Analysis of perioperative outcome and long-term survival rate of thoracic endovascular aortic repair in uncomplicated type B dissection: single-centre experience with 751 patients

Gao, Hui‐Qiang; Xu, Shumin; Ren, Changwei; Yang, Sihua; Liu, Chao-Liang; Zhen, Jun; Liu, Yongmin; Huang, Lianjun; Sun, Lu

doi:10.1093/ejcts/ezz131

Cited by 15 publications

(33 citation statements)

References 22 publications

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“…In the present study, there was no difference in survival rates among the four types of lesions, as well as no difference in survival rates was found between the two kinds of bypass. In our center, the 5 and 10‐year survival rates for uncomplicated Type B dissection were 96.5% and 83.0%, respectively 24 . The median age of the hybrid group was older than that of the uncomplicated Type B dissection group, which may have caused this substantial difference between the survival rates.…”

Section: Discussionmentioning

confidence: 83%

Analysis of clinical outcomes of one‐staged hybrid procedure without thoracotomy for aorta lesion involving distal aortic arch

et al. 2021

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Background This study aimed to evaluate the clinical outcomes of one‐staged hybrid procedure for aortic lesions involving the distal aortic arch. Methods We retrospectively studied 99 consecutive patients who underwent the hybrid procedure (thoracic endovascular aortic repair combined with supra‐arch branch vessel bypass) in our center between April 2009 and January 2020 for lesions involving the distal aortic arch. Results Median age was 64.0 (57.0–69.0) years, and 83 (83.8%) patients were male. There were five deaths in the perioperative period (three due to cerebral infarction and two due to intimal rupture). During the median follow‐up of 41.0 months, 20 patients died, three had endoleak, one had a newly formed intimal tear, and two had femoral artery pseudoaneurysm. The 5‐ and 10‐year survival rates of the total population were 72.2% and 48.8%, respectively. Additionally, there was no difference in the 5‐year survival rate among the four groups according to different pathologies (Type B aortic dissection, aortic ulcer, aortic aneurysm, aortic pseudoaneurysm: 74.7%, 78.2%, 61.1%, and 75.5%, respectively, p = .58). Furthermore, there was no difference in the 5‐ and 10‐year survival rates between the two groups according to the different bypass methods (right axillary artery [RAA]‐left axillary artery [LAA] vs. RAA‐LAA‐left common carotid artery: 74.1% vs. 68.9%, p = .38). Conclusions Although one‐staged hybrid procedure has fewer complications in high‐risk patients with lesions involving the distal aortic arch, the long‐term survival rate is not optimistic.

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Section: Discussionmentioning

confidence: 83%

Analysis of clinical outcomes of one‐staged hybrid procedure without thoracotomy for aorta lesion involving distal aortic arch

et al. 2021

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“…Rupture and RTAD were the most commonly reported causes of aortic-related death in patients who underwent TEVAR for unTBAD. Rupture is associated with high mortality at the indexed event [21]. Other observational studies reported the incidence of aortic rupture to be 2.5%-5% [12,14,20].…”

Section: Aorta-related Mortality and Rupturementioning

confidence: 99%

“…Type II endoleak describes a backward flow from a single (IIa) or multiple (IIb) side branches as the intercostal or lumbar arteries into the false lumen [24,25]. Type I and Type II endoleaks are the most commonly observed endoleaks during later follow-up after TEVAR in un-TBAD [8,12,21,26]. Some endoleaks such as type Ia and Ib can eventually resolve on their own without any need for re-intervention [12,27].…”

Section: Late Endoleaksmentioning

confidence: 99%

“…Distal SINE (dSINE) occurs distal to the stent-graft landing zone resulting in increased pressure in the FL, leading to further expansion in its diameter [37]. The occurrence of SINE has been frequently reported particularly following TEVAR in un-TBAD [12,21,28], with a distal SINE being the most commonly observed type [8,12,21,38]. SINE is considered a dangerous complication of TEVAR, especially since it is usually asymptomatic and incidentally discovered with routine surveillance [39][40][41].…”

Section: Stent Graft-induced New Entry (Sine)mentioning

confidence: 99%

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Mid- and long-term outcomes of thoracic endovascular aortic repair in acute and subacute uncomplicated type B aortic dissection

