Protocol for the ROBUST (Registry Of type B aortic dissection with the Utility of STent graft) study: an ambispective, multicentre, open cohort study

Rong, Dan; Ge, Yangyang; Xue, Yan; Liu, Feng; Lu, Kai; Liu, Peng; Zhang, Lei; Ge, Xiaohu; Miu, Jianhang; Zhong, Lin‐Kun; Fan, Weidong; Zhang, Hongpeng; Jia, Xin; Ma, Xin; Xiong, Jiang; Li, Xiaoping; Guo, Wei

doi:10.1136/bmjopen-2017-019317

Cited by 9 publications

(3 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The study was registered with the Chinese Clinical Trials Registry (ChiCTR-POC-17011726), and the protocol for the ROBUST study was previously published. 18 In the ambispective ROBUST study design, patients with TBAD managed by TEVAR were retrospectively enrolled from 1 January 2008 to 31 December 2016; prospective enrollment began in 1 January 2017 and will continue to 31 December 2027. The 254 retrospectively enrolled patients were candidates for the current analysis.…”

Section: Study Populationmentioning

confidence: 99%

Association Between Extent of Stent-Graft Coverage and Thoracic Aortic Remodeling After Endovascular Repair of Type B Aortic Dissection

Xue

et al. 2020

J Endovasc Ther

Self Cite

View full text Add to dashboard Cite

Purpose: To examine the association between the extent of stent-graft coverage and thoracic aortic expansion after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection. Materials and Methods: A retrospective analysis was conducted of 201 patients (mean age 52.4±11.5 years; 178 men) with acute (135, 67.2%) or chronic (66, 32.8%) type B aortic dissection who underwent TEVAR at 4 medical centers. The mean stent-graft length was 157.1±33.3 mm. The percentage of stented descending aorta (PSDA) represented the extent of stent-graft coverage. After using restricted cubic smoothing spline plots to confirm the roughly linear relationship between PSDA and the risk of thoracic aortic expansion, patients were stratified into 2 groups on the median PSDA: the lower group (≤31.3%) and the higher group (>31.3%). Thoracic aortic expansion was defined as a ≥20% increase in the total thoracic aortic volume on the most recent postoperative computed tomography angiography scan compared with the preoperative measurement. The Kaplan-Meier method was used to estimate the cumulative freedom from thoracic aortic expansion after TEVAR; estimates are given with the 95% confidence interval (CI). A multivariable Cox proportional hazards model was used to analyze any independent association of the PSDA as a continuous or categorical variable with the risk of thoracic aortic expansion; results are presented as the hazard ratio (HR) and 95% CI. Results: No patients developed symptoms of spinal cord ischemia during hospitalization. Over a median 12.4 months of imaging follow-up, 34 (16.9%) patients developed thoracic aortic expansion. The estimate of freedom from thoracic aortic expansion at 12 months for the overall PSDA was 84.0% (95% CI 77.8% to 88.6%); between the groups, the freedom from thoracic aortic expansion estimate for the PSDA ≤31.3% group was significantly lower than in the higher group (p=0.032). Regression analysis showed no significant association between the risk of thoracic aortic expansion and the PSDA as a continuous variable (HR 0.97, 95% CI 0.91 to 1.03, p=0.288); however, analyzing the PSDA as a categorical variable indicated a significantly lower risk of thoracic aortic expansion for the PSDA >31.3% group (HR 0.46, 95% CI 0.22 to 0.95, p=0.036) after adjusting for a variety of demographic and anatomical characteristics. Conclusion: More extensive stent-graft coverage appears to improve thoracic aortic remodeling after TEVAR. However, the clinician should balance the benefit of extensive stent-graft coverage and its related risk of spinal cord ischemia.

show abstract

Section: Study Populationmentioning

confidence: 99%

Association Between Extent of Stent-Graft Coverage and Thoracic Aortic Remodeling After Endovascular Repair of Type B Aortic Dissection

Xue

et al. 2020

J Endovasc Ther

Self Cite

View full text Add to dashboard Cite

show abstract

“…All patients enrolled in this retrospective study were derived from the ROBUST (Registry Of type B aortic dissection with the Utility of STent graft) study, which is a multicenter, open study (ChiCTR-POC-17011726) that focuses on the adverse events after TEVAR. Further, it was conducted at four different medical centers in China (Chinese PLA General Hospital, People's Hospital of Xinjiang Uygur Autonomous Region, Zhongshan People's Hospital, and Henan Provincial Chest Hospital) [12]. In total, 228 patients were identi ed from the ROBUST study.…”

Section: Patientsmentioning

confidence: 99%

WITHDRAWN: Machine Learning-Based Prediction of Distal Aortic Enlargement after Thoracic Endovascular Aortic Repair of Stanford Type B Aortic Dissection: A Multicenter, Retrospective Cohort Study

