Endovascular Treatment of Patients With Types A and B Thoracic Aortic Dissection Using Relay Thoracic Stent-Grafts: Results From the RESTORE Patient Registry

Zipfel, Burkhart; Czerny, Martin; Funovics, Martin; Coppi, Gioacchino; Ferro, C.; Rousseau, Hervé; Berti, Sérgio; Tealdi, D.G.; Riambau, Vincent; Mangialardi, Nicola; Sassi, Carlo

doi:10.1583/10-3233mr.1

Cited by 44 publications

(25 citation statements)

References 37 publications

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“…Two-year survival rate was 84% in type B AD. 15 Although IS stiffness is accepted as a marker for chronicity of a dissection, changes in IS mobility over time have not yet systematically been investigated. In an in vivo study, Wedding et al demonstrated the feasibility of cine phase contrast MRI for measuring the velocity of the aortic wall and calculated changes in circumferential strain over the cardiac cycle.…”

Section: Discussionmentioning

confidence: 99%

“…In the study described herein, a new methodology based on 2D ECG-gated phase-contrast magnetic resonance imaging (2D pcMRI) 7 is presented and is illustrated for quantifying IS mobility in 10 patients diagnosed with type B AD who underwent a dynamic MRI examination both at initial presentation and at a follow-up examination. In contrast to static imaging methods, which oftentimes provide an image where anatomic features (such as the position of the IS) are shown at an average location across the cardiac cycle, 2D pcMRI allows the acquisition of several separate images (typically [12][13][14][15][16][17][18][19][20] during the cardiac cycle. Image data acquisition is synchronized to the cardiac cycle with parts of each image acquired during one cycle.…”

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confidence: 99%

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Preliminary findings in quantification of changes in septal motion during follow-up of type B aortic dissections

Karmonik

Duran

Shah

et al. 2012

Journal of Vascular Surgery

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Reduction of IS motion in AD is seen with short-term and midterm follow-up. Intersubject variability of this trend is high at short-term follow-up but low at midterm follow-up. Detailed analysis of IS motion parameters indicate reduction of IS contraction and IS compliance with time. This has potential implications for endovascular management of type B aortic dissections, as expansion of aortic stent grafts can be limited by a stiff IS.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Preliminary findings in quantification of changes in septal motion during follow-up of type B aortic dissections

Karmonik

Duran

Shah

et al. 2012

Journal of Vascular Surgery

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“…15–17 We suspect that these outcomes are influenced by the increasing eligibility of the patient population, the new generations of stent grafts, and the modifications to operating room technique. 18–20 For instance, even within our study period, the U.S. Food and Drug Administration approved the use of the conformable Gore TAG device for the new indication of isolated aortic lesion in 2013, soon followed by the Medtronic Captivia Valiant graft in early 2014. These regulatory changes are typically followed by an investigational device exemption trial targeting the latest diagnostic indication, and stringent inclusion and exclusion criteria may result in a selection bias towards patients with more favorable outcomes.…”

Section: Discussionmentioning

confidence: 97%

Contemporary evaluation of mortality and stroke risk after thoracic endovascular aortic repair

Fang

Leshnower

et al. 2017

Journal of Vascular Surgery

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Objective Over the past decade, thoracic endovascular aortic repair (TEVAR) has increased as a treatment option for a variety of aortic pathologies. Despite this rise in the use of thoracic stent grafts, real-world outcomes from a robust, adjudicated, contemporary dataset have yet to be reported. Previous studies have shown peri-procedural mortality rates between 1.5%-9.5% and procedure-related stroke rates of 2.3%-8.2%. With advances in device engineering and increased physician experience, we hypothesized that the rates of these complications would be reduced in a more recent sample set. The purpose of this study was to determine current rates of mortality and stroke after TEVAR, identify risk factors that contribute to thirty-day mortality, and develop a simple scoring system that allows for risk stratification of patients undergoing TEVAR. Methods We examined the 30-day mortality rate following TEVAR using the 2013-2014 American College of Surgeons National Surgical Quality Improvement Program database. Patients undergoing TEVAR for all aortic pathology were identified using procedure codes. Bivariate analyses were performed to evaluate the association of pre-, intra- and post-operative variables with 30-day mortality, followed by multivariable logistic analysis using pre-operative variables only, with P<.10 as criteria for model entry. The predictive logistic model was internally validated by cross validation. Variables included in the multivariable model were used to develop a risk score. Results Eight hundred twenty-six patients were included. The thirty-day mortality and stroke rate were 7.63% (n=63) and 4.5% (n= 37), respectively. In regression analysis, mortality was independently associated with age ≥80 years (odds ratio [OR] 2.32, 95% confidence interval [CI] 1.25-4.31), emergency case (OR 2.61, 95% CI 1.39-4.90), ASA classification >3 (OR 2.89, 95% CI 1.34-6.24), transfusion >4 units in the 72 hours prior to surgery (OR 2.86, 95% CI 1.30-6.28), pre-operative creatinine ≥1.8 mg/dL (OR 2.07, 95% CI 1.05-4.08), and pre-operative white blood cell count ≥12 × 109/L (OR 2.65, 95% CI 1.41-4.96). Incorporating these factors, a six-point risk score was generated and demonstrated high predictability for overall thirty-day mortality. Conclusions Recent data from a national, retrospective dataset demonstrate that high perioperative mortality and stroke rates have persisted over the last decade. The risk score derived from this dataset is simple and convenient and serves as a prognostic tool in the pre-operative risk stratification of patients being evaluated for thoracic endovascular aortic repair.