Jubouri

Al-Tawil

Yip

et al. 2022

Preprint

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Background: Uncomplicated type B aortic dissection (un-TBAD) has been managed conservatively with medical therapy in order to control the heart rate and blood pressure to limit disease progression, in addition to radiological follow-up. However, several trials and observational studies have investigated the use of thoracic endovascular aortic repair (TEVAR) in un-TBAD and suggested that TEVAR provides a survival benefit over medical therapy. Outcomes of TEVAR have also been linked with the timing of intervention. Aims: The scope of this review is to collate and summarise all the evidence in the literature on the mid- and long-term outcomes of TEVAR in un-TBAD, confirming its superiority. We also aimed to investigate the relationship between timing of TEVAR intervention and results. Methods: We carried out a comprehensive literature search on multiple electronic databases including PubMed, Scopus and EMBASE in order to collate and summarise all research evidence on the mid- and long-term outcomes of TEVAR in un-TBAD, as well as its relationship with intervention timing. Results: TEVAR has proven to be a safe and effective tool in un-TBAD, offering superior mid- and long-term outcomes including all-cause and aorta-related mortality, aortic-specific adverse events, aortic remodelling, and need for reintervention. Additionally, performing TEVAR during the subacute phase of dissection seems to yield optimal results. Conclusion: The evidence demonstrating a survival advantage in favour TEVAR over medical therapy in un-TBAD means that with further research, particular trials and observational studies, TEVAR could become the gold-standard treatment option for un-TBAD patients.

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“…In addition, the strategy of stenting should be based on the pathologies and prognoses of individuals. In our center, for dissection involving the distal arch, we performed two-stent implantation with tapered stents to avoid endoleak ( 27 ). Notably, late reintervention may be unavoidable for degenerative aortic lesions.…”

Section: Commentmentioning

confidence: 99%

Comparison of Open Repair vs. the One-Stage Hybrid Extra-Anatomic Technique for Distal Aortic Arch Disease Treatment: Mid-term Outcomes With a Risk-Adjusted Analysis

Qiao

Chen

Guo

et al. 2021

Front. Cardiovasc. Med.

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Objective: This study aims to compare the short- and mid-term outcomes of the stented elephant trunk (SET) procedure combined with supra-arch branch reconstruction and one-stage hybrid arch repair combined thoracic endovascular aortic repair (TEVAR) with extra-anatomic bypass in the management of distal arch disease.Methods: From January 2009 to January 2019, 97 patients underwent one-stage hybrid arch repair combined with TEVAR with extra-anatomic bypass (HAR group), and 206 patients underwent the SET procedure with supra-arch branch reconstruction (SET group). We used inverse-probability-of treatment weighting (IPTW) to adjust baseline differences.Results: Before IPTW adjustment, there was no significant difference in operative mortality between the two groups (5.2 vs. 1.0%, P = 0.064). The incidences of stroke, spinal cord injury (SCI), acute kidney injury (AKI), and endoleak also showed no significant differences (4.1 vs. 0.5%, P = 0.066; 2.1 vs. 1.5%, P = 1.000; 0 vs. 1.0%, P = 0.831; 6.2 vs. 1.9%, P = 0.113, respectively). After IPTW adjustment, the incidences of stroke, SCI, and AKI showed no significant differences between the two groups (1.8 vs. 1.1%, P = 0.138; 0.8 vs. 1.6%, P = 0.448; and 0 vs. 0.7%, P = 0.148, respectively). However, the HAR group tended to have higher operative mortality and incidence of endoleak than the SET group (12.4 vs. 1.3%, P = 0.01; 9.9 vs. 1.8%, P = 0.031, respectively). In the multivariate analysis, open repair decreased the risks of endoleak (odds ratio [OR], 0.171, 95% CI, 0.060–0.401; P < 0.001) and operative mortality (OR, 0.093, 95% CI, 0.027–0.238; P < 0.001). The overall survival and event-free survival of the HAR group were significantly lower than those of the SET group (P < 0.001).Conclusion: One-stage hybrid arch repair combined TEVAR with extra-anatomic bypass and the SET procedure with supra-arch branch reconstruction both provided good postoperative treatment outcomes for distal arch disease. However, hybrid arch repair increased the risks of endoleak and operative mortality. The SET procedure provided better mid-term survival than hybrid arch repair without increasing operative mortality. Carefully selecting the indications for the procedure, while receiving close long-term follow-up, may improve the survival rate of patients undergoing hybrid arch repair.

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Analysis of perioperative outcome and long-term survival rate of thoracic endovascular aortic repair in uncomplicated type B dissection: single-centre experience with 751 patients

Cited by 15 publications

References 22 publications

Analysis of clinical outcomes of one‐staged hybrid procedure without thoracotomy for aorta lesion involving distal aortic arch

Analysis of clinical outcomes of one‐staged hybrid procedure without thoracotomy for aorta lesion involving distal aortic arch

Mid- and long-term outcomes of thoracic endovascular aortic repair in acute and subacute uncomplicated type B aortic dissection

Comparison of Open Repair vs. the One-Stage Hybrid Extra-Anatomic Technique for Distal Aortic Arch Disease Treatment: Mid-term Outcomes With a Risk-Adjusted Analysis

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