Guo

Rong

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Thoracic endovascular aortic repair (TEVAR) is an important treatment for patients with acute complicated Stanford type B aortic dissection. However, postoperative distal aortic enlargement is a severe complication of TEVAR. This study aimed to construct a prediction model for postoperative distal aortic enlargement using machine learning algorithms and explore high-risk factors that accelerate the progression of postoperative distal aortic enlargement. Methods: Study participants were selected from the multicenter, open cohort ROBUST (Registry Of type B aortic dissection with the Utility of STent graft) study. The least absolute shrinkage and selection operator regression method was employed to select variables. Seven machine learning algorithms (k-nearest neighbor, logistic regression, decision tree, random forest, support vector machine, sklearn neural network, and extreme gradient boosting) were applied to construct prediction models. Further, to explore the important factors that affected the progression of postoperative distal aortic enlargement, we applied three different regression algorithms (random forest, extreme gradient boosting, and light gradient boosting machine) to analyze the data of patients with postoperative distal aortic enlargement. Results: We retrospectively analyzed the data of 184 patients who underwent thoracic endovascular aortic repair for type B aortic dissection at four medical centers. The median follow-up time was 12.37 months (IQR, 8.07–18.17 months). In total, 26 variables were identified using the least absolute shrinkage and selection operator regression. The model constructed using the random forest algorithm exhibited the best prediction performance among the seven models. The regression model constructed by the light gradient boosting machine showed better performance than the other two models. Accordingly, TAT_2.0 (partial thrombosis of the thoracic aorta), SVS (scored according to the comorbidity grading system of the Society for Vascular Surgery), and VRAOFL (visceral or renal aorta originating from a false lumen) were the top three high-risk factors that accelerated the progression of PDAE. Conclusions: The random forest prediction model can improve the prediction accuracy for postoperative distal aortic enlargement, and the light gradient boosting machine regression model can identify high-risk factors that accelerate the progression of postoperative distal aortic enlargement.

show abstract

“…The details of the ROBUST study have been previously described. 8 The ROBUST study was approved by the Institutional Review Board of each participating center and was conducted in compliance with the Declaration of Helsinki. Each Institutional Review Board waived the need for consent from patients whose data were retrospectively reviewed.…”

Section: Study Populationmentioning

confidence: 99%

The Distance From the Primary Intimal Tear to the Left Subclavian Artery Predicts Thoracic Aortic Enlargement After Thoracic Endovascular Aortic Repair of Type B Aortic Dissection: A Retrospective Cohort Study

Rong

et al. 2021

J Endovasc Ther

Self Cite

View full text Add to dashboard Cite

Purpose: The purpose of this study was to evaluate the association between the distance from the primary intimal tear (PIT) to the left subclavian artery (LSA) (PIT–LSA distance) and the risk of aortic enlargement after thoracic endovascular aortic repair (TEVAR). Methods: This is a retrospective cohort study. A total of 228 patients were reviewed from the database of the Registry Of type B aortic dissection with the Utility of STent graft (ROBUST) study performed from January 1, 2011, to December 31, 2016. Of them, 196 patients were eligible for analysis. The PIT–LSA distance was defined as the length from the distal edge of the LSA orifice to the proximal edge of the PIT along the centerline of the true lumen. According to the border between zone 3 and zone 4 of the Ishimaru classification, patients were divided into group A (n = 117, PIT–LSA distance ≤ 2 cm) and group B (n = 79, PIT–LSA distance > 2 cm). Thoracic aortic enlargement (TAE) was defined as a thoracic aortic volume increase of ≥20%. Multivariate Cox regression was used to estimate the association between the PIT–LSA distance and risk of TAE after TEVAR. Results: The mean age was 52.3 ± 11.6 years, and 88.8% of patients were male. There were no significant differences between groups in demographic and baseline characteristics. The PIT–LSA distance was 1.1 cm (range, −1.6 to 2.0 cm) in group A, and 2.9 cm (range, 2.1–12.6 cm) in group B. TAE occurred in 27 patients in group A, and 6 in group B. The mean follow-up was 12.4 months (range, 0.10–83.1 months) in group A, and 12.63 months (range, 0.10–82.77 months) in group B. The cumulative 12- and 24-month rates of freedom from TAE were 79.0% and 71.3% in group A, versus 92.5% and 92.5% in group B, respectively. Multivariate Cox regression analysis revealed that the PIT–LSA distance was an independent predictor of TAE after TEVAR (adjusted hazard ratio, 0.66; 95% confidence interval, 0.48–0.90; p = 0.009). Conclusion: Patients with a more proximal PIT location have a higher incidence of thoracic aortic enlargement after TEVAR. The location of the PIT in relation to the LSA can be used to identify patients who need closed surveillance after TEVAR or early preemptive intervention.

show abstract

Protocol for the ROBUST (Registry Of type B aortic dissection with the Utility of STent graft) study: an ambispective, multicentre, open cohort study

Cited by 9 publications

References 27 publications

Association Between Extent of Stent-Graft Coverage and Thoracic Aortic Remodeling After Endovascular Repair of Type B Aortic Dissection

Association Between Extent of Stent-Graft Coverage and Thoracic Aortic Remodeling After Endovascular Repair of Type B Aortic Dissection

WITHDRAWN: Machine Learning-Based Prediction of Distal Aortic Enlargement after Thoracic Endovascular Aortic Repair of Stanford Type B Aortic Dissection: A Multicenter, Retrospective Cohort Study

The Distance From the Primary Intimal Tear to the Left Subclavian Artery Predicts Thoracic Aortic Enlargement After Thoracic Endovascular Aortic Repair of Type B Aortic Dissection: A Retrospective Cohort Study

Contact Info

Product

Resources

About