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“…Kang and colleagues reported an early endoleak rate of 11.9% among 76 patients with chronic, complicated distal aortic dissection (9). The prevalence of Marfan syndrome among the patients in these three series ranged from 1.3% to 5.5% (7)(8)(9).…”

Section: Perspectivementioning

confidence: 95%

Endovascular surgery in Marfan syndrome: CON

Kouchoukos¹

2017

Ann. Cardiothorac. Surg.

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The frequency of endovascular stent grafting procedures to treat various conditions of the thoracic aorta has increased dramatically over the past three decades. Stent grafting has been applied on a limited basis in patients with Marfan syndrome and other connective tissue disorders, despite recommendations from current guidelines and expert consensus statements against its use in this setting. A review of publications reporting outcomes after stent grafting of the descending thoracic aorta in Marfan patients with acute or chronic aortic dissection indicates that these procedures can be accomplished with rates of early mortality, stroke and spinal cord ischemic injury that are comparable to those observed in patients who do not have Marfan syndrome. However, the rates of primary treatment failure (principally endoleak), secondary treatment failure, need for open repair and late death among the Marfan patients are substantially higher than those observed in patients without this condition. In addition, the rates of retrograde aortic dissection and development of stent-graft induced new entry (SINE), are also greater among patients with Marfan syndrome. All of these findings argue strongly against the routine use of endovascular grafts in Marfan patients with type B or residual type A dissection. Few data are available to assess the role of endografting in Marfan patients with aneurysmal disease, but the progressive aortic dilatation noted in these patients argues strongly against its use in this setting as well. At present, the available data indicate that there is no justification for elective stent grafting in PerspectiveThe frequency of endovascular stent grafting procedures on the thoracic aorta has increased dramatically over the past three decades. In many centers, stent grafting has become the treatment of choice for thoracic aortic aneurysm, dissection, coarctation and traumatic aortic disruption. It has also been used on a limited basis in patients with Marfan syndrome and other connective tissue disorders. At present, endovascular stent grafting for the latter group of patients is considered off-label and current guidelines and expert consensus statements do not recommend endovascular repair (1-3). This manuscript reviews the experience with endovascular stent grafting in Marfan syndrome focusing on patients with aortic dissection involving the descending thoracic aorta and provides evidence to support the recommendation that, with few exceptions, endovascular stent grafting for this condition is not advisable.In 2013, Pacini and colleagues published a systematic review of studies reporting the early and mid-term results of endovascular stent grafting in patients with Marfan syndrome and type B aortic dissection (4). They identified 54 patients from 12 publications who had data suitable for analysis. The mean age of the patients was 40.9 years and approximately 75% were men (data for each of the variables examined in this review were not available for all patients). The majority had undergone a previou...

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Endovascular Treatment of Patients With Types A and B Thoracic Aortic Dissection Using Relay Thoracic Stent-Grafts: Results From the RESTORE Patient Registry

Cited by 44 publications

References 37 publications

Preliminary findings in quantification of changes in septal motion during follow-up of type B aortic dissections

Preliminary findings in quantification of changes in septal motion during follow-up of type B aortic dissections

Contemporary evaluation of mortality and stroke risk after thoracic endovascular aortic repair

Endovascular surgery in Marfan syndrome: CON

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