95.6 ± 3.1%. A significant trend was observed with a higher rate of shrinkage of overall aortic diameter, expansion of the true lumen, and shrinkage of the false lumen more proximally from the stent graft-covered site. Rate of aortic shrinkage in chronic with aortic diameter more than 50 mm was lower compared with the other (proximal: 33.3% vs. 80–100%, distal 0–16.7% vs. 50–52.9%). Rate of aortic dilation distally to the stent graft-covered site was 28% in chronic compared with 5% in non-chronic. Adverse events were mainly due to distal aortic dilation, and 3-year freedom from all adverse events was 79.8 ± 6.5%.

Conclusions

Favorable aortic remodeling of the proximal stent graft-covered site could be expected even in the chronic phase if preoperative aortic dilation over 50 mm is unaccompanied. Careful follow-up focusing on dilation of the distal aortic segment is mandatory especially in patients who underwent TEVAR in chronic phase.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka, 565-8565, Japan

    Atsushi Omura, Hitoshi Matsuda, Tetsuya Fukuda & Junjiro Kobayashi

  2. Hyogo Brain and Heart Center, Himeji, Hyogo, Japan

    Yoshikatsu Nomura, Ryota Kawasaki, Hirohisa Murakami & Nobuhiko Mukohara

  3. Kitaharima Medical Center, Ono, Hyogo, Japan

    Akitoshi Yamada & Kunio Gan

Authors
  1. Atsushi Omura
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  2. Hitoshi Matsuda
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  3. Tetsuya Fukuda
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  4. Yoshikatsu Nomura
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  5. Ryota Kawasaki
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  6. Hirohisa Murakami
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  7. Akitoshi Yamada
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  8. Kunio Gan
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  9. Nobuhiko Mukohara
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  10. Junjiro Kobayashi
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Correspondence to Hitoshi Matsuda.

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Omura, A., Matsuda, H., Fukuda, T. et al. Midterm outcomes of thoracic endovascular repair for uncomplicated type B aortic dissection with double-barrel type. Gen Thorac Cardiovasc Surg 67, 1021–1029 (2019). https://doi.org/10.1007/s11748-019-01128-0

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  • DOI: https://doi.org/10.1007/s11748-019-01128-0